Produced commercially under the brand names Botox, Xeomin and Dysport, botulinum toxin injections diminish facial lines by selectively limiting the movement of various facial muscles.
The appearance of frown lines and wrinkles can result in a prematurely aged appearance. Many people would like to alleviate the problem without having to undergo a surgical procedure. One of the biggest names in the facial rejuvenation business is botulinum toxin, an effective non-invasive alternative for reducing lines and revitalising the appearance.
Botulinum toxin is a protein produced by the bacterium Clostridium botulinum. It is a muscle relaxant that is commonly used for cosmetic facial enhancement, particularly to treat crow’s feet around the eyes, the frown lines between the eyebrows (glabellar lines) and the worry lines across the forehead. The marionette or sad lines, from the corner of the mouth to the chin, can be effectively treated with botulinum toxin. It can also be used to produce the effect of a brow lift by relaxing the muscles that drag down the brow.
In cosmetic procedures, botulinum toxin works by blocking nerve stimulation to wrinkle-causing muscles, which prevents the muscle from contracting and significantly reduces wrinkles and fine lines.
Botulinum toxin is used by thousands of women and an increasing number of men to help rejuvenate their appearances. In 2003, 2.2 million Americans had botulinum toxin injections and the procedure is becoming increasingly popular here in Australia.
History
While many people think of botulinum toxin as a new treatment for wrinkles, it has actually been used since the 1960s to treat a range of medical conditions.
However, it was in the 19th century that German physician Justinus Christian Kerner first recognised the potential therapeutic uses of botulinum toxin. An 1815 outbreak of botulism (a dangerous paralytic illness caused by the toxin, botulin) in southern Germany among people who had eaten uncooked blood sausage led Kerner to publish a precise description of botulism’s symptoms – from blurred vision to progressive muscle weakness, culminating in respiratory failure. He postulated that minute quantities of the disease-producing substance might be able to treat disorders of the nervous system.
In 1895 Belgian bacteriologist Emile Van Ermengem was the first to isolate the bacterium, in much the same way that penicillin was first isolated from a mould that grows on bread. What was once known as Kerner’s disease was renamed botulism from the Latin botulus for sausage.
In 1946 Edward Schantz succeeded in purifying botulinum toxin type A in crystalline form for the first time, providing scientists with the raw material necessary to study the molecule in greater detail.
In the 1970s Dr Alan Scott of the Smith-Kettlewell Eye Institute demonstrated that botulinum toxin was a powerful therapeutic agent that could be used to treat ophthalmic disorders associated with muscle over-activity such as lazy eye. Since then it has been used to treat a variety of involuntary muscle contractions or disorders. Its use as a cosmetic treatment was only discovered when people using it to treat facial muscle spasms noticed an improvement in their facial wrinkles.
Botulinum toxin is used in much higher doses to treat children two years of age or older suffering from cerebral palsy to help them walk. It can also be injected into the skin to block the action of the nerves that control sweat glands, and in this way treat excessive localised sweating (hyperhidrosis), especially severe underarm sweating.
In recent years Botox has been used to treat patients suffering from migraines and severe tension headaches, as well as to relieve teeth clenching and grinding. Researchers at the Royal Hospital for Women in Sydney have found that just one injection of Botox can stop chronic pelvic pain.
Cosmetic treatment
In cosmetic procedures, injections of botulinum toxin work by relaxing wrinkle-causing muscles, which softens existing facial lines and can also prevent the formation of new ones. A few tiny injections are administered just under the skin, reducing nerve stimulation to the targeted muscles. The procedure usually takes about 10 minutes but this can vary depending on the number of areas being treated. Because men tend to have larger and stronger muscles, they often require more injections to achieve satisfactory results.
Generally, no anaesthetic is required. The needles are very fine and only a small volume of the product is needed, so the procedure is relatively painless. If the patient is particularly concerned, the physician can numb the skin over the area before administering the injection.
After treatment for lines on the forehead, for example, patients are physically unable to frown. Over the next few days, the muscles gradually relax, and it often takes three to four days for results to become visible, normally reaching their full action by one week. Botulinum toxin is gradually reabsorbed by the body so in order to maintain results repeat injections are necessary every three to five months. With continued use, the effects may start to last longer because the targeted muscles have ‘unlearned’ the response that originally contributed to the development of the lines.
