Botox ® Cosmetic

Botox ® Cosmetic

Botulinum toxin works at the neuromuscular junction thereby blocking transmission from nerves to muscles effectively paralysing the overactive muscles.

One of the first signs of ageing is appearance of dynamic wrinkles which are created by overuse of muscles of facial expression, brought on by emotional lability and stress. These are especially visible in the brow, next to the eyes (crow’s feet), above the mouth and around the neck. One of the most clinically proven options to treat dynamic wrinkles is Botulinum Toxin Type A.

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What is Botulinum Toxin Type A ?

Botulinum toxins is derived from the bacterium Clostridium botulinum. Although there are seven different types of botulinum toxin (A, B, C1, D, E, F, and G), most of the research conducted to date has focused on type A.

Since its discovery in the 1960’s as a non-surgical treatment for children suffering from squints, it has gradually received approval to extend its application for many other uses including facial rejuvenation, and especially for the elimination of dynamic wrinkles. Administered correctly by a trained medical professional, it can give you a noticeable temporary improvement of moderate to severe frown lines, creating a subtle, more relaxed look.

Mechanism of action of Botulinum Toxin Type A

Botulinum toxin works by acting at the neuromuscular junction and impeding the messages sent from nerves to muscles. The bacterium produces a protein that blocks the release of acetylcholine, which normally transmits messages from the nerves to the muscles to make them contract and move. Once transmission has been blocked, muscles relax, providing relief to patients with overactive muscles, reducing spasms and pain. The effect is completely reversible and generally lasts for three to six months in most clinical uses.

What areas can be treated with Botox ?

  • The vertical lines between the two eyebrows
  • More pronounced horizontal lines on the forehead
  • The lines on the outside or lateral of the eye (otherwise referred to as Crow’s Feet)
  • Downturned lips
  • Mild level of eyebrow droop
  • Bunny lines on nose

It is important to realise that it cannot be used to support sagging face and neck skin, increase the volume of thin lips, or help skin imperfections, such as thread veins.

The First Consultation

Before starting treatment you will want to discuss your medical history and what you can expect from your treatment with your consultant. Wrinkle-relaxing treatments should not be used if you have a history of previous allergy to botulinum toxins. They may not be suitable for those with an active infection such as acne at the injection site or a history of disease affecting your nerves and muscles.

It should never be injected into muscles used for motor functions such as the eyelids and the lips. It is particularly effective for dynamic wrinkles but not for static wrinkles such as the nasolabial folds on either side of the nose.

Your Procedure

Botox is an OPD procedure. The injection site is usually numbed by application of a topical anaesthetic approximately 15 minutes prior to the treatment. The injection is relatively quick and will usually take only 10 to 15 minutes. Small volumes (0.05ml to 0.1ml) are injected by a 30 G needle into the muscle over a short period of approximately 20 seconds. The procedure is essentially painless as the needles used are extremely fine.

It is important to note that Botox must be injected in the appropriate site at the correct depth and with the right amount of volume for maximum effect.

The effect is usually noticed after two to five days and should last from four to six months. The effects of subsequent injections may be apparent for slightly longer.

To increase the effectiveness of the treatment you should try to use the respective muscles as much as possible for approximately 30 minutes after the injection. You will be advised to abstain from touching or massaging the injection area for 24 hours. You can return to work immediately.

Is it safe to use ?

Botulinum toxin is potentially a dangerous poison but, as very tiny doses are used for cosmetic purposes, it has been clinically proven to be safe when properly administered. There is a huge volume of clinical research studies that have been published in respective clinical journals worldwide proving the safety and efficacy of this treatment. It has been in use since 1973 and more and more applications are being approved.

Common Questions

A lot of women worry that wrinkle-relaxing treatments may ruin their facial expressions or lead to a frozen-looking forehead that doesn’t move when they laugh, smile, or frown. However, an experienced Aesthetic surgeon will try to make sure that wrinkle-relaxing treatments affect only the tiny muscles being directly treated, and not the surrounding muscles. This way, when you laugh or frown, the untreated muscles work normally so your expressions still look like you.

No, it is best delivered by injection which ensures that it reaches the target muscles.

Side effects may include soreness, swelling or mild bruising around the injection site. In rare instances patients may experience a droopy eyebrow or eyelid: this side effect tends to be temporary and disappears when the effects of the injection wear off. Dry eyes, double vision, and headaches can also occur and are temporary. In summary, any side effects occur within the first few days following the injections and are temporary. Patients who are pregnant or who plan to try to become pregnant soon, or are breastfeeding, should also seek advice on the suitability of this treatment. The risk of side effects is reduced in the hands of an experienced Plastic Surgeon.

In order to optimise your facial rejuvenation treatment botox administration can be combined with dermal fillers or other cosmetic procedures including light and laser rejuvenation. For example, wrinkle-relaxing treatments may be used on forehead wrinkles, while a dermal filler may be better used to treat lines around the mouth ar

Studies have shown it can relieve

  • Migraine headaches
  • Excessive underarm sweating
  • Uncontrollable blinking
  • Muscle spasms in the neck and eye.
  • Spastic paralysis

It is also used to help treat overactive bladders, control pain during operations, help children with cerebral palsy, prevent ringing in the ears, assist diabetics with weight gain and control drooling in some cerebral palsy patients.

Risks and Potential Complications

Possible complications include bleeding and collection of blood under the skin (hematoma), fluid accumulation(seroma), infection or poor healing at the incision site. These risks are common to many operations and can be dealt with easily. Blood clots in the deep veins of the leg is a problem associated with lying still for too long for which adequate prophylaxis is taken prior to surgery. Rarely pulmonary and Fat embolism are risks associated with any major prolonged surgery. Any surgery carries risks associated with anaesthesia. These risks will be fully discussed with you prior to your consent for surgery. It is important that you understand these aspects of your surgery and that you seek clarification from your surgeon.

During the Operation: Reactions to Drugs, Bleeding
Later: Painful Scars, Abnormal Scars, Persistent Lower Abdomen Numbness and Swelling and Umbilical Deformity