Risks of Botulinum and Dermal Fillers

This assignment delves into the potential risks associated with Botulinum Toxin and Dermal Filler treatments. It highlights how these injectables, while effective in reducing wrinkles, can penetrate the epidermis, disrupt the natural defense mechanisms of the skin, and lead to infections and microbial colonization. The text emphasizes the damaging effects on both the epidermis and dermis, impacting the normal function and structure of the skin.

Running head: AESTHETICS
AESTHETICS
Name of the Student
Name of the university
Author’s note

1AESTHETICS
a) Skin is the largest organ of the body. It mainly consists of three layers.
Epidermis, Dermis, Subcutaneous layer 1.
Epidermis: The epidermis is the elastic outer layer of the body that is continuously
undergoing division and is getting regenerated. Dermis consists of the following cells:-
 Keratinocytes- These are the main cells of the epidermis that are found at the base1.
 Corneocytes- These are nothing but the flattened dead keratinocytes. These together form
the very outer layer of the epidermis, called the stratum corneum or the horny layer.
 Melatocytes- They produces the melanin pigments that is responsible for the color of the
skin and also protects from the harmful UV rays of the sun1.
Dermis: the inner layer of the skin is called the dermis. It consists of the following parts.
 Sweat glands- It produces sweat that travels outside through the sweat glands via
openings found in the epidermis. They help in the regulation of body temperature1.
 Hair follicles- These are part of the skin that produces hairs by packing of the old cells.
These also play part in temperature regulation.
 Sebaceous gland- this gland is responsible for the production of sebum, in order to keep
the hair devoid of any bacteria and dust1.
The subcutaneous layer: this layer is found underneath the dermis and is mainly made up of
connective tissues and fat. This layer acts as an insulator1.
Function of the skin
The skin acts as a barrier against any physical, mechanical and thermal injury1.

2AESTHETICS
 Resists loss of moisture
 The melanin pigment found in the epidermis reduces effect of Ultraviolet radiation.
 It helps to regulate the temperature.
 It raises inflammatory response on detecting infections4.
 Helps in the production of Vitamin D.(308)
b) There are 3 major parameters that influence the ageing process of the body. Firstly, as the
skin ages it starts to create non functional cells, which lead to thinning of the skin cells7.
Secondly shortening of the DNA occurs with age, which triggers apoptosis, which leads to
the programmed cell death of the dermis and the epidermis4. Thirdly, with the increased
age the free radicals increase as the antioxidant defense system of the body decreases with
the age, due to the down regulation of the oxidative enzymes. These unstable free radicals
vibrate inside the skin and are reported to poke holes in the collage fiber of the dermis7.
Due to this free radical assault for years the collagen layer turns weaker and eventually the
sin collapse to form wrinkles. (129)
c) Extrinsic process of aging is the skin’s response to the external damage, which can be
caused or which can be modified by our change in life style6. Extrinsic aging may be
caused due to several factors like physiological and psychological stresses, improper
nutrition, and consumption of alcohol, environmental pollution and overeating. Thinning
of the skin cells occur due to photodamage6. In the extrinsic aging process the epidermis
thickens and the dermis thins. It has been found that the molecular mechanism responsible
for the extrinsic aging is the aryl hydrocarbon receptor, which is normally an important
regulatory and the protective component of the cell7. Chronic exposure to the UV or the
particulate matter in air pollution produces environment induced lentigines that are

3AESTHETICS
absorbed in the skin and disorganize the cross talk between the fibroblasts, keratinocytes
and melanocytes7. The skin thus becomes loose and wrinkled.(144)
d) There should be standardized systems to evaluate skin ageing. They help the dermatologist
to select best treatments for the individual patients.
Glogau classification of photo-aging6
The Glogau system of photo-aging helps the dermatologists to evaluate the severity of the
wrinkles from a scale of I to IV 10.
Type 1: No wrinkles
 No age spots
 Mild change in the pigments
 Minimal wrinkles
 Early photo aging
Type 2: Wrinkles in motion
 Early to moderate photo aging
 Lines appear, when the face moves
 Skin pores becomes more prominent
Type 3: Wrinkles at rest
 Advance photoaging
 Visible age spots
 Clear wrinkles visible

4AESTHETICS
Type 3: only wrinkles
 Severe photo aging
 Prominent wrinkles
 Changes that is pre-cancerous6.
The Fitzpatrick classification scale helps to classify the skin types on the basis of their ability
to tan11.
Six categories are there:-
I. (0-7) fair and white with the probability of developing freckles. Absence of tanning
ability.
II. (8-16) White having some ability to tan. Skin gets burnt easily due to sun exposure.
III. (25-30) Tanning predomiant although burning is rare.
IV. (30+) Dark brown, Tans easily but hardy burns
V. Black . Tans easily but doesn’t burn.(208)
e) Cosmeceutical skin care products have the ability to improve the skin, brighten the face.
Facial products that contain alphahydroxy acid (AHA) helps in delaying the skin aging,
they encourages old skin cell shedding and replicate to produce new cells3. Vitamin C
found in many skin care products also helps the skin to detoxify itself. Licorice experts
found in some cosmeceutical lo helps in lightening the sun spots3. Sun blockers help to
provide a barrier against the harmful UV rays and helps in preventing skin cancer. Other
than the oxidants from the UV rays, sources like alcohol, pollution, fatty foods, and
cigarettes contribute to the increased levels of oxidants, which affect the skin structure it is
for this reason that antioxidants can be used. Good anti aging products should contain skin

