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, frown 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 a 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 moderate-to-severe 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, excessive 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.
Difference Between BOTOX and Facial Fillers
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 to result 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 intradermal injection of the filler masks the wrinkle by adding volume.
There are several available fillers; they include:
BOTOX Cosmetic Candidates:
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.
What You Need to Know Before Getting BOTOX Cosmetic
Important Facts to Consider before getting BOTOX
- Ask about how BOTOX could help or hurt you
- Make sure your doctor/nurse is trained in the use of BOTOX
- Make sure you get treatment in a doctor or nurse’s office or clinic
- Emergency equipment should be on hand in case of a problem
- Do not use if you are pregnant or think you might be pregnant
- Do not use if you are breastfeeding
- Tell your doctor/nurse if you are taking antibiotics
- Tell your doctor/nurse if you have any problems with nerves or muscles
Longevity of BOTOX:
BOTOX injections work by weakening or paralyzing certain muscles or by blocking certain nerves. The effects last about three to four months.
Pros and Cons of BOTOX:
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 furrows the forehead when you raise the eyebrow area, the crow’s feet that appears when you squint and the glabellar 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, the asymmetry with their smile, and cause drooling.
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.
A 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 overdosing”.
Advantages and Disadvantages of BOTOX
ADVANTAGES OF BOTOX:
- The whole procedure takes little time, no anesthesia is needed and the person can get back to his/her usual activities almost immediately
- The effects appear in a short period of time (3 to 5 days) and last from three to four months
- The treatment can be repeated and in time its effects will start lasting longer
- It can also help with sweating (by paralyzing the muscles responsible for it) when injected in small amounts into the underarm skin or skin on the palms and soles of the hand or foot
- Improves the appearance of the skin
- BOTOX relieves migraine headaches
DISADVANTAGES OF BOTOX:
- Pain and bruising or bleeding at the injection site
- Temporary headaches can occur
- Results are temporary – last 3 to 6 months
- Treatment can be expensive over the long term – costs vary
- Common side effects include mild to moderate headaches, flu symptoms, temporary eyelid drooping and nausea
- Less than 1% of patients have reported the drooping of the eyelid.
- Unnatural facial expressions due to the certain parts of the face being blocked with BOTOX
- Some believe that because some parts of the face are “frozen”; that the brain redirects the impulses to other muscles and wrinkles can grow in parts of the face which are not being treated
- BOTOX should never be used on women who are pregnant
Risks of BOTOX
Botox: Safety First
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.
Also, stop taking fish oil, or eating a lot of fish, no green tea, spicy foods, or alcohol is advised.
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 done your treatments. Make sure your doctor is an experienced specialist. Find out how many years the doctor/nurse has been in practice and how many patients the doctor/nurse has treated with BOTOX in the past year.
What to expect during your BOTOX Treatment
BOTOX Procedure FAST FACTS:
The procedure takes 5 minutes, and you can return to work or daily activities immediately.
Your doctor/nurse 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 those muscles.
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/nurse can ensure an eye-drop can be prescribed 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 “pinprick” 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 areas.
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.
How BOTOX Cosmetic Works
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 from BOTOX Cosmetic Treatment
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 in 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
improving “the appearance of moderate to severe frown lines between the eyebrows (the glabellar line) and crows feet around the eyes”.
The second 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 results 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.