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John R. Burroughs, M.D., Springs Aesthetics, Medical Director

Wrinkle blockers (Xeomin, Dysport) are FDA-approved for eye misalignment (strabismus), blepharospasm, hemifacial spasm, rhytids, migraines, excess sweating (hyperhidrosis), and neck spasms (cervical dystonia). Dr. Alan Scott, an ophthalmologist, was the first to use botulinum toxin (BT) for strabismus uses back in the ’60s. Later in the ’90s, Carruthers, also an ophthalmologist, noted that BT treatments for facial muscle spasm disorders led to the improvement of wrinkles. Nowadays, BT is used more cosmetically, but it still is used medically throughout the world.

BT act as “wrinkle blockers” by acting at the neuromuscular junction. Tiny amounts are injected, at any given area, causing only targeted and localized areas of muscle relaxation and wrinkle improvement. Dr. Burroughs began using wrinkle blockers in the mid to late ’90s for patients with blepharospasm and hemifacial spasm disorders, followed by cosmetic uses shortly thereafter.

Dr. Burroughs has taught many physicians and surgeons proper injection techniques on a one-on-one basis as well through teaching videos and book chapters. Dr. Burroughs and Springs Aesthetics has become the leading injector practice in Colorado for Merz BT, Xeomin.  Xeomin is a type A form of BT. Dr. Burroughs’ experience agrees with other studies that have shown equal Xeomin efficacy and dosing to other wrinkle blockers. He also has found Galderma BT, Dysport, to work in an outstanding manner. Dysport also has a wider area of effect, so it is great in the forehead and crow’s feet areas.

Off-label uses of BT have been growing greatly over the last 10 years and can include the treatment of the following: painful sex, premature ejaculation, tension headaches, Raynaud’s syndrome (peripheral and oftentimes painful circulatory disorder), and depression. Additional cosmetic off-label uses of BT now include: chin cobble stoning, facial appearance softening (microdroplet technique), skin quality improvement (even acne), neck band softening, lip lifting, “gummy smile,” wide face reduction (especially in Far East), hand/feet excess sweating, scar healing, and as an adjunct to surgery, chemical peels and other facial resurfacing treatments (Fraxel, Fractora). Dr. Burroughs has used BT for most of the above off-label, beneficial though not specific FDA-approved, uses. He has treated patients for over 11 years who have hyperhidrosis problems in their arm pits, palms, and feet. He has treated one patient with painful Raynaud’s that is an avid outdoorsman that was suffering painful fingers during the winter season prior to the BT injections.

Recently, a very exciting area that BT is showing promise is in the treatment and improvement of depression. Happy faces seem to feel better and boost the mood. Finzi and Rosenthal (Journal of Psychiatric Research, 2016) published a review and discussion on what they term “emotional proprioception.” Essentially, they found that frowning faces feel depressed while smiling faces feel happier. Apparently, our external appearance sends a feedback to the brain’s emotional centers. Studies on the effect of our facial expressions on the autonomic nervous system show that objective changes in heart rate, blood pressure, and sweating are quite measurable. Therefore, it is not a great leap of faith to see how facial expressions can also impact our emotional well-being. The main frowning muscle around the eyes is the corrugator and when it is actively contracted, we look mad or sad and this signals stress to the brain. Conversely, the zygomatic muscles are the major smiling muscles and send signals of happiness and relaxation. I think parents have intuitively seen this in their young children where, if they observe them following getting hurt, putting on an unhappy face often precedes the inevitable tears that follow. If these children can be quickly encouraged to not frown, their emotional state often immediately improves. Dr. Burroughs has also observed that the simple act of smiling can lower one’s heart rate. Medically, it is speculated that there is a feedback from the trigeminal (ophthalmic) nerve branch that comes from the corrugators, and BT, by relaxing this frowning muscle, leads to a decreased signal to the brain that is involved with pain, position, and muscle tension, leading to less stress. By reducing this signal, it seems to help with those adverse emotions.

Three well-conducted double-masked, randomized, and placebo controlled studies have shown BT injections in severely depressed patients led to an up to 60% positive response rate, and nearly a third went into remission of their depression. Fortunately, BT has very few systemic side effects that are usually extremely rare and minimal along with no adverse interaction with other systemic medications. Potentially, new BT psychiatric benefits may include anger and anxiety issues.

Dr. Burroughs now has 20 years of experience with BT, and his interest in these additional benefits beyond wrinkle blocking excites him and grows his passion to help patients feel better about themselves. Not only do his wrinkle blocker patients feel better about how they look, he is confident that many feel better emotionally as well. It is a win-win in the cosmetic world. Dr. Burroughs is proud to be the founder and medical director of Springs Aesthetics in Colorado Springs, whose mission is to help patients feel better about themselves.

  1. Finzi E, Rosenthal NE.  Emotional proprioception:  Treatment of depression with afferent facial feedback.  Journal of Psychiatric Research.  2016: 93-96.
  2. Wollmer, M.A., de Boer, C., Kalak, N., Beck, J., G€otz, T., Schmidt, T., et al., 2012. Facing depression with botulinum toxin: a randomized controlled trial. J. Psychiatr. Res. 46 (5), 574e581.
  3. Finzi, E., Rosenthal, N.E., 2014. Treatment of depression with onabotulinumtoxinA: a Randomized, double-blind, placebo controlled trial. J. Psychiatr. Res. 52, 1e6.
  4. Magid, M., Reichenberg, J.S., Poth, P.E., Robertson, H.T., LaViolette, A.K., Kruger, T.H., Wollmer, M.A., 2014. Pharmacopsychiatry 48 (6), 205e210: a 24-week randomized, double-blind, placebo-controlled study. J. Clin. Psychiatry 75 (8), 837e844.
  5. Magid, M., Finzi, E., Kruger, T.H., Robertson, H.T., Keeling, B.H., Jung, S., Reichenberg, J.S., Rosenthal, N.E., Wollmer, M.A., 2015 Sep. Treating depression with botulinum toxin: a pooled analysis of randomized controlled trials Pharmacopsychiatry 48 (6), 205e210.