5AESTHETICS
specific moisturizers for reducing the drying of the skin as aging progresses. To struggle
with skin problems such as psoriasis, eczema and dermatitis, products having calciteriol
should be used, to balance out skin shedding3. Cosmetic products containing benzoyl
peroxide, alphahydroxyacid salicylic acid, and charcoal can be used to check the acne.
Non comedogenic lotions should be used to avoid pore clogging and accumulation of dirt3.
(200)
f) The hair follicle is that cavity from where the hair grows. The parts of the hair follicles
are-
 The terminal portion of the hair follicle inside the skin is called the hair bulb1.
 The germinating layer of the hair bulb merges with outer root sheath.
 The outer root sheath forms the germinal matrix surrounding the dermal papilla.
 A sebaceous gland lies within each hair follicle, which is responsible for the formation of
sebum from a duct that opens in to the hair follicle4.
 The follicle forms a bulge below the sebaceous gland below the sebaceous gland in the
outer root sheath at the attachment point of the arrector pili muscle. The bulge produces
stem cells that regenerate the follicle during the next hair growth cycle1. It contains
sensitive touch receptors. The sebaceous gland associated with the hair follicle also helps
in conditioning the hair and the surrounding skin1. (154)
g) Injectable treatments are progressing rapidly in the field of aesthetic medicine and are
quickly replacing the invasive surgeries.

6AESTHETICS
Botox- It is a purified injectable protein for reducing the appearance of moderate to severe
wrinkles. It helps in relaxing the muscles of the body to even out the wrinkles2. It is normally
prepared from the toxin produced by Clostridium botulinum.
The various gel fillers like Juvederm, Voluma, Radiesse and many more are used to mitigate the
appearance of the wrinkles in the skin2.
The human skin is exposed to a large number of microorganisms. The protective mechanism of
the skin prevents the colonization of the harmful microorganisms in the skin. In cases of
Botulinum Toxin and Dermal Filler treatments, the injectables penetrate the epidermis of the
skin, which is resident to both pathological and physiological skin microflora and destroy the
natural defense mechanism on the skin opening door for infections and microbial colonization.
Botulinum Toxin and Dermal Filler treatments destroy the epidermis and the dermis affecting the
normal skin structure and functions of the epidermis and the dermis. (180)

7AESTHETICS
References
1. Montagna W. The structure and function of skin. Elsevier; 2012 Dec 2.
2. Schommer NN, Gallo RL. Structure and function of the human skin microbiome. Trends
in microbiology. 2013 Dec 31;21(12):660-8.
3. Tiganescu A, Tahrani AA, Morgan SA, Otranto M, Desmoulière A, Abrahams L,
Hassan-Smith Z, Walker EA, Rabbitt EH, Cooper MS, Amrein K. 11β-Hydroxysteroid
dehydrogenase blockade prevents age-induced skin structure and function defects. The
Journal of clinical investigation. 2013 Jul 1;123(7):3051.
4. Montagna W, Prota G, Kenney Jr JA. Black skin: structure and function. Elsevier; 2012
Dec 2.
5. "Device for the treatment of skin diseases such as skin overgrowths, eruptions and the
like or other skin disfigurements." U.S. Patent 2,921,585, issued January 19, 1960.
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morphologic assessment of facial skin. Journal of cutaneous pathology. 1995 Apr
1;22(2):154-9.
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ageing: a review. International Journal of Cosmetic Science. 2008 Apr 1;30(2):87-95.
8. Ruey JY, Van Scott EJ, inventors; Tristrata Technology, Inc., assignee. Method of using
hydroxycarboxylic acids or related compounds for treating skin changes associated with
intrinsic and extrinsic aging. United States patent US 6,767,924. 2004 Jul 27.
9. Kreindel M, Waldman A, inventors; Syneron Medical Ltd., assignee. Method and system
for treating skin. United States patent US 6,662,054. 2003 Dec 9.

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10. Roberts WE. Skin type classification systems old and new. Dermatologic clinics. 2009
Oct 31;27(4):529-33.
11. Pichon LC, Landrine H, Corral I, Hao Y, Mayer JA, Hoerster KD. Measuring skin cancer
risk in African Americans: is the Fitzpatrick Skin Type Classification Scale culturally
sensitive. Ethn Dis. 2010 Mar 1;20(2):174-9.