BOTOX Cosmetic is the most popular
minimally-invasive cosmetic procedure performed today. BOTOX in the cosmetic
world is used to treat facial lines and wrinkles such as forehead lines,
crow's feet, and lines around the neck.
For over the past 20 years, Botulinum Toxin Type A (BOTOX) has been evaluated in
more than 200 studies. BOTOX has been widely used for general use, for more than
a decade with a few million people.
BOTOX comes to the physician in freeze dried form which requires dilution with
saline for injections. BOTOX is marketed and produced by Allergan Inc., Irvine,
California. In April 2002, BOTOX gained FDA approval for treatment of
frown lines between the eyebrows - called glabellar lines.
However, BOTOX is often used off label for other areas of the face as well.
BOTOX Cosmetic is the registered product name for Botulinum toxin, Type A.
Botulinum toxin is produced by a bacterium known as "clostridium botulinum", and
is normally responsible for causing the bacterial infection known as botulism.
However, in small doses, botulinum toxin can be used safely to reduce the
appearance of facial lines and wrinkles. Botulinum toxin has been shown to be an
effective method and is
indicated for treating other conditions, such as migraines,
sweating, and muscle spasms, among others.
The FDA approved the usage in the late 1980s upon the discovery that BOTOX could
stop ailments like blepharospasm (uncontrolled blinking) and strabismus (lazy
eye). Cosmetic physicians have been using BOTOX for years before its official
approval in 2002 to successfully treat wrinkles, lines and facial creases.
BOTOX Cosmetic temporarily corrects or eliminates the dynamic wrinkles due to
overactive facial muscles by blocking the chemicals that cause the facial
muscles to contract resulting in muscle relaxation. BOTOX is only effective for
the correction of dynamic wrinkles. Skin sagging and wrinkles of the face start
to develop as we get older; they are the result of thinned and broken collagen.
These types of wrinkles are different from the dynamic wrinkles and require the
use of fillers to fill out and plump up the depressed areas. The intra-dermal
injection of the filler masks the wrinkle by adding volume.
There are several
available fillers; they include:
Ideal candidates for BOTOX treatments are those that wish to see an improvement
in their facial wrinkles and lines however; they do not want to commit to facial
plastic surgery just yet. Pregnant women are advised to avoid treatment, as the
effect on the fetus is not yet known, and patients with certain neurological
disorders are not considered good candidates. BOTOX has been tested successfully
in patients (male and female) between the ages of 18 to 65 years old.
BOTOX is short for botulinum
toxin, “the substance that causes botulism”. This is sometimes a fatal form of
food poisoning. In smaller quantities, BOTOX interrupts nerve impulses to
muscles in the face. The line that furrow the forehead when you raise the
eyebrow area, the
crow’s feet that appears when you squint and the
line (the creases between the eyebrows). When you frown, tension occurs with the
underlying muscles in the forehead; which contract and squeeze the skin like an
accordion. BOTOX keeps this from happening.
BOTOX is so diluted that serious side effects like an allergic reaction are very
rare. If the physician administering the injection, targets the wrong muscle
group then you could lose the ability to raise your eyelids all the way. If you
are getting the BOTOX injected around the mouth area, sometimes this can leave
the patient unable to drink out of straw, asymmetry with their smile, and cause
If there is a problem with the wrong muscles being injected and causing a droopy
eyelid, unable to have a full range of facial expressions, etc.; BOTOX does
wear off within a few months.
Most important factor to remember with getting BOTOX injections is that you are
getting the actual BOTOX brand product made from Allergan, Inc. Some firms and
doctors have been found guilty and imprisoned for selling or using
research-grade botulinum toxin, causing harm to unknowing patients.
There have been deaths linked to BOTOX injections, but they were not from
cosmetic use. The deaths involved cases in which children were injected with
BOTOX for muscle spasms, and the toxin spread beyond the injection site. The FDA
concluded in 2008 that BOTOX is safe and that adverse reactions were “related to
All patients wanting to get BOTOX
injections are advised not to take any ibuprofen (Advil or Motrin) or aspirin
for a week before having a BOTOX treatment to minimize bruising and bleeding.
Other precautions to take:
Make sure that the BOTOX
you’re being injected with is the authentic product made by Allergan. Every
single vial of BOTOX has the Allergan hologram on it along with a cap marked
with the company’s name.
Doctors of all kinds are
hanging out their “BOTOX signs,” so everyone needs to be careful with whom
you decide to have do your treatments. Make sure your doctor is an
experienced specialist in either dermatology or facial plastic surgery. Find
out how many years the doctor has been in practice and how many patients the
doctor has treated with BOTOX in the past year.
