Botox: By David Robles, MD, PhD

What is Botox? 

 

 

Botox, short for Botulinum toxin, is a neurotoxin produced by a bacterium called Clostridium Botulinum. The toxin was initially responsible for botulism outbreaks in the early 1700s and subsequently named after its source, German sausage. Because the toxin acts as a paralytic agent, its ingestion interfered with respiration and vital bodily functions upon oral consumption, leading to multiple deaths during these outbreaks. 

 

To this end, however, scientists proposed value in selective use of the toxin, later extracting it to treat certain neurological abnormalities. The toxins isolation was revolutionary in that it permitted local muscle paralysis as a course of treatment and became the first microbial injection to treat disease. By 1989, Botox was well-known for its treatment of crossed eyes and eye twitching. It has since been FDA approved to treat a multitude of other diseases including but not limited to: fine lines, migraines, and hyperhidrosis. However, the toxin is particularly renown for its cosmetic value.   

 

 

 

 

How does Botox work for wrinkles? 

 

The toxin works by blocking the release of acetylcholine, a neurotransmitter required for muscle contraction. Through this mechanism, it induces muscle paralysis at the site of injection, causing wrinkles to relax and the skin to soften. Administration by injection is the required method of treatment because it permits selectivity of the drugs action, posing no harm to vitality.  

 

 

 

 

 

What does the Botox treatment process consist of? 

 

The area being treated is usually anesthetized or iced prior to injection. An injection pattern will be determined based on the area being treated (see diagram below). The quantity injected will also depend on the severity of the wrinkles present. Generally, forehead and glabellar lines require an injection of around 20 units of Botox while crow's feet lines require approximately 24 units of Botox.  

 

 

 

 

 

 

 

 

 

 

How long does it take for results to show?  

 

Results are noticeable just 4-7 days following injection. 

 

 

 

 

How long does Botox treatment usually last? 

 

The effects of Botox wear off with time. This occurs because the nerve endings at the injection site will sprout out and eventually restore functionality. You can expect results to last approximately 3-4 months until repeat or touch up treatment is necessary.  

 

 

 

 

 

 

 

What are the potential side effects and contraindications of Botox injections? 

 

Side effects may include bruising, swelling, discomfort, localized muscle weakness or infection where injected. Botox treatment is contraindicated in those who have a neuromuscular disease, those who are pregnant, or those who have a bleeding or clotting disorder. 

 

 

What types of wrinkles has the FDA approved Botox treatment for? 

 

Botox was first approved for glabellar lines in 2002. It later became FDA approved for crow's feet in 2013 and forehead lines in 2017.  

 

 

 

 

The toxin is widely known for its versatility. As mentioned earlier, Botox is also FDA approved to treat a number of other conditions including migraine headaches and axillary hyperhidrosis.