Some History first. Botulinum Toxin was discovered in 19th century Germany in rotten delicatessen. Produced by a bacteria, the first cases of botulism were described back then among that deli shop customers. More recently, Botulinum Toxin, Type A was approved for medical use in 1989 to treat eye muscle disorders (strabismus and blepharospasm) and in 2000 to treat cervical dystonia responsible for sever neck and shoulder contractions. Approved bythe FDA since 2001 for cosmetic use, it has gained the same regulatory approval in France in 2003.
Botulinum Toxin A is a protein produced by Clostridium botulinium. For medical use, this toxin is purified and lyophilized; it is a sterile powder, which needs to be mixed with sodium chloride (water for injection) right before use. Some tiny doses of product are then injected in targeted facial muscles to produce the desired effect. The toxin prevents the release of a key biochemical agent (acetycholin) responsible for muscle contraction. The effect is a temporary paralysis of the targeted muscle. Once that muscle is relaxed, it won’t contract again and will leave the skin above smooth and flat.
The direct translation for our wrinkles is that they stop from worsening; they stop from getting deeper while the effect last. The skin stays smooth because it is no longer caught between muscle branches consequently frowns are diminished. Your face appears relaxed and natural.
Wrinkles created by our facial expressions are dynamic, they will keep getting deeper as we age. The more we express ourselves with our face, the deeper our wrinkles will get. So, when someone is being treated with Botox, these expressions are reduced, wrinkles around the eyes and forehead are diminished. Botox injections are a non-surgical tool capable of reducing the effects of aging so annoying on our face.
In placebo-controlled multicenter randomized clinical studies, 405 patients presenting moderate to severe glabellar lines were iunjected with Botox Cosmetic. After 30 days, patients’ evaluations stated that 82% showed improvements and/or line disappearance. In these studies, the effect duration was up to 120 days. The results were very low in the placebo group.
The most common and best studied are:
a) a) Lion’s frown (glabellar area): wrinkles, usually vertical, between the eyes going upo towards the forehead.
b) b) Forehead: horizontal and parallel lines
c) Crow’s feet: annoying fine lines by the side of our eyes. They tell quickly about our age. They worsen when we smile a lot or when we are frequently exposed to bright sun without sunglasses (i.e. driving).
d) d) Neck lines (platysma)
Some operators venture in non-approved areas such as the lower face (jaws, chin, etc…). The increased risks associated with unapproved uses are not worth the aggravation. In the absence of major clinical trials in those areas, you should stay away from botox injections in facial areas below the eye line.
People who use botox have reported that they have a more rested face, a more wide-eyed and less angry look. Repeated injections but correctly spaced may prolong your results beyond the traditional 4 months. Botox can easily be combined with other techniques such as fillers (Hyaluronic Acid or Collagen
Some patients have observed side effects. Some are operator dependant such as little bruises at injection points. In fact many little veins go through the temporal area where Crow’s feet are treated or the forehead.
The most common side effects following injections are :
- Headache (13,3%)
- Respiratory infection (3,5%)
- Dropped eyelid (3,2%)
- Nausea (3,0%)
- Flu like syndrome (2,0%)
- Less common (<3%): local redness at injection point, local pain and muscle weakness.
Key recommendations :
- Do not lie down for 4 hours following the injection
- Do not go to bed on the injected area. Best to sleep on your back
- Do not massage the injected areas
These practical recommendation should reduce your risk of headache and prevent the product from migrating in the vicinity of the treated areas. It could yield to a non-desired eyelid drop for example.
Precautions : people who have muscle problems of nerve problems should discuss the opportunity of botox injections with their operator first. People who present a heart condition should be evaluated prior to an injection.
A vial costs about $400 to your provider. The amount you are charged usually depends on the amount of product you are going to need. For a complete session (Lion’s frown, Crow’s feet and forehead you should run un the $500 range). One area only should run in the $250 range. You should consider that as an investment you will repeat between 2 and 3 times a year to maintain your results.
Given the fact that our body develops ways to circumvent the paralysis, the toxin effects are temporary. On average, the effects fade away after 3 months. Some people have reported efficacy at 6 months. On the other hand, some individuals might show shorter action. They tend to develop new neuro-muscular contacts more rapidly than expected. So, for them a dose adjustment is necessary.
No. A local anesthesia is not necessary. Injections are usually done with insulin type syringes with extremely fine needles. The vast majority of people do not feel the sting, some may just feel the product being pushed..
Ask your physician if the toxin is right for you. It should not be used on pregnant or breastfeeding women or if you take certain medications. It is not recommended for those who have neuro-muscular troubles. The effect of botox could be increased with the use of some antibiotics that interfere with neuro-muscular transmission.