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Botox Treatment (Botulinum Toxin A) - Rajiv Grover, BAAPS

Introduction

“Botox” is the world’s most popular non- surgical cosmetic treatment. The word Botox is actually a trade name for Botulinum toxin A (produced by the American company Allergan). An alternative Botulinum toxin A product is also made by the company Galderma under the trade name “Azzalure”. Botox is a treatment to relax muscles which therefore reduces the lines produced on the skin surface from movement. It is most commonly used in the upper face to reduce lines in the frown area, horizontal lines in the forehead and at the side of the eyes (“smile lines”). This gives a smoother, more rested appearance to the face. Botox also has a preventative effect when used repeatedly to reduce the onset of wrinkles forming in the long term. This is partly due to the effect of re-educating the facial muscles not to make expressions which result in wrinkling. To achieve the best results botox is injected to a level which does not cause complete freezing of the muscles but weakens them so that some movement is still possible. It is most effective in the age group from 35 to 55 where it can have a rejuvenating effect as well as preventative action. In addition to reducing lines and wrinkles, by rebalancing the forehead muscles botox can lift the brow and give a more open look to the eyes.

Is Botox safe?

Botox injection is currently the most popular cosmetic procedure with over 200,000 Botox injections being performed last year in the UK (Mintel survey). The treatment is now over 20 years old and therefore has a well established safety record. In the USA the Food and Drug Administration (FDA) now licenses Botox for cosmetic use as well as having a cosmetic license in the European Union countries. For many people, Botox treatment represents their first experience with cosmetic surgery. As a quick and effective treatment, it is perfect for those patients who have minimal signs of facial aging such as forehead furrows and crow's feet. Whilst Botox can often delay the need for more extensive surgery, it is important to stress that it does not achieve the same results as surgical procedures.

What should be expected after Botox therapy?

Botox is administered by a tiny injection under the skin in the area where muscle relaxation is desired. Occasionally slight bruising may occur where botox is injected and very occasionally a mild headache may follow. Bruising may be greater in patients who are taking aspirin or any blood thinning medicines. These products should be avoided if possible prior to the injection. Muscle relaxation is first seen between the 3rd and 10th day after injection, so it is not immediate. The effect after the initial injection lasts between 3 and 5 months for most patients. The cost in the UK averages between £250 and £400 depending on how many areas are treated.

How often is Botox needed?

Repeat treatment is suggested every 4-5 months to keep the muscles sufficiently relaxed to allow the furrows to smooth out. In practice this means coming three times in the first year. After using botox for one year the intervals between injections may be a little longer so that you need it only twice a year.

What unexpected benefits have come from Botox?

Tension headaches and migraine for some patients have disappeared (about 20% of migraine sufferers). These occurred in patients who were recruiting forehead and brow muscles during periods of stress and tension. When these muscles were relaxed, the headaches faded.

Who should not receive Botox?

• Pregnant women; although there have been no reports of birth defects with this medicine.
• Breastfeeding; similarly, there is no evidence that Botox is expressed in breast milk but it is best avoided if breastfeeding.
• Patients with a history of neuromuscular disease (multiple sclerosis and myasthenia gravis) or other types of diseases involving nerve transmission should avoid this medicine.
• Known allergy to human albumin (egg white) or Botox itself.

What are the risks?

As with any sort of injection there can be some bruising and minor swelling although this is not severe and usually settles within a few days. Very rarely if the botox reaches the upper eyelid muscle there may be transient drooping. This is the most significant risk and occurs in about 1 in 1000 injections. It occurs from local spread of the botox from the injection site and can be minimised by accurate dosage, proper placement, as well as keeping in an upright position for three to four hours after the injection. If drooping eyelids occur, it usually resolves over a few weeks. Special eye drops may temporarily reduce eyelid droop if it occurs. Although a safe treatment it is clear that you should research your practitioner carefully as getting a good result and avoiding problems are directly proportional to the experience of your doctor.

Summary

Botox was first used for cosmetic use in 1987 and since the year 2000 there has been a 1200% (yes, 12 thousand percent!) rise in its use according to the American Society of Aesthetic Plastic Surgeons (ASAPS). It is valuable as a treatment for rejuvenating the upper third of the face particularly around the eyes, lifting the brow to give an open look to the eye as well as having a preventative role in reducing future lines and wrinkles.

Rajiv Grover

Rajiv is a Consultant Plastic Surgeon and Honorary Secretary of BAAPS

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