Botox Explained

By: Katharine Griffiths
Created on 09th November 2009

Most of us have heard of Botox® but many of us don't actually understand much about this wonder drug. Cosmetic Surgery & Aesthetics Magazine investigates

An incredible 2.46 million Americans had a Botox® treatment in 2008 and it is the number one cosmetic treatment in the UK but many people are still unsure as to exactly what it is and the many and varied conditions it can treat.

What is Botox®?
Botox® is derived from botulinum toxin, a protein produced by the bacterium Clostridium botulinum. It works by preventing nerve impulses from reaching the muscle which causes the muscle to relax. Many people do not realise that botulinum toxin or Botox®, as it is more commonly known as, actually has a history that stretches back over a hundred years since it was first identified and its therapeutic uses were realised.

It was in the 1980s that its cosmetic benefits were discovered. In 1987 a Canadian Ophthalmologist, Dr Jean Carruthers was treating patients for blepharospasm (eye spasms) with Botox® and observed that a side effect of the treatment was the reduction of crow's feet and wrinkles around the eyes.

Since then there has been a massive amount of clinical research into the safety and efficacy of Botox® for cosmetic uses and in 2006 Allegan, the manufacturers of Botox®, received a license from the UK for Vistabel® (the cosmetic brand of Botox®) for the temporary improvement of moderate to severe glabellar lines (the vertical 'frown lines' between the brows) in adult men and women aged 65 and younger. Vistabel® was the first botulinum toxin type A licensed for cosmetic use in the UK.

How does it work?
Botox® blocks the nerve impulses that trigger wrinkle-causing muscle contractions, creating a temporary smooth and improved appearance between the brows. The treatment is temporary and the effects last for up to four months. The skin around the injection site will look smoother but the rest of your face will not be affected and you'll still be able to laugh, smile and frown.

It can be used to treat any dynamic wrinkles on the face; that is any wrinkles caused by movement. It is not suitable for permanent wrinkles that are caused by excessive sun exposure.

Where does Botox® work best?
The upper third of the face is where Botox® is most commonly used - reducing frown lines, both across the forehead and between the eyebrows, and crow's feet. However, the cosmetic benefits of Botox® are continually being expanded as practitioners find new ways to use this product.

For example, Botox® can be used to lift the eyebrows by a few millimetres giving the impression of a brow lift for less severe brow drooping. It is also used in the treatment of hyperhidrosis or excessive sweating. Dr Bob Khanna, a cosmetic dental surgeon and an internationally renowned expert in facial aesthetics, uses Botox® to tackle teeth grinding (see box).

Safety of Botox®
Data shows that botulinum toxin type A is well tolerated and that it is an effective treatment for reducing the severity of glabellar lines with treatment achieving high levels of patient satisfaction.

As with any other type of procedure, there are certain risks, complications, and side effects that can occur, and these all need to be taken fully into consideration. Bruising or bleeding at the site of injection, headaches, and, very rarely, eyelid ptosis or diplopia, and brow droop.

Who can administer Botox®?
Botox® is a prescription only medicine so should only be used by trained members of the medical profession; from dentists, plastic surgeons, dermatologists, cosmetic doctors, to ophthalmologists. Nurses are allowed to inject it but only acting under a doctor's instruction and you should have seen a doctor first to ensure you are suitable. Beauticians, beauty therapists and other non-medics are not allowed to inject botulinum toxin.
CS&AM