The most common cosmetic procedure done nowadays is Botox injections for wrinkles. Its popularity has soared thanks to Hollywood personalities who use it to look glamorous when they are out and about town. As far back as 2002, botulinum toxin injections were already FDA approved for glabellar lines (frown lines.) Before this time, this toxin had a very different reputation.
Clostridium botulinum is the bacteria responsible for producing the botulinum toxin, which has serotypes from A to H. The serotypes that can cause disease in humans are A, B, E, F, and H. Type H is the considered the most potent and most deadly to humans. The others are less common and can cause disease in other animals. Types A and B are those used commercially and medically. The botulinum toxin is a neurotoxin, hence it affects the nervous system. Normally, when the brain sends signals to muscles to move, there is a release of Acetylcholine (a neurotransmitter) which binds to the muscle causing them to contract. Botulinum toxin works at the neuromuscular junction, the space between the nerve and the muscle. It binds to certain receptors blocking the release of Acetylcholine. The absence of this neurotransmitter prevents the muscle from acting on the impulse sent by the brain, effectively “paralyzing” the muscle.
The Development of Botulinum Toxin
Historically, at the end of the 18th century, several reports of dilated pupils and fatal muscle paralysis were received after the ingestion of sausages in Southern Germany. The high incidence of these “sausage poisoning” cases prompted early systematic research in botulinum toxin.
In 1895, a botulism outbreak at a funeral with smoked ham in Belgium led to the discovery of the bacteria Clostridium botulinum by Emile Pierre van Ermengem. Botulism has also been reported in infants who are fed honey. C. botulinum spores have been found in honey. When the spores are ingested by babies, their immature digestive systems are unable to prevent the toxin from the spores from developing, leading to various forms of muscle weakness ranging from drooping eyelids and constipation to difficulty breathing and poor sucking. Effects become apparent anywhere from 3 to 30 days upon ingestion.
Nowadays, botulism is rarely fatal as long as the disease is detected early. It was years later that the botulinum toxin was isolated in crystalline form for medical purposes. For modern medical purposes, specifically, type A is used. One great achievement in this research is making the toxin injectable rather than ingestible in order to keep effects focal and specific and not systemic. In this way, muscle relaxation stays at the area of injection and there is no risk of affecting other muscles for which the treatment was not intended.
The first medical use for the toxin was the correction of strabismus (cross-eyes) in the 1970s. Upon its injection on test monkeys, it was noted that wrinkles on their frown lines improved. Since then, a multitude of conditions has been corrected with the use of botulinum toxin A injections. Apart from facial rhytides on the forehead, glabella and crow’s feet, these include treatment of excessive sweating of the hands, feet, and axilla, facial tics, migraines and cosmetic contouring (debulking of masseter muscles of the face and gastrocnemius of the calf, etc).
The Botox Injection Procedure
During the consultation, pictures of the patients’ wrinkles are taken on their phones so that they may easily compare results once the treatment takes effect. The mechanism of action and its effects are explained along with possible risks, like ptosis or “Spock Brows”. These possible complications are preventable but are also correctible. Especially for first-time patients, it is always prudent to use a conservative dose and have them follow up rather than giving them a high dose at the beginning. Using an initial high dose runs the risk of having effects that are too strong. In those cases, the patient will have to wait for the effects to wear off. Bearing negative physical effects for four to six months is not something that should be inflicted on anyone.
The areas of concern are cleansed and marked. A topical anesthetic is placed then after about a 20 to 30-minute wait, the procedure is done. Patients are typically advised of what to expect after treatment like some slight pain at the sites, possible bruises and/or wheals. These are expected and temporary for which no other intervention may be needed. They will start to see results around the 5th day from treatment. Maximal effects are observed in the first two weeks after which the effects will soften. The best results are seen in the first 2 months.
The body will start to degrade the toxin around the 3rd month. Patients are also advised to follow up in one to two weeks to see whether they may benefit from some tweaks or top-ups. It is important to note that the effects are dose-related. This means that adding more does not necessarily mean lengthening its effect. In fact, administering too much may lead to excessive weakness of the muscles which may appear as low eyebrows or heavy eyelids. Patients usually have their next treatment between 4 to 6 months after the initial treatment.
Although it is apparent that the effects of the botulinum toxin A treatments are temporary, they still carry a significant long term effect. During the period that the muscles are relaxed, patients are unable to bring out their wrinkles. Hence, these wrinkles are also prevented from etching on the skin. This makes patients appear younger than their contemporaries who have not had the treatment.
Frequently Ask Questions
How does Botox work?
Botulinum Toxin Type A, the generic form being marketed under the brand name BOTOX, is a muscle relaxant. Facial wrinkles are caused by muscle contraction whenever you express. If the muscles are relaxed and cannot contract, wrinkles cannot come out.
How is Botox administered?
BOTOX is given using a very fine small needle. BOTOX is also concentrated, therefore only a small amount needs to be injected. Both these factors make BOTOX injections easy and tolerable for patients.
Will there be any bruising?
Bruising is a possibility but the chance that it happens is quite small. When it does happen, it is only about a pinhead in size and can be easily covered with powder or concealer.
Where is Botox usually placed?
BOTOX is administered for the treatment of wrinkles of the forehead, the frown (between the eyebrows), and the crow’s feet (sides of the eyes). Some patients may need some to address their Bunny Lines (wrinkles around the bridge of the nose) and their Kisser’s Lines (around the mouth when making the “O” sound).
For facial contouring, BOTOX may be placed on the Masseter Muscle. It’s the bulky muscle on the side of the face that gives a square shaped jaw.
BOTOX may also be used to flatten neck muscles (Platysma) that have started to protrude in the form of vertical neck cords from aging.
How soon before I see the effects of Botox?
It will takes 1 week for the effects to become evident but you may appreciate results as early as 3 days after.
How often will I need to do Botox?
BOTOX for the treatment of wrinkles can last anywhere from 4 to 6 months. This means you should come in for your BOTOX treatment twice to three times a year.
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