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Botulinum Toxin



What is Botulinum Toxin A?

Botulinum toxin is a protein produced by the bacterium Clostridium botulinum. It blocks the release of acetylcholine, the substance responsible for transmitting electrical impulses that elicit muscle contraction. In medicine, Botulinum toxin is injected directly into hyperactive muscles. It has been safely and effectively used for treatment of strabismus (cross-eye) and lid spasm since the early eighties. In the USA, Botulinum toxin was approved for aesthetic use by FDA (Food and Drug Administration) way back in 2002.

How does Botulinum Toxin work?

Hyperactivity of the facial expression muscles often results in the development of deep frown lines, forehead lines and crow’s feet. Injecting botulinum toxin into the affected area temporarily paralyzes the underlying muscles responsible for wrinkling, giving the face a more relaxed, softer and pleasing appearance.

What results can I expect after Botulinum Toxin treatment?

Botulinum toxin treatment is the most common cosmetic procedure performed all over the world. It consists of series of small injections, mostly in the frown area (between eyebrows), crows-feet, forehead, bunny lines (lines in the upper nose). Botulinum toxin also gives satisfactory results in treatment of gummy smile, prominent platysma (prominent vertical lines in the neck) as well as in elevation of mouth corners. The main aim of the treatment is to improve the appearance of wrinkles and fine lines when in relaxed state and also to avoid muscle contractions. The wrinkles become smoother and with time disappear altogether. Botulinum toxin can also be used for correction of certain type of facial asymmetry. Some patients may also achieve eyebrows lift.

How long does Botulinum toxin work?

The initial effects of the treatment become visible within 48 to 72 hours. The maximum effect is reached in about 2 weeks and generally lasts 3-4 months. The procedure may be repeated and with each new treatment the results tend to last longer. One should not wait until Botulinum toxin has completely worn off before another treatment because this allows the muscles contributing to expression lines to become stronger again. It is also important to note that after the initial treatment one can get only a partial response. For some people the second or third series of injections elicits the expected results. For some people Botulinum toxin injections have no effect (rare)

Are there any special preparations needed before the Botulinum toxin treatment?

No special preparation are needed. On the day of the treatment the patient does not need to be fasting. Patients taking Aspirin, anti-coagulants (Warfarin), non-steroidal anti-inflammatories (diclofenac, ibuprofen etc) may consider to stop taking them for a week prior the treatment, in order to minimalize bruising and only after consultation with their physician. For the same reason it is also recommended to stop taking supplements like Omega 3, garlic, Vitamin E.

How long does the Botulinum toxin treatment take?

The treatment itself takes few minutes, but it obviously depends of how many areas of the face are needing to be treated.

Is there any anesthesia needed?

No, no anesthesia is needed; the injections are performed with a very fine needle therefore they are not very painful. In some cases a topical anesthetic cream (numbing) can be used prior the treatment.

What are the potential side effects and complications after the Botulinum toxin treatment?

Botulinum toxin injections are generally safe. At the extremely low doses used in cosmetic procedures, botulinum toxin has a very low degree of human toxicity. Nevertheless, certain side effects can occur, but they are mostly reversible. Most unwanted side effects wear off in a short period; some might last up to 6 weeks. The most common side effects include: bruising and swelling at the injection site, slight feeling of nausea, tiredness, pain in the arms and legs, temporary drooping of the eyebrow or upper eyelid, brief visual disturbances, dryness of the eyes, skin rash, itching, allergic reaction, dry mouth, headache, migraine and neck pain. Very rarely the following have been reported: Influenza like symptoms, fever, anaphylaxis, hypertension, cardiac dysrhythmia, myocardial infarction, seizures, muscles atrophy. Effects of injected botulinum toxin may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These symptoms include fatigue, generalized muscle weakness, double and blurred vision, difficulties to swallow and to speak, urinary incontinence or retention as well as breathing difficulties. These side effects are very seldom observed in patients undergoing cosmetic procedures.

What are the contraindications for the treatment with Botulinum toxin?

Pregnancy and breast feeding Blood coagulation disorders Neuromuscular disorder (Myasthenia gravis, Lambert-Eaton syndrome) Allergies to Botulinum toxin Patients on certain drugs should also not be injected with Botulinum toxin A. Drugs that are contraindicated when using Botulinum toxin A are: Antimicrobials: aminoglycosides, tetracyclines, Clindamycin, Amphotericin B, Quinine Muscle relaxants, Anticholinergic, Amitryptyline, Chlorpromazine, Sedatives and Anesthetics

What are the aftercare instructions?

For first 4 hours own must not lie down or do strenuous exercise, one should avoid anything that might increase the blood flow to the injected area. It is recommended for the first 12 hours to avoid extreme facial expressions and alcohol consumptions. For first 24 hours one must not rub or massage the treated areas. For 2 weeks avoidance of direct sun exposure, UV light, freezing temperature and saunas are strongly recommended.