What is Botox?
Botox, the miracle treatment for wrinkles and the reason why so many modern men and women seem to defy aging. In this day and age, it is hard to tell how old anyone actually is due to these types of aesthetic procedures.
What many people don’t know, is that Botox is actually a toxin. In modern medicine, it is used to treat specific muscular conditions and cosmetically in aesthetic medicine to smooth out wrinkles. In being a neurotoxin, it works by temporarily paralysing the muscles. The Botulinum type A toxin is marketed under the brands names Botox, Xeomin and Dysport, with Botox being the first brand to market.
Botox is derived from a neurotoxin that is produced by Clostridium botulinum, a bacterium also known as botulinum toxin, this toxin is an organism that is found in the natural environment in an inactive and non-toxic state. Scientists discovered a way to use this toxin for human advantage though using small and diluted amounts that are directly injected into the muscles, causing them to weaken.
It is the most popular kind of cosmetic treatment with a staggering six million Botox treatments administered every year. The most common use of Botox is to smooth out wrinkles such as crow’s feet, forehead and frown lines, drastically reducing the effects of aging. However, it can also be used medically to prevent excessive sweating, migraines, some bladder, bowel and muscular disorders. It becomes easy to understand why the drug is sometimes referred to as the ‘miracle poison’.
**Interesting fact, botulism, is an infection with the botulinum toxin which can lead to respiratory failure and even death. A mere gram of the toxin is able to kill over one million people and two kilograms is able to kill the entirety of the human population. However, the toxin used in Botox is purified and mostly harmless.
Many people do not know the severity of the toxin as the use of it has been socially accepted for years and FDA approved since 2002. The following article outlines the important factors of Botox, what it does, how it is administered and most importantly, what it is made of, drawing focus to the cosmetic uses of Botox and then touching on the medical side of it. It must be noted that this article is written only to serve as a guideline to help you make better informed decisions about whether or not this procedure could be for you and is not intended as a diagnosis or professional medical opinion. Please consult with your doctor for that.
How did Botox begin?
Clostridium botulinum, as previously mentioned, is a bacterial organism that produces Botox, it is found in its inactive form in natural settings such as forests and cultivated soils as well as in the sediment of streams, lakes and coastal waters. The bacterium is also found in the tracts of fish, mammals and in the viscera and gills of shellfish.
These naturally occurring forms of the bacterium are typically harmless, the problem arises when the spores convert into vegetative cells, which results in the cell population increasing. This is when the bacterium produces the botulinum toxin, which is a deadly neurotoxin that can result in botulism (an infection with the toxin). It is interesting to think that such a dangerous toxin, which is injected into the human body in a weakened state, is found in the natural environment in a dormant state.
Neurotoxins work by targeting and disrupting the nervous system (the word ‘neuro’ relating to nerves). The nervous system is a network made up of nerve cells that transmit impulses between different parts of the body, it is basically the message system of the body which is constantly communicating. A neurotoxin is able to block this system, causing the neurons (nerve cells - the messengers) to not work as effectively.
To think about it in a simple way, when this toxin enters the body, it blocks the signal between the messenger cells, which can be likened to the cutting of telephone lines, which stops the messages from being sent to other parts of the body.
The neurotoxin that produces Botox can be divided in eight different types, these being, A, B, C [C1, C2], D, E, F, G 18 and H.19. The types A, B, E and in rare occasions, F, are known to cause botulism in humans. Types C and D are known to cause illnesses in some birds, fish and other mammals. Type A is typically used for cosmetic procedures.
Botox was first discovered in the 1820s by the German scientist Dr. Kerner. At the time, he was trying to understand what caused food poisoning, and found that it was a specific toxin in spoiled sausages. Over 70 years later, in wanting to further explore the properties of the toxin, another doctor then expanded on this discovery and found several strains of the botulinum toxin, four of which were harmful to humans.
It was only in the 1960s that scientists found that injecting small doses of the toxin type A seemed to relax hyperactive muscles, it was then used for several years to treat muscle spasms. It was first used to treat strabismus (squint). Further research also began in exploring the helpful effects of the toxin. In the 1980s, the botulinum toxin was called Botox and was then FDA approved for treatment on humans as an aesthetic treatment in 2002.
How does Botox work?
As mentioned, being a neurotoxin, Botox blocks the signals sent from the nerves to the muscles. For cosmetic use, the facial muscles injected with Botox are unable to contract which results in the wrinkles in the overlying skin, relaxing and softening in two weeks.