The procedure takes 5 minutes,
and you can return to work or daily activities immediately.
Your doctor may ask you to
squeeze and relax the muscles that were injected several times during the
first day to help disperse the BOTOX.
Some people experience a
slight twitching of the muscles as the BOTOX begins to do its work relaxing
Some patients experience a
mild headache for the first few days also.
Some may notice drooping of
their upper eyelid or eyelids. This is due to BOTOX affecting the muscle that opens
the eyelid. If this happens, your doctor can prescribe an eye-drop that will
help open your eyelid until that effect wears off. With an experienced
injector, you should not have this happen.
Results of BOTOX Cosmetic
injections are noticeable in a few days, and last for several months.
Prior to your procedure, the treatment area will be thoroughly cleansed, usually
with an alcohol-based cleanser.
BOTOX Cosmetic is injected into the specific muscle that is contracting and
causing the lines and wrinkles on the face with a very fine needle. Treatment is
effective, safe, and takes approximately 10 minutes.
The pain is a minimal "pin
prick" and no anesthetic is required normally; however, some physicians will give
you an option of using a topical anesthetic treatment, such as EMLA Cream to
help you stay comfortable and relaxed during the procedure. If an anesthetic has
not been administered, you may feel a slight stinging or burning sensation
during the procedure.
Before performing the injections, the physician will ask you to contract your
facial muscles in the desired treatment area in order to determine the precise
injection sites. The entire procedure typically takes approximately ten to
fifteen minutes, but may vary depending on the number of desired treatment
Factors such as age, sun exposure and or course heredity all contribute to the
primary causes of facial lines and wrinkles. Also repetitive muscle
contractions, such as squinting from the sun; can also contribute to the
formation of wrinkles.
Nerves release neurotransmitters, which are chemicals that send signals, or
impulses to other nerves, muscles, or the brain. Nerve impulses are what trigger
muscles to contract, or move. When injected into facial muscles, the toxin in
BOTOX Cosmetic injections blocks the transmission of these nerve impulses, which
temporarily paralyzes muscles and prevents them from contracting.
Under normal conditions, a neurotransmitter known as acetylcholine is released
by the nerve cell. Acetylcholine vesicles must be able to bind to the nerve
membrane, in order to release the acetylcholine and transmit a signal to the
muscle. Once released, acetylcholine triggers the muscle to contract. As you
know, this repeated muscle contraction causes facial lines and wrinkles to form.
Once BOTOX Cosmetic is injected into the treatment area; the toxin enters the
nerve and slices a special protein along the nerve membrane that is necessary
for acetylcholine to bind properly. Because of this mechanism, acetylcholine
cannot bind to the nerve membrane and is not released. Without the release of
the neurotransmitter, acetylcholine, facial muscles are unable to contract and
are temporarily paralyzed, giving the face a smooth, less wrinkled appearance.
Recovery following BOTOX treatment is very minimal and brief. You will be able
to resume your normal activities right after the injections. The only issue that
is recommended is that you do not lie down immediately following your procedure.
No massaging should take place on the area that was treated, along with no
strenuous activities for the first 24 hours.
BOTOX has long had a
monopoly on the neurotoxin market with its ability to temporary
appearance of moderate to severe frown lines between the eyebrows (the
crows feet around the eyes".
botulinum toxin to be approved,
Myobloc or NeuroBloc. Myobloc lasts for a shorter amount of
time than BOTOX, however. Myobloc is cheaper in price compared to
BOTOX - and can be stored longer than BOTOX.
There is a new product out on the market called
Dysport - which has just
been approved for use by the FDA. Dysport has had a long history of
success in Europe and was found to not only be very safe - but effective.
In fact, it has been used in twenty seven countries outside the United States.
Until the recent approval by the U.S. Food and Drug Administration, it could not
be marketed in the United States. Dysport/Reloxin has been in use
since 1991, in over 23 countries.
Purtox, a third competitor, is expected to hit the market in the
spring of 2010.
PurTox is a botulinum toxin type
A cosmetic injectable that reduce the appearance of facial
wrinkles. PurTox restricts muscle action that result in facial
creases or wrinkles. PurTox is pending approval from the United
States FDA. Mentor Corporation is the manufacturer of PurTox.
Xeomin is made by Mers
Pharmaceuticals and was launched in the United Kingdom in 2008, Xeomin is the
third botulinum toxin type A to be promoted in the United Kingdom. Xeomin
has not been approved for use in the United States yet.