Getting the Most from Botox (Botulinum Toxin)

Botulinum Toxin, commonly known as Botox or Dysport, can be called the cautious woman’s (or man’s) facelift. Like other drugs that are now common household names, the effects of this neurotoxin were discovered by accident. Botulinum toxin was first used in the late 60s as a treatment for crossed eyes. Although the treatment worked well, patients kept coming back for more when they noticed it erased facial lines. The rest is history. At present, botulinum toxin, which does everything except sail ships, addresses new medical conditions almost every day, including sweating, chronic migraine, teeth grinding, muscle spasms, cerebral palsy, urinary incontinence and cervical dystonia.

These medical uses are impressive, but what’s put Botox on the map is a stubborn human condition: aging. Botulinum toxin injections have ranked as our nation’s top nonsurgical cosmetic procedure since 2000, providing almost instant wrinkle erasure with no downtime at costs that may make you flinch but, for many, are not out of reach.

It seems like everyone’s getting it, including your mother, and even your daughter. While most people who get injections are older than 35, doctors say that this anti-aging treatment is becoming more popular among men and women in their 20s to prevent wrinkles from forming.

According to the American Society for Aesthetic Plastic Surgery (ASAPS), Botulinum Toxin was the most commonly performed non-cosmetic surgical procedure in 2011, with more than 2.6 million takers. April 15th, 2011 marked the 10-year anniversary of the approval of Botox Cosmetic by the U.S. Food and Drug Administration (FDA).

Botulinum toxin is popular because of its results and its benefits. Generally, it remains only in the treated muscle, gradually disappearing without breaking down or traveling throughout the body, which may explain why serious side effects are uncommon. To date, no systemic complications have been documented. Side effects are temporary and typically disappear within a few hours. Sooner or later, you may ask yourself, “What can Botox do to improve my facial appearance?”

What to expect

Botulinum Toxin is effective for wrinkles in motion. These are the lines that form when you scrunch your nose, yell at the dog, squint at the sun and grin. It is less effective for wrinkles that are visible when your face is relaxed or static.

Wrinkles and facial lines are reduced through the injection of a solution of onabotulintoxinA, a toxin that weakens the muscles that can cause wrinkling. Facial areas most commonly smoothed are crowís feet, wrinkles that fan out of the corner of the eyes; glabellar lines, the parallel frown lines between your eyes; horizontal forehead creases aka ìworry linesî and lipstick bleed lines caused by upper lip wrinkles. Botulinum toxin can also relax prominent neck bands, elevate the brow, enhance facial symmetry and lift the corners of a downturned mouth.

You will see the effects within 24 to 48 hours after injection. On average, effects last for about four months (with a range of one to five months). So, improvements are temporary and injections need to be repeated to maintain the desired effect. Some surgeons believe that the duration of muscle “relaxation” is cumulative and lasts longer with each treatment, although there are no supporting scientific data.

Injection day

You will be injected while seated. Following the injection, you will be asked to maintain an upright position for about four hours until the toxin attaches to and acts upon the nerve-muscle connection. During the injection, which is performed with a tiny needle, you may be asked to contract the muscles in the area being treated so your surgeon can determine the proper location for injection. The diluted toxin, in most cases, is injected directly into the muscle. Your physician will probably ask you to curtail physical activity for a set time following injection.

Ensuring the best outcome

Botulinum toxin treatments are safe when performed by a qualified clinician in an appropriate setting, but according to ASAPS, the leading organization of board-certified plastic surgeons, before undergoing injections, make sure you can answer ìyesî to the following questions:

  • Have you been asked to provide a complete medical history? If you take aspirin or anti-inflammatory medications, you may experience increased bruising from injections. Taking certain medications, including specific antibiotics, may increase potency. You should fully disclose your medical conditions and medications, including vitamins and over-the-counter drugs, to help your clinician select the most effective procedure with the fewest side effects.
  • Will Botulinum toxin solve your aesthetic problem? One advantage of consulting with a board-certified plastic surgeon is that he or she has the training and experience to assess whether it will give you the results you want, or whether a minimally invasive or other surgical procedure may be your best bet.
  • Have you been advised of the risks and given your informed consent? Make sure the benefits and risks are fully explained in your consultation.
  • Is a qualified clinician administering the treatment? While the injection of Botulinum toxin is a nonsurgical procedure, it is still a medical one. Make sure your injections are handled by an experienced clinician who understands facial anatomy, including musculature, and is trained in proper injection techniques.
  • Is the physical setting appropriate for medical treatment, including the handling of emergency situations? Injectables must be administered in an appropriate setting with sterile instruments.
  • Do you know what you are being injected with? To make sure you’re getting the real thing, donít be afraid to ask questions. No doctor should hesitate to prove to you that heís using an FDA-approved injectable. So far, only Botox and Dysport have FDA approval for use in humans.
  • Are you willing and able to follow posttreatment instructions? Botulinum toxin treatment requires that you restrict physical activity for a period following the injections.
  • Will you receive adequate follow-up care? Although Botulinum toxin is a temporary treatment, you will need follow-up care if you have side effects, are disappointed in the results or simply have questions.
  • Are you pregnant or nursing? Pregnant or nursing women should discuss undergoing this procedure with their surgeon. Currently, it is not known whether Botulinum toxin has any effect on a fetus or whether it is found in breast milk, so most physicians recommend discontinuing injections during pregnancy and lactation.

Pitfalls to avoid

  • Do-it-yourself Botoxî (no matter how cheap). Risks of a do-it-yourself kit include paralysis of one side of the face, making it droop; ptosis (drooping) of the eye and an abscess or bad infection that can morph into a staph infection.ïBotox parties. Parties may lower costs but eliminate pretreatment consultation and aftercare and usually occur outside of a medical environment.
  • Back-street or bargain-basement Botox or Dysport. Illegal botulinum toxin treatments are enticing because of their low costs. Injections in unhygienic, unaccredited facilities performed by people with little-to-no medical training can leave you with blemishes and deadly skin infections among other ailments.

Possible risks and side effects

No systemic complications associated with Botulinum toxin have been documented but as with all biologic products, there is a rare possibility of an allergic reaction. Among the most common side effects are local numbness, swelling, bruising, or a burning sensation during injection. Headaches or nausea may also occur. These are usually temporary and typically disappear within a few hours. Bruising and swelling may persist for several days. Currently, there are no known long-term effects of repeated Botulinum toxin injections.

Board-certification is your best bet

There have been cases of mild to moderate drooping of one or both eyelids, which usually lasts about two weeks. These effects, or more serious problems, may occur as a result of inaccurate injection of the toxin, which is one of many reasons, according to a prominent plastic surgeon, why it is important to choose a board-certified physician with appropriate training. “People may think that the procedure is only a simple injection and not realize that it requires an in-depth knowledge of the facial muscles and the relationship of these muscles to normal facial movement.” A skilled aesthetic plastic surgeon will use Botulinum toxin to enhance a person’s appearance, not create an unnatural or ‘mask-like’ quality to the face.”

Injecting Botulinum toxin is a science, but it is also an art. Your results will vary greatly, depending on your injector, and if you are careless in choosing an injector you may not only be temporarily stuck with a frozen forehead but also with droopy eyelids or overly-elevated eyebrows. You owe it to yourself to find a highly-qualified injector operating out of an accredited medical facility. Do your homework and you will get the most from this powerful anti-aging treatment.