Cosmetic treatment with botulinum toxin is considered safe in that there are no major or harmful side effects. Common side effects are generally restricted to minor temporary redness or bruising at the injection site. There is a very slight risk that it can cause a temporary weakness in nearby muscles, which can result in a slight drooping of an eyelid or eyebrow lasting from one to six weeks. Occasionally patients may experience a slight headache or nausea. Treatment with botulinum toxin is not recommended for women who are pregnant or breastfeeding. In its 10 years of cosmetic use, there have been no reported long-term or permanent side effects from the use of botulinum toxin.
The old school of thought that wrinkles are character lines that portray someone’s emotions, life experiences and credibility is fast diminishing. People are living longer, smooth skin is keenly sought after and procedures to minimise wrinkles are now widely available.
By definition, a wrinkle is a line, furrow, crease or depression in the skin’s surface. Wrinkles form due to a combination of factors – sun damage, habitual facial expressions (frowning, smiling, squinting), smoking, genetic disposition, lifestyle and as part of the natural ageing process. They fall into two main categories: dynamic and static wrinkles.
Dynamic wrinkles are formed by the repeated muscle contraction involved in facial movement. Static wrinkles are formed during the normal ageing process. Botulinum toxin is used to reduce dynamic wrinkles such as crow’s feet, frown lines and the lines across the forehead. Here are some facts about this popular wrinkle treatment.
Botulinum Toxin FAQs
Q. What is botulinum toxin?
A. Botulinum toxin is a purified protein manufactured in pharmaceutical laboratories. It acts by reducing nerve stimulation in muscles and therefore induces relaxation. It is administered by a few tiny injections under the skin. The entire procedure only takes a few minutes, depending upon the number of areas being treated.
Q. How does it work?
A. Botulinum toxin works by relaxing wrinkle-causing muscles, allowing the wrinkles to relax away and leaving facial expression free of lines or at least significantly reduced.
Q. How long does it last?
A. Botulinum toxin will continue to prevent and reduce facial lines and wrinkles for three to four months but sometimes up to six months or longer. Following treatment, the results are not immediately apparent. It usually takes two days to begin to relax away lines, reaching its full potential after about a week.
Q. Is it safe?
A. Cosmetic treatment with botulinum toxin is safe in that there are no major or harmful side effects. Botulinum toxin is used to treat children as young as three years of age at much higher doses in the treatment of cerebral palsy to help them walk. Botulinum toxin has been used medically for the past 25 years to treat a variety of medical conditions such as nervous ticks.
Q. What are the side effects?
A. Common side effects are restricted to minor and temporary redness, and swelling or bruising at the injection site. Very rarely laziness of an eyelid or mild double vision is reported. These effects are temporary, lasting one to two weeks, and will occur if the injections are inappropriately placed. Recovery is spontaneous.
Q. Which lines can I treat with botulinum toxin?
A. Botulinum toxin is commonly used to treat the crow’s feet around the eyes, the central frown lines between the eyebrows (glabellar lines) and the worry lines across the forehead. Botulinum toxin represents the treatment of choice for these lines. The marionette lines, from the corner of the mouth to the chin, are also effectively treated with botulinum toxin.
Q. Can botulinum toxin be used to stop headaches and excess sweating?
A. Yes. In many patients botulinum toxin has proven very effective in preventing both migraine and stress headaches. It also reduces armpit sweating by well over 90 percent for an average of eight to 10 months.
Q. What should I do to prepare for a botulinum toxin injection?
A. Avoid the use of aspirin, anti-inflammatory drugs or blood-thinning agents, unless they are medically required, for two weeks prior to treatment to minimise bruising. For women, avoid treatment either before or after menstruation as the skin is more sensitive and tender at this time.
Q. Can I have botulinum toxin when I am pregnant or breastfeeding?
A. As with all non-essential medications, it should be avoided during pregnancy and breastfeeding.
Q. Is it true that botulinum toxin can be used to prevent the occurrence of new lines and wrinkles?
A. Yes. Because botulinum toxin relaxes the wrinkle-causing muscles, it prevents the recurrent skin creasing produced by these muscles and therefore prevents the occurrence of new lines and wrinkles. It is a good preventative treatment.
Q. I have heard that botulinum toxin will produce a blank, expressionless face. Is this true?
A. No. Three important terms regarding the use of botulinum toxin are character, natural and youthful. Character makes the face interesting, gives insight into the personality and is often very attractive. A natural appearance is achieved by preserving normal expression while relaxing unwanted lines. A youthful appearance is created by softening features that reflect the ageing process, such as crow’s feet, forehead furrows and sagging brows. With careful placement, a talented and experienced botulinum toxin injector can achieve a youthful appearance on a patient while maintaining their natural expression with character.
