What is Botox?
 Botox is a protein produced by the bacterium
Clostridium botulinum that has been purified for medical usage.
Since the 1980’s it has been used to correct abnormal muscle
movements of the eye. A short time later, neurologists found it to
be helpful in correcting muscle spasms in the face. And for the past
decade it has found its greatest use in relaxing the muscles
responsible for facial lines and wrinkles. It has become the safest
and most effective way to eliminate or reduce worry and frown lines
and “crow’s feet.”
How does it work?
The procedure works by physiologically weakening
facial muscles beneath the skin that are related to expression
lines. It is the contraction of these muscles that leads to
wrinkles. By blocking the impulses from the nerve to the facial
muscle, Botox allows the muscles to remain in their relaxed state
resulting in a smooth, unwrinkled and less stressed appearance.
Technically, Botox works by blocking nerve impulses.
It binds to nerve endings and prevents the release of chemical
transmitters that activate muscles. Normally, an impulse is sent
from the brain to the nerves that control muscle action. The nerve
then releases a chemical that causes the muscle to contract. If the
chemical messenger is blocked, the muscle cannot contract. And this
is precisely what Botox allows us to do in preventing unwanted
muscle action, as in frowning.
The full effect of Botox generally takes several
days to a couple of weeks to see, and it usually then takes the
nerves four to five months to regenerate, at which time the
procedure needs to be repeated. Over a period of time, because of
disuse, the muscles tend to weaken, often allowing for longer
periods between injections.
Is it safe?
In the more than twenty years since botulinum toxin
was first used, there have never been any serious or prolonged side
effects. It has been used for cosmetic purposes for the past ten or
so years on tens of thousands of patients. There are no reports of
allergy to the substance or of any serious reaction. However, that
is not to say there are no potential side effects.
Occasionally there is transient bruising at the site
of injection. (We recommend patients avoid aspirin for two weeks
prior to Botox injection since aspirin increases the risk of
bruising.) In very rare instances there can be a slight drooping of
the eyebrow or upper eyelid. Fortunately, when this occurs, it
corrects itself in two to three weeks. There are no other visible
signs of the treatment.
The procedure
Botox is injected into various locations on the
face. The needle is extremely small, and only a tiny amount of
liquid is injected at one time. Anesthetic is not used because the
discomfort is minimal.
Following the procedure
Because there is no sedative or anesthetic used,
patients can return to normal activities immediately after the
procedure. However, we recommend that aggressive exercise be avoided
and that the patient not lie down for a few hours. Some people
experience a mild headache following the procedure for which
acetaminophen can be taken. The treatment generally takes a few days
to take effect, and the benefits last from three to six
months.
When Botox begins to wear off, the wrinkles begin to
reappear; however, they frequently are not as deep as the original
ones. It usually takes two or three injections per year to maintain
the smooth, youthful appearance that is desired. Clinical studies
suggest that, after several treatments, the patient may require
injections less often.
Who are the best candidates for Botox?
The ideal candidate is between the ages of 25 and
65. Older individuals whose wrinkles are sun related and are not
caused by muscle pull do not respond to Botox.
What results can be expected?
This procedure will smooth wrinkles that are caused
by frown and worry lines, “crow’s feet,” and laugh lines. We will
often use Botox in conjunction with other procedures, such as laser
resurfacing, to maintain the relaxation of the muscles that cause
wrinkles in the first place.
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