Being injected in extremely small doses, the muscles are left without the instructions from the neurons to contract and are then left paralysed. To be more scientific about this process, the chemical messenger released by the nerves that causes the muscles to contract is called acetylcholine (ACh), which is a neurotransmitter. When Botox is injected, it blocks the release of this neurotransmitter which stops the contraction of the target muscles. The effect of the toxin results in abnormal muscle contraction being reduced, allowing the muscles to become less stiff.
How is Botox administered?
The botulinum toxin in the form of the brand your plastic surgeon or aesthetic medicine practitioner sells such as Botox, is first diluted in saline (sodium chloride or basically a salt water solution) and is then injected directly into the neuromuscular tissue. It can take between 3 and 7 days for the Botox to take effect, with full effects being achieved by 2 weeks, this is reflective of the time it takes the toxin to disrupt the muscles contracting and for the patient to see a noticeable result.
The procedure only lasts a few minutes and the drug is injected using a fine needle, causing only minor discomfort.
What kinds of wrinkles does Botox treat?
There are two different types of wrinkles, dynamic and static. Dynamic lines are wrinkles that appear when your face is animated, so when you smile or frown. Static lines are due to a loss of volume over time (these are better treated with dermal fillers).
Botox is used to treat dynamic lines, relaxing the muscles that create them and stopping more wrinkles from being formed. Botox is typically injected into the forehead, around the eyes, mouth (to soften lip lines) and also the neck.
How long does a Botox injection last?
How long a Botox injection lasts is dependent on a variety of factors, the type of Botox used is the first factor:
- Botox type A will last around three to six months.
- Dysport will last around two to three months.
- Myoblok or Neuroblok with last two to three months.
The second factor is the determined by the total dosage given – the higher the dose, the longer the effect. However, higher doses have a higher chance of side effects.
Other factors include the skin elasticity, ethnicity, gender and muscle mass. The Botox effect stops working when the muscle contraction starts to gradually return, resulting in the lines and wrinkles reappearing and needing to the treated once again. Over time the wrinkles will be less severe as the muscles are trained to relax. If the area is more relaxed, natural collagen can begin to build up once again as it is not depleted due to the constant motion of the muscles. Best results are achieved through constant treatment every four months over 10 years.
The sites on the body where Botox will work best
There are a number of areas on the body where cosmetic Botox can be beneficial. These being:
- The upper face –between and around the eyes (11 lines and crow’s feet) and forehead (forehead lines) are the most common
- Wrinkles on the side of nose (known as bunny lines)
- Neck (to stop spasms)
- Breasts (occasionally used for breast lifts – this is done by injecting the pectoralis minor chest
- Muscle which stops it from contracting, forcing the back muscles to compensate by lifting the breast area).
- Under the armpits for eliminating excessive sweating – here the Botox blocks the
- signals that stimulate the sweat glands.
- Facial acne – Botox can decrease the secretion of sebum (natural oils)
Who is the ideal candidate for Botox?
Botox, being a fantastic treatment for the prevention of wrinkles as it stops the muscles from contracting and can result in natural collagen building up again, should start to be administered to people from the ages of 27 to 30 for maximum benefit. Both men and women can receive the treatment.
An individual treatment plan can be designed for each individual, and the drug is suited for anyone who wants to enhance and improve their appearance as well as prolong future surgery that may be warranted due to aging.
Who is not an ideal candidate for Botox?
Consultation with a certified doctor or plastic surgeon is vital in determining what you can achieve through the treatment. Both you and your doctor can determine a realistic goal and formulate a programme that will hopefully give you the results you seek.
Those who have unrealistic expectations about the treatment will walk away disappointed. Balance needs to be created between the natural contour, lines of the face and wrinkle removal in isolation so as to avoid looking like you are wearing an expressionless mask. The treatment should be all about balance.
Pregnant and breastfeeding women should not receive Botox as well as those with neurological disorders.
Possible side effects of cosmetic Botox
- The site of the injection might swell, however, this will normally disappear quite quickly.
- The site of the injection might bruise, this is rare and will heal in two to five days and is also easily hidden with makeup.
- It might sting at the injection site.
- The upper eyelids may also swell. This can last up to two weeks, it is normally mild.
Possible complications of cosmetic Botox
Eyebrow and eyelid ptosis (the drooping of the eyebrow/eye) can be a possible complication of Botox injections, however, it is very rare and only one in 100 people develop this side effect. It is also normally very mild.
- Eyebrow ptosis is the result of the dosage being administered too high or too close to the orbital rim which lifts the upper half of the face. If this happens, the effect can last between two and three months.
