1-
How does it work ?
Some History first. Botulinum Toxin was discovered in 19th
century Germany in rotten delicatessen. Produced by a bacteria, the
first cases of botulism were described back then among that deli shop
customers. More recently, Botulinum Toxin, Type A was approved for
medical use in 1989 to treat eye muscle disorders (strabismus and
blepharospasm) and in 2000 to treat cervical dystonia responsible for
sever neck and shoulder contractions. Approved bythe FDA since 2001
for cosmetic use, it has gained the same regulatory approval in France
in 2003.
Botulinum Toxin A is a protein produced by Clostridium
botulinium. For medical use, this toxin is purified and lyophilized;
it is a sterile powder, which needs to be mixed with sodium chloride
(water for injection) right before use. Some tiny doses
of product are
then injected in targeted facial muscles to produce the desired
effect. The toxin prevents the release of a key biochemical agent (acetycholin)
responsible for muscle contraction. The effect is a temporary
paralysis of the targeted muscle. Once that muscle is relaxed, it
won’t contract again and will leave the skin above smooth and flat.
The direct translation for our wrinkles is that they stop
from worsening; they stop from getting deeper while the effect last.
The skin stays smooth because it is no longer caught between muscle
branches consequently frowns are diminished. Your face appears relaxed
and natural.
  Wrinkles
created by our facial expressions are dynamic, they will keep getting
deeper as we age. The more we express ourselves with our face, the
deeper our wrinkles will get. So, when someone is being treated with
Botox, these expressions are reduced, wrinkles around the eyes and
forehead are diminished. Botox injections are a non-surgical tool
capable of reducing the effects of aging so annoying on our face.
In placebo-controlled multicenter randomized clinical
studies, 405 patients presenting moderate to severe glabellar lines
were iunjected with Botox Cosmetic. After 30 days, patients’
evaluations stated that 82% showed improvements and/or line
disappearance. In these studies, the effect duration was up to 120
days. The results were very low in the placebo group.
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2- What are the best indications?
The most common and best studied are:
a) Lion’s frown (glabellar area): wrinkles, usually
vertical, between the eyes going upo towards the forehead.
b) Forehead: horizontal and parallel lines
c) Crow’s feet: annoying fine lines by the side of our
eyes. They tell quickly about our age. They worsen when we smile a lot
or when we are frequently exposed to bright sun without sunglasses
(i.e. driving).
d) Neck lines (platysma)
 Some
operators venture in non-approved areas such as the lower face (jaws,
chin, etc…). The increased risks associated with unapproved uses are
not worth the aggravation. In the absence of major clinical trials in
those areas, you should stay away from botox injections in facial
areas below the eye line.
People who use botox have reported that they have a more
rested face, a more wide-eyed and less angry look.
Repeated injections but correctly spaced may prolong your
results beyond the traditional 4 months. Botox can easily be combined
with other techniques such as fillers (Hyaluronic Acid or Collagen
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3- Quels about side effects ?
Some patients have observed side effects. Some are
operator dependant such as little bruises at injection points. In fact
many little veins go through the temporal area where Crow’s feet are
treated or the forehead.
The most common side effects following injections are :
- Headache (13,3%)
- Respiratory infection (3,5%)
- Dropped eyelid (3,2%)
- Nausea (3,0%)
- Flu like syndrome (2,0%)
- Less common (<3%): local redness at injection point,
local pain and muscle weakness.
Key
recommendations :
- Do not lie down for 4 hours following the injection
- Do not go to bed on the injected area. Best to sleep on
your back.
- Do not massage the injected areas
These practical recommendation should reduce your risk of
headache and prevent the product from migrating in the vicinity of the
treated areas. It could yield to a non-desired eyelid drop for
example.
Precautions : people who have muscle problems of nerve
problems should discuss the opportunity of botox injections with their
operator first.
People who present a heart condition should be evaluated prior to an
injection.
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4- How much does it cost ?
A vial costs about $400 to your provider. The amount you
are charged usually depends on the amount of product you are going to
need. For a complete session (Lion’s frown, Crow’s feet and forehead
you should run un the $500 range). One area only should run in the
$250 range. You should consider that as an investment you will repeat
between 2 and 3 times a year to maintain your results.
5- How long does it last?
Given the fact that our body develops ways to circumvent
the paralysis, the toxin effects are temporary. On average, the
effects fade away after 3 months. Some people have reported efficacy
at 6 months. On the other hand, some individuals might show shorter
action. They tend to develop new neuro-muscular contacts more rapidly
than expected.
So, for them a dose adjustment is necessary.
6- Is it painful?
No. A local anesthesia is not necessary. Injections are
usually done with insulin type syringes with extremely fine needles.
The vast majority of people do not feel the sting, some may just feel
the product being pushed..
7- Is it dangerous?
Ask your physician if the toxin is right for you. It
should not be used on pregnant or breastfeeding women or if you take
certain medications. It is not recommended for those who have neuro-muscular
troubles. The effect of botox could be increased with the use of some
antibiotics that interfere with neuro-muscular transmission.
Given at the appropriate does (for cosmetic use, it is 3600 times less
than what it takes to cause serious damage) by an experienced
physician, botox does not present an immediate and sudden danger.
Botulism is the consequence of massive injestion (eating) of toxin
from contaminated food. It is wise to read the
PROs and CONs
section about botox.
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