Botulinum toxin

Botulinum toxin is a very successful medical treatment for facial lines and wrinkles.

How does it work?

BOTOX® Cosmetic, a registered trade mark of Allergan Inc., is a forms of purified botulinum toxin A, and is produced by the bacterium Clostridium botulinum, the cause of a dangerous disease called botulism.  Botulinum toxin is a neuromuscular blocking agent, which means it causes paralysis of the injected muscle.  Without its nerve supply, the muscle fiber withers away. The muscle strengthens again as the nerves regenerate.

What can botulinum toxin be used for?

Botulinum toxin treatment was originally introduced to treat muscle spasms, including blepharospasm (spasms of the eyelids), strabismus (squint), cervical dystonia (torticollis of the neck) and spasticity due to cerebral palsy or other muscular diseases.

In patients treated for facial spasms it was noted that facial wrinkling decreased over the treated muscle. This experience lead to the development of botulinum toxin for the treatment of dynamic facial wrinkles

People often dislike their central scowl lines (called glabellar lines), which are caused by the corrugator and procerus muscles contracting when concentrating, squinting, or frowning.  Botulinum toxin injections into these muscles weaken them and successfully reduce the prominence of the line.

Effects of botulinum toxin

Subject relaxed prior to botulinum toxin injections	Subject frowning prior to botulinum toxin injectons
Subject relaxed after botulinum toxin injections	Subject attempting to frown after botulinum toxin injections

Botulinum toxin can also be used to lessen crows' feet.   The treatment can be combined with implantations of hyaluronic acid to further improve the appearance. It can also be used to shape the eyebrows into an arch or flare and to correct facial asymmetry.

Botulinum toxin injections for crows' feet

Before injection

After injection

How is botulinum toxin administered?

Tiny quantities of the toxin are injected directly into the affected muscles. It takes three to five small injections between the eyebrows to treat the frown line. The injection is almost painless. The treated muscles weaken over the following week or so. Most people do not notice anything. They simply become aware that they are no longer able to contract the frown muscles. They can still lift their eyebrows normally and blink without problems.

You can frown as often as you like in the first day or so, but the treated areas should not be touched.  Don't have a facial massage!

The effect of botulinum toxin starts wearing off within a few weeks but retreatment is not usually needed for three to six months. It can be repeated as required. Many people find after three or four treatments to glabellar lines that they don't need another one for a long time; the muscle has markedly weakened or they have broken the bad habit that led to the frowning or squinting originally.

Side effects and risks

Some people have a slight headache after treatment for several hours; it is safe to take Tylenol to relieve this. Very long lasting headaches have rarely been reported. A bruise at the site of injection is possible.

Contraindications

Botulinum toxin injections should not be used in pregnancy or when breast feeding. It is also inadvisable for those with certain neurological conditions such as motor neuron disease or myasthenia gravis.

Caution is necessary for patients on the following medications:

• Aminoglycoside antibiotics (may increase effect of botulinum toxin).
• Chloroquine and hydroxychloroquine (may reduce effect).
• Blood thining agents eg. warfarin or aspirin (may result in bruising).