The Botulinum toxin is used to minimize the appearance of skin creases, frown lines, and crow’s feet. It is produced by a bacterium called Clostridium botulinum. It is one of the most poisonous substances known and occurs naturally in spoiled food such as meat and fish products. When the toxin is isolated and purified, it can be used as an effective medication.
Botulinum neurotoxin works by blocking neurotransmitter (acetylcholine) release in the muscles resulting in progressive muscular weakness.
Botox is the brand name of botulinum neurotoxin type A used for cosmetic purposes. Cosmetic skin treatment with Botox was developed by dermatologic surgeons in 1987.
Cosmetic Uses of Botox
The skin of the face and neck develop an aged look due to effects of sun damage, gravity, sleep lines and muscular action. Years of squinting and frowning can leave deep wrinkles between the eyebrows and may extend to the bridge of the nose. These defects also may appear across the forehead and at the corners of the eyes as “crow’s feet.”
Botox is approved by the Food and Drug Administration (FDA) for the treatment of the lines between the eyebrows and also can be effectively used for “off-label” indications in other facial areas.
Botox injections reduce facial lines by temporarily interrupting the connections between the underlying nerves and muscles. With decreased muscular contractions, the overlying skin smooths, decreasing the appearance of skin creases and preventing new creases from developing.
Injections of Botox are done with very small amounts of the toxin at several points along the muscle with a very thin needle. Patients usually notice a clinical effect 1-3 days following injections and the effect maximizes by 1-2 weeks.
The effects of the toxin usually last 3-6 months and then resolve as the body produces more of the protein that was inactivated by the toxin. Additional injections are done at that time to regain the clinical effect.
Some patients do not respond to injections. Those with lines or wrinkles caused by sun damage and age-related changes are among this group. Some patients may theoretically have neutralizing antibodies in their blood from prior exposure to the toxin that can be present in spoiled food. Secondary non-responders respond initially but lose the response on subsequent injections due to developing antibodies against the toxin.
Risks and Adverse Effects
Botox has a very good safety record when treatments are done by a trained doctor. Negative effects are generally mild and transient and include the following:
- Flu-like symptoms
- Rashes at sites distant from the injection
The actual injections can cause some mild pain, swelling, bruising, headache and redness.
The most common adverse event is unwanted weakness in facial muscles. This usually resolves in several months or sooner in most individuals.
Patients should not use Botox if there has been a prior allergic reaction to the medication. Injections should not be done in areas of infection or inflammation. Pregnant and breastfeeding women are not advised to receive the injections.
Relative contraindications include those with neuromuscular diseases such as myasthenia gravis. Medications such as aminoglycosides, penicillamine, quinine and calcium channel blockers should be monitored.
Medications such as blood thinners like aspirin, other nonsteriodal anti-inflammatory drugs, warfarin (Coumadin) and heparin should be stopped 7-14 days prior to injection if medically safe to do so.
Preparation for Injections
Prior to receiving injections, patients should receive a complete physical exam and review their medical history with the doctor.
A review of all medications being taken should be done.
Patient expectations and a review of what Botox can and can’t do for you should be covered with the doctor.