Botulinum Toxin, better known as Botox

 Botulinum toxin

The use of Botox neurotoxin as an anti-wrinkle agent is increasing at a rapid rate. In the Australian aesthetic market $350 million was spent in 2018 and it is reported to be growing 20 % per year.

It has been effective in clinical practice for more than 30 years. There are over 21,000 patients which have been treated with more than 3500 clinical and non-clinical publications including 140 clinical studies in aesthetic use.

How does botox work?

Botulin toxin acts directly on the neuromuscular endplate where it inhibits release of the neurotransmitter, acetylcholine. This leads to muscular paralysis of the affected fibre.

Eventually the neurotoxin is broken down by enzymes called protease. The synapses regain function in about 3 months time. It leads to the formation of new nerve endings.

How long does botulinum toxin work?

Botulin toxin can be divided into 7 serological testing forms, types A to G. Type A has the most pain effect with the longest duration. Type A botulinum toxin is the main serotype in therapeutic use particularly in regards to aesthetic indications.

Its initial clinical response is usually seen at 24 to 48 hours after the injection. The peak effect is reached in about 2 weeks. New protein complexes form 10 to 12 weeks after the injection. The nerve endings then start to regain their original function. The effects of botulinum toxin persist for a proximally 3 months. However persistent use and behaviour modification can lead to considerably longer duration.

In the area of treatment of hyperhidrosis the effects can last up to 6 to 12 months. In some cases remission has occurred up to 18 months.

Contraindications

Hypersensitivity to botulinum toxin A
Infection in the area being treated
Bleeding disorders
Treatment with anticoagulants
Pregnancy or breast feeding
Certain medications such as aminoglycosides or muscle relaxants
Neuromuscular disorders such as myasthenia gravis
Allergy to the active substance or the additives

Side effects

The use of botulinum toxin is generally well tolerated but side effects can occur during treatment.

Common side effects include swelling and redness of the tissues such as local bruising. Infection in the area can lead to infection of the skin. Allergic reactions have been described but are rare. Excessive weakening of the target muscle as well is weakening of the neighbouring muscles can also occur. The frequency and extent of adverse effects vary according to the location, dose, injection volume and the type of product use. Fortunately the effects of botulinum toxin are reversible.

Toxicity

Toxicity in humans has not been published in the medical literature. The lethal dose has been estimated be 200 ng in monkeys which is equivalent to 50 vials.

Treatment failure

Antibody formation may lead to treatment failure. Initially good treatment effects diminish following repeated injections. Botulinum toxin is protein and can therefore be a target for antibody production. Potential risk factors for antibody formation include high doses and short intervals between injections. In cosmetic treatment low botulinum toxin doses are used and therefore antibody production are very rare.

To decrease the potential risk of treatment failure due to antibody production the intervals should be as long as clinically possible. We would recommend a minimum of 2 months.

Where can Botox be used?

A thorough medical history should be done including any previous aesthetic treatments on what was done, when they were done and how successful was the procedure. Any surgical procedure should be documented. In  particular blepharoplasty, brow lifts and face lifts can  lead to alterations in the anatomical positions of muscles.

Indirect inspection of the face at rest and during natural facial expressions such as speaking and laughing are noted. Direct inspection of targeted muscles groups involved during frowning, raising the eyebrows, smiling and wrinkling of the nose are important to note. These actions are observed from the front and from the side.

The common areas that Botulinum toxin can be used are:

Forehead lines

Glabellar lines

Crow’s lines

Brow positioning

Lateral canthal lines

Bunny lines

Fine skin creases on the lower eyelid

Lines around the upper and lower lips

Marionette lines

Cobblestone chin

Neck

Why choose Botox?

The aim is to give the patient a more relaxed and refresh look by minimising the lines and wrinkles but still allowing for movement. The aim is to create a better version of the patient rather than looking like they had work done. It can be used to sculpt facial features and correct asymmetry.

When used effectively it can soften crow’s feet, frown lines and in addition give the appearance of a complete lift to the face. It can also be administered to elevate the brow and address a drooping upper eyelid and give a more open eyed expression with results lasting typically up to 4 months or longer.

To find out more please contact SkinDoc 02 96025785.