- Eyelid ptosis develops when the Botox spreads from certain injection sites to the eyelid muscle. Being a diffused and lower dose, the effect will only last about two weeks, but in some rare cases it is known to last up to two months.
Other rare side effects can include:
- Mild nausea
- Neck weakness
- Gallbladder dysfunction
- Blurred vision
- Dry mouth
Medical and cosmetic uses of Botox
Botox is mostly used as a treatment to reduce wrinkles and lines in the face. However, the uses of the drug go beyond purely cosmetic applications as it also helps in the treatment of certain medical conditions. The most common of these include:
Rectifying Crossed Eyes (Squint)
This was the first medical use of Botox. Injecting the drug into the muscles of the eyes allows the movement of the eyes to be more controlled, reducing the appearance of cross eyes.
By paralysing the muscles that produce and excrete sweat from the body, it stops the sweat glands from functioning normally and prevents sweat from being produced. This also helps to reduce body odour.
Myofascial pain syndrome is a chronic disorder wherein pressure is applied to certain muscle trigger points which results in pain being triggered in unrelated parts of the body. Botox is injected into painful muscles in the shoulder and neck areas which is known to help improve the level of pain experienced.
The uses of Botox are even spreading into the area of psychiatry. It was discovered that higher levels of frowning have been known to contribute to depression symptoms. In 2014, a study was published in the Journal of Psychiatric Research wherein 74 depression patients were administered with Botox in the frown line area. The study found their symptoms of depression decreased by 47%. However, Botox is not approved for the treatment of depression by the FDA.
People with this condition, suffer from their bladder releasing urine (by squeezing it out) without warning. If Botox is injected into the bladder, the muscles relax more, which can also improve the storage capacity. This treatment has been used in patients with spinal injuries as well.
Suffering from chronic migraines means that you suffer from a severe and debilitating headache for more than 14 days of the month. To treat this, Botox is injected into the temples, forehead and possibly the neck muscles. This helps these muscles to relax, taking away some of the tension that can cause a tension migraine headache.
Drooling in Parkinson's disease
Parkinson’s disease causes issues with muscle functions and sometimes affects the salivary glands which can result in excessive drooling due swallowing being less frequent. Botox can be administered into the salivary glands to decrease the production of saliva.
These are just some of the uses for the drug, more are being investigated daily with the hopes of alleviating and improving the symptoms of other medical conditions.
Some questions answered
Will my insurance/medical aid pay for Botox?
Being a cosmetic procedure, it is unlikely that your insurance provider will cover the costs of Botox. However, if the drug is needed for medical purposes, your insurance is likely to cover the costs. It is best to speak to your insurance company to see what is covered.
Where is the Botox procedure performed?
Botox should be performed in the sterile rooms of an aesthetic doctor or plastic surgeon and will last typically between 15 to 30 minutes, depending on the procedure and dose.
How long will it take me to look normal again?
Many people fear they will look ‘frozen’, however this is not the goal of Botox and when administered by a trained medical professional, should not be the result. The effect of Botox is related to the level of dosage. Apart from some expected redness and swelling, your face should return to normal within 72 hours. If you walk out of your treatment looking like a ‘frozen’ villain from an animated movie, something has gone wrong and too much Botox was administered.
What is the difference between Botox and fillers?
Botox is used to treat dynamic lines which appear when the muscles contract through frowning, smiling, laughing etc. Whereas both Botox and fillers reduce the effects of aging, Botox reduces the activity of the muscles that lead to wrinkles, and fillers are able to fill the wrinkled areas which in turn helps to stimulate the collagen growth in the face as well as plumping and lifting the area. Fillers eliminate signs of aging due to collagen loss as well as other causes for volume loss such as fat pads and even skeletal changes.
What is collagen?
Collagen is a structural protein that can be found in the skin as well as other connective tissues. It provides the structure and substance that holds the body together and is composed of amino acids.
What causes wrinkles?
Wrinkles are a natural result of aging. Other contributing factors can include sun-damage due to over exposure to the sun or UV lights, unhealthy habits such as drinking and smoking as well as a reduction in the elasticity of your skin.
Wrinkles are a result of the collagen in your skin being depleted through the contraction and movement of the muscles in the skin. When we are young, we only have dynamic lines on our face, being those that show when we make various facial expressions and move the muscles in our face. These eventually lead to static wrinkles as each time we use a facial muscle, a groove forms under the skin’s surface. As we begin to age and our skin starts to lose its elasticity and collagen, it can no longer bounce back as quickly and the lines start to become permanently etched into our skin, forming the static lines.