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What is Botox?
Botox is a trade name that is a short form for botulinum toxin, a toxin produced by the bacterium known as Clostridium botulinum. In small doses this toxin produces temporary paralysis.
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What is Botox used for?
Doctors first began using Botox in the mid-80s to help people with blepharospasm, annoying spasms around the eyes that disturb vision. While using Botox for this condition, a Vancouver ophthalmologist noticed that Botox reduced wrinkles around patients' eyes, and she told her husband, a dermatologist, about this phenomenon. He began to use it for wrinkles, and the rest is history. In 2006 in the US more than 2,800,000 Botox treatments were performed.
Botox is now used for the treatment of migraine headaches, neck tension headaches, and chronic back pain.
Only the cosmetic use of Botox is discussed here.
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How does Botox work?
Botox interferes with the transmission of signals from nerves to muscles. With no nerve impulses to tell the muscle to contract, the muscle is paralyzed. The relaxation of selected facial muscles results in loss of dynamic wrinkles in the area.
Dynamic wrinkles are wrinkles that are produced by muscle activity such as frowning and smiling. These are completely different from static wrinkles that are the result of the loss of elasticity and subsequent sagging of aging skin.
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What areas can be treated?
The most common areas treated are the forehead, glabella (between the eyebrows), and the outside rim of the eyes (for crow's feet). Less commonly, the upper lip and the muscle that turns the corners of the mouth down can be treated.
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Who is a good candidate for Botox?
Women and men in their 20s to 50s are candidates. Generally speaking, by the time people are in their 60s, static wrinkles predominate, and Botox has no effect on these wrinkles. However, there certainly are many people over 60 who would still benefit.
Younger people will benefit from Botox because early use will prevent deep dynamic wrinkles from forming.
Smoking and excessive sun exposure age skin more rapidly, so there are many people younger than 60 who are poor candidates for Botox.
Look in the mirror and compare the wrinkles in your relaxed face with the wrinkles that appear when you frown, smile, and raise your eyebrows. If there is no substantial difference, then Botox will not help. (If you find yourself in this category, don't despair! There are several treatment options that can improve your skin including dermal fillers, peels, laser resurfacing, and facelifts. You should also stop smoking and wear sunscreen!)
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How are treatments done?
At each site where you want your dynamic wrinkles reduced, several tiny injections are placed in the muscles using a very short very fine needle. Generally 5 shots are given for the forehead, 3 around each eye, and 5-7 shots are given in the glabellum (between the eyebrows).
Treating the entire face takes 10 minutes.
There is no downtime. The tiny holes created are usually not visible by the time you get to your car to drive home.
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Do Botox treatments hurt?
When done properly, Botox injections are almost painless. Cooling and topical anesthetics can be used to reduce or eliminate discomfort, but almost no one needs these.
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How long does it take to see results and how long does Botox last?
It takes 2 to 7 days before results are noticeable. The effect of Botox wears off after about 12 weeks.
Botox is most commonly repeated at 3 to 4 month intervals in the first year. In the second year, treatments are usually done at 5-6 month intervals, and up to 20% less Botox is required. Some people experience benefits for as long as 8 or 9 months.
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What are the side effects of Botox?
Bruising is not very common (<5%), but it is unavoidable.
If Botox spreads too far, weakness of muscles other than the targeted muscles can occur. This is rare. Around the eyes, weakness of the muscles for blinking could occur. This may cause the upper eyelid to sag. Similarly, the muscles around the mouth may be weakened, resulting in drooling. Usually no treatment is needed for these complications except waiting for the Botox to wear off. Usually it only takes 2-3 weeks for the weakness to resolve , because the amount of Botox in the affected muscles is much less than the targeted muscles.
Botox can aggravate nerve and muscle disorders, so it cannot be used in rare disease states such as myaesthenia gravis, Eaton-Lambert syndrome, and amyotrophic lateral sclerosis.
Occasionally, headaches and flu-like body aches can occur.
Rarely, the immune system produces antibodies against the toxin, destroying it as it enters the body. In these cases, Botox will no longer work.
Allergic reactions are possible, but I have never heard an allergy to Botox described.
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What are the alternatives to Botox?
There are no other muscle paralyzing treatments available. However, there are several treatment options that can improve your skin including peels of varying strengths, laser resurfacing, and facelifts. You should also stop smoking, start using cosmeceuticals regularly, and wear sunscreen!
BEFORE AFTER
After regular use of botox and fillers, this patient looks 10 years younger 3 years later !
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