Botox: Cosmetic Uses of Botulinum Toxin

Introduction and History

Botulinum Toxin (BTX) is considered as one of the most poisonous biological substances. It is produced by an anaerobic gram-positive bacteria, Clostridium Botulinum, occurring naturally in soil, water, plants and digestive tracts of animals. The word botulinum comes from the Latin word “Botulus”, sausage, as it was first described as a food-borne disease by a German doctor at the beginning of the 19^th century.

The medical use of the purified version of this toxin, Botulinum Toxin Type A (or BTX-A or BoNT-A), began in the early ‘80s and since then it started to be used for a variety of treatments among many different medical specialties.

It was approved by the FDA in 2002 for cosmetic use and its application expanded widely since then. According to ASPS (American Society of Plastic Surgeons) Botox was the top minimally invasive procedure performed in the U.S.A. in 2017 with over 7.2 Million treatments and accounting for about 46% of the minimally invasive procedures performed.

Since around 2010 the word neuromodulator has become more widespread and contemporary than the use of the word neurotoxin; this is because it is not a drug which is toxic to cells, it just changes the way signals are conducted between nerves and muscles.

Mechanism of Action

Botulinum temporarily blocks or reduces the signal to contract from the nerve to the muscle in the application area.

Types of Wrinkles

Not all wrinkles are the same:

• Compression wrinkles are mainly caused by the weight of the head pressing the face on the pillow while asleep.
• Gravitational wrinkles are caused by gravity, which pushes down tissue, especially when due to aging there has been a loss of subcutaneous material. The wrinkle in this case will be right under the affected area.
• Elastotic wrinkles are caused by loss of elasticity of the skin, mainly due to sun damage.
• Atrophic wrinkles are similar to the elastotic ones and are caused by loss of collagen structure under the skin, mainly due to physiological aging.
• Dynamic wrinkles (aka expression wrinkles) are caused by continuous and repeated muscular contraction over time.

They have different etiology (mechanism of origin), location and directionality and are present on our faces as a combination. Hence, different treatments and combination of treatments are required to take care of the different lines.

Dynamic wrinkles are the ones that yield the best results with the use of Botox both as a treatment and as preventative treatment.

Other therapies for wrinkles are peels, fillers, laser, lifts etc. but will be discussed in other articles.

Cosmetic Indications

Platysmal bands (turkey neck) and aging neck, popply chin, masseter hypertrophy, perioral lines, melolabial fold, melomental lines, nasal crunch lines (bunny lines), glabellar complex and vertical frow lines, crows feet, horizontal forehead lines.

Contraindications

Botox injections are absolutely contraindicated for people affected by neuromuscular disorders, or allergic to any of the substances in the BoTX-A solution (such as lactose or human albumin), or in case of infection at the injection site, or in case of pregnancy and lactation (Pregnancy Cat. C drug).

Relative contraindications (caution recommended) are, among the others, people with coagulation defects or using anti-coagulant drugs such as warfarin as well as other medications that potentiate the effect of BTX such as aminoglycosides or calcium channel blockers. Pre-treatment consultation and informed consent will go through all of these and make sure that the treatment will be safe and expectations will be realistic.

Other Indications

It is very effective also against hyperhidrosis (excessive sweating) for example of the armpits or of the hands and against tension headache.

Duration of the effects

Depending on the area treated and on each patient the effect should be visible after 1-3 days and maximal effect occurs after 10-14 days. It is expected to last for 3-6 months. Repeated use may cause the effects to last longer.

Complications, Risks and Adverse Effects

Botox treatment is relatively safe when performed by an experienced doctor.

Possible side effects on treated area are pain, swelling and bruising. Headache, droopy eyelid, uneven eyebrows, dry eyes or excessive lacrimation.

Although extremely unlikely, some severe botulism-like effect might be possible, such as muscle weakness, vision problems, trouble breathing or speaking.

Being a temporary treatment, the sides are temporary too.

Last update: 15/05/2018

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