Botox – Pretty Poison

Botox – Pretty Poison

One of the most powerful new weapons in the war against aging is a toxin produced by a tiny organism. The toxin is commonly known as Botox and is short for botulism toxin.  Injection of minute amounts of this toxin is now commonly being used to treat facial wrinkles.  And yes it is a toxin produced by the same bacteria that can cause illness in contaminated food.  But when injected in the tiny doses used for facial rejuvenation, it causes no such systemic symptoms and can make you look younger.

The toxin is produced by a bacterium by the name of clostridium Botulinum.  In fact the bacteria produce several toxins but only one, type A, is used for medical purposes. Botox is a trade name for botulinum toxin type A produced by the Allergan Company.  In the 1960’s botulinum toxin type A was first used as a therapeutic agent to treat several neurologic disorders such as strabismus and blepharospasm.  These are diseases associated with hyperactivity of the small muscles surrounding the eye.  It was used for many years before being approved, but in 1989 the FDA approved Botox for use in these disorders.  Researchers soon noticed improvement in the longstanding wrinkles associated with aging in these patients injected with botox. Since then doctors have been finding usefulness of botox for a variety of conditions including muscular spasm associated with back pain, neck pain and possibly migraines along with the improvement seen with facial lines and wrinkles.

Another interesting use is in people who have profuse uncontrollable sweating of their palms and armpits. Presently these other injections are an off label use of the drug since the FDA has only approved botox for use with blepharospasm and strabismus.  But this hasn’t hurt its popularity.  Many plastic surgery practices have seen explosive growth of patients interested in the treatment.  The beauty of Botox lies in the fact that the procedure is easy to perform, is associated with little discomfort, requires little to no down time, results are seen almost immediately and most importantly side effects or complications are uncommon.  Women make up the majority of patients but a large number of men have it done as well.   Men are attracted to it because they generally have heavier brows and prominent creases in the brow and the procedure allows them to look better immediately without the tell tale signs of surgery.

Botox works at the end of the nerve when it communicates with the muscle.  When the brain sends a message to a muscle for it to contract an electrical impulse is sent down to the end of the nerve.  At the end of the nerve a minute amount of a chemical, or neurotransmitter, is sent from the end of the nerve to the muscle and tells the muscle to contract.  Botox works here to block transmission of the neurotransmitter to the muscle.  The muscle does not receive the signal to contract and remains in the relaxed state. Therefore, if there is no muscle contraction there is no skin wrinkle.  The Botox binds only to the cell in the local area of injection so there is no effect on any of the other muscles in the body or face.

The procedure is relatively easy and painless.  The Botox is injected during a short office visit with your doctor through a tiny needle.  Treatment of the frown lines may require five or six small injections, while treating larger areas such as the forehead may require more.   This is all done during one visit that usually lasts about 15 minutes and is only minimally uncomfortable.  Afterwards the patient may return to normal non-strenuous activities almost immediately. Maximal effect after the injections is usually reached 3 to five days following the injection.   The muscle is weakened from the injections but there is usually still voluntary activity.  You call still frown and express emotions but not nearly as strongly in the injected areas.  Within days there is a noticeable improvement of the wrinkles.

Because Botox acts on the muscles, only “dynamic lines” or the lines caused by underlying muscles respond.  Wrinkles that are secondary to sun damage, smoking or aging (static lines) usually do not respond.  Since the muscles are weakened the lines do not form and aging is stalled for as long as the botox is working.  However Botox is not permanent and repeat injections are usually needed every 4-6 months.  Long term usage of botox may cause long term weakening of the muscle and atrophy, leading to a better long-term result. Many surgeons feel the injections are more effective in treating certain areas than other agents such as collagen since Botox is addressing the underlying cause of the wrinkles.  But collagen and other fillers work differently and still have a role in treatment of other various problems.  Since the procedure is relatively straightforward patients commonly return several times a year and may be able to postpone more extensive surgery indefinitely.

The areas where it works best are the frown lines between the eyes, the forehead muscles and the crows foot area.  The frown lines between the eyes can cause a scowling or angry appearance.  Botox can minimize these lines and produce a more relaxed or peaceful appearance.  Similarly, forehead creases are caused by hyperactivity of the forehead muscles.  As the face ages the brow sags from gravity.  The brow muscles try to counteract this by lifting the forehead and causing forehead creases.  Botox can soften these lines and once again give a more relaxed appearance.  The corners of the eye and crows feet are also treated very nicely with Botox.  The lines can be minimized and the signs of aging reversed.

Some of the newest cosmetic uses for Botox are in treating smoker’s lines or fine lines around the mouth.  There is some early experience with hyperactive and loose muscles in the neck associated with aging.  These can be one of the earliest signs of aging and can be improved with injections.  Non cosmetic uses include injection for blepharospasm or spasticity of the muscles surrounding the eyes, hyperhidrosis which is excessive sweating of the palms and armpits, and lastly there are some reports of Botox effectively treating migraine headaches.

In general side effects are a few and uncommon.  Bruising can occur at the site of injection.  This usually only lasts for several days.  A troublesome uncommon temporary side effects may be drooping of the upper eyelid or drooping of the eyebrow.  The droopy eyelid may lasts several weeks however this may be treated with prescription eyedrops.  Within several minutes of applying the drops the eyelid droop can be corrected. A common misconception is that Botox will paralyze all of the muscles of the face and lead to an inability to express oneself or smile.  In fact botox is targeted to only several of the small muscles of the face where it is injected and facial expression is still for the most part normal. Other potential side effects should be discussed with your physician.

Botox is a new and exciting new treatment in the struggle against aging.  Its advantages include dramatic effectiveness with minimal side effects.  The main disadvantage is the need for re-treatment several months later.  It does not promise eternal youth but it can help you look and often feel your best along the journey.

The above information is not meant to be a complete or thorough discourse on the subject.  Medical knowledge and surgical techniques are constantly evolving. One of the most important factors, which cannot be underestimated for a successful procedure, is the development of a good relationship with your doctor.  To be properly informed a full and open discussion should be had with a physician.

Lawrence Rosenberg M.D. is a plastic surgeon in private practice in Baltimore.  He is board certified by the American Board of Plastic Surgery and the American Board of Surgery.  He has a surgical facility on premises and has operative privileges at several locations in Baltimore, Howard and Anne Arundel counties.

If you are thinking about botox treatments, I invite you to explore all of your options by scheduling a consultation with me… Call 410.616.3000 or use our contact form.