Botulinum toxin has been used for wrinkle removal since approved in 2002. Within 20 years it has become the most commonly used cosmetic treatment worldwide.
What it really is, how does it work, is it safe, and is the effect reversible? Can you be allergic to it? Or resistant?
I’ll try to give you an idea of this incredible toxin in a way that won't make you tired after the first chapter.
"Cosmetic Botulinum toxin treatment is sending your skin on Holiday for a few months" That's what I was told, when I started my adventure with botulinum toxin. First results are observed a few days (usually 4-5) after the procedure. Dependent on the wrinkle severity they may be softened, reduced, or completely removed. The first symptoms of muscle relaxation are visible 4-5 days after the procedure. For the full result you must wait around two weeks and then it's the right time to assess the result.
Usually after three months new connections (synapses) between muscle and nerves occur and muscle activity slowly begins again. Gentle lines re-occur about 4-5 months after the procedure. Usually after six months full muscles activity is presented, due to re-innervation and regeneration of neuromuscular connections.
As you can see the changes, that botulinum toxin makes on your skin are reversible. This is good news in case the appearance post treatment is not what you desired; on the other hand treatments need to be repeated periodically.
How would your skin look like after the results of the action completely wearing off? Exactly how it did before the first treatment and no damages or skin laxity will be noticed. Then you can make the decision whether you want to continue your adventure with botulinum toxin or prefer the natural aging process.
They have nothing to do with botulinum toxin injections and they are the most common myths I hear almost every day. I’ll describe how you can get that "disaster" on your face in the fillers section.
What is the most common unwanted face disfiguration caused by botulinum toxin?
There are actually two:
1) Clown’s eye brows, called Mephisto effect, caused by the toxin. The main reason for this effect is the inappropriate botulinum administration on the forehead. This can easily be fixed, during the follow up appointment, by injecting an additional number of units in some key anatomical points.
2) Dripping eyelid, is caused by the opposite action – too many units injected to close to the eye brow. Unfortunately, while reversible, the only remedy for this is time.
Botulinum toxin is the product of Clostridium botulinum. C botulinum bacteria and their spores are ubiquitous. The bacteria are found in soil and marine sediments; the spores can be detected on fruits and vegetables and in seafood.
The growing bacteria produce the neurotoxin botulinum toxin, which is often referred to as the most poisonous substance known to mankind. The neurotoxin inhibits the release of acetylcholine and results in the flaccid paralysis of the affected muscles.
Seven serologically distinct types of botulinum toxin exist: A, B, C1, D, E, F, and G.
The history of Botulinum toxin in medicine started over two centuries ago. However the first clinical experiments on monkeys resulted in first use on human 1980 by dr Alan B. Scott to treat strabismus.
In December 1989 onabotulinotoxin A under brand name Botox® synthesized by Allegran was approved for the treatment of strabismus, blepharospasm, and hemifacial spasm in patients aged younger than 12 years old. Further years brought approval for a variety of other indications; including: cervical dystonia; excessive sweating; indication for neurologic disorders (muscle spasms, migraines, etc.), bladder disfunctions and skin disorders, such as hyperhidrosis and some cosmetic treatments. In UK Allegran also produces the same onabotulinotoxin A under the brand name Vistabel® with exactly the same indications and injection techniques.
Other available brands include: abobotuliumtoxin A, known under brand name Azzalure® produced by French company and
Incobotulinotoxin A, known under Bocouture®. The last one is the most innovative and free of complexing proteins product, which makes it suitable for patients with known allergy to other botulinum toxins. It doesn't have to be store in a fridge and has a higher biological activity than other licensed botulinum toxins.
Not very popular Prabotulinumtoxin A under the brand name Jeuveau® is also sometimes used for cosmetic purposes.
All of these brands differ within each other, however we commonly call them all Botox, which is a common mistake.
In 1989 Botox® was for the first time used for medical purposes. Wrinkles softening and further cosmetic outcomes, like sebum and pores size reduction were actually the side effect of botulinum toxin injection. After registration for cosmetic use in 2002 has changed the face of beauty and became a billion dollar industry!
Recently, due to a common use of botulinum toxin, there are some other side effects reported, like easing the symptoms of depression and mood fluctuation in menopause (read more on my Blog).