Botox
For Facial Lines
What is Botox (Botulinum Toxin) ?
Botulinum toxin is a nerve chemicle produced by the bacteria
Clostridium botulinum. It is the cause of a type of food
poisoning known as botulism. Whilst Botulinum toxin is an
extremely potent agent, in very small doses it is very safe
and useful for treating facial lines.
Botulinum toxin type A is used for the treatment of facial
wrinkles and is available in two commercial forms - Dysport
and Botox. These two varieties of botulinum toxin have the
same clinical effects but are administered in different
doses. Throughout the rest of this article the term Botox
will be used to mean Botulinum toxin type A, without preference
to either of these commercially available toxins.
What Causes Facial Lines?
These are the result of internal factors, such as your genes,
the ageing process and muscle activity/overactivity. External
factors such as sun damage, the effects of gravity and smoking
are also important. Excess sun exposure can be reduced by
the use of sun blocks and avoiding strong sun. Smoking can
also be avoided. The patient cannot influence most of the
other factors in the appearance of facial lines and wrinkles.
Which Facial Lines Are Suitable For Treatment With
Botox?
Botox treatment can help the appearance of facial lines
due to activity/over activity in the small muscles of the
face. Botox can also improve the appearance of deep facial
lines associated with facial expressions. Botox is not effective
for the treatment of, so called static lines. Static lines
are lines that do not disappear when the skin around the
line is stretched out under tension.
Which Sites Of Facial Lines Are Most Amenable To
Botox Treatment?
• Glabella - the glabella is the area between your
eyebrows and bridge of the nose. Vertical and horizontal
lines in this area are common. The presence of these lines
is ageing and also may be taken to imply a person is tense
or frowning. Glabella lines are readily treated with Botox.
• Forehead - horizontal
forehead lines are also amenable to Botox treatment. These
lines are also ageing and may convey the appearance of stress
or surprise.
• Crows feet - crows
feet or laughter lines around the outside of the eye respond
well to Botox treatment.
All of these lines are due to contraction of the underlying
small muscles of the face. The aim of Botox treatment is
not to paralyse these muscles but to weaken them so their
effect on the skin is less marked.
What is Botox?
The Botox preparations available come as a sterile freeze
dried powder. This powder has to be stored in a deep freeze
until it is used. The doctor adds a small amount of sterile
saline prior to injection.
Treatment of wrinkles with Botox is considered "off
label". This means that the American Federal Drug Agency
and the British Committee for Safety of Medicines has not
yet licensed Botox for the treatment of facial wrinkles.
Botox is licensed for the treatment of squints and eyelid
spasm. However, Botox is widely used to treat facial lines
and has been demonstrated, in the medical literature, to
be safe.
How Does Botox Work?
Tiny amounts of Botox are injected into the small muscles
of the face that are responsible for wrinkles in the overlying
skin. The toxin produces temporary weakness in the muscles
by interfering with the normal nerve-muscle connection.
How Is Botox Treatment Performed?
The doctor will mark the injection sites to be treated.
A local anaesthetic cream (EMLA) may be used if desired
prior to treatment. Tiny amounts of Botox solution are injected
into the appropriate muscles. Botox administration is an
out-patient procedure and takes about thirty minutes
Effect of Botox
Botox takes between twenty-four and forty eight hours to
show an effect. The peak effect will not be seen for seven
to ten days. At this stage patients will notice smoothing
in the facial lines treated.
Limitations Of Botox Treatment
Whilst Botox is very effective in the treatment of facial
lines there are some limitations.
Botox treatment is temporary. For most patients it will
be effective for three to six months after the first procedure.
Repeat treatments seems to have a longer gap before Botox
is needed again. Botox will not remove static wrinkle lines.
Botox is best for the upper face and should only be used
with extreme care in the lower face. Use in the lower face
risks weakness around the mouth.
There are a small number of patients who do not respond
to Botox treatment. It is not clear why these, so called
non-responders exist; they may have had a very minor form
of botulism and, therefore, have antibodies to the toxin.
Side Effects Of Botox
There are no known permanent side effects of botulinum toxin.
The following is a list of problems that rarely complicate
botulinum treatment: -
• Eyebrow and eyelid
drooping - These complications occur in 1-2 %of patients
and usually last two to four weeks. If the drooping eyelid
is a problem eye drops can be administered to correct it.
• Double vision 1-2 %
- Lasts two to four weeks; may need to patch the effected
eye.
These two complications are probably due to injection of
the toxin too close to the eye socket.
The following minor side effects may also occur: - bruising,
headache, asymmetry and change in sensation.
Who Should Not Have Botox?
The following patients should not have Botox:
• Pregnant women, nursing
mothers. Whilst no adverse effects from the administration
of Botox to these groups have been reported this has not
been extensively researched and it would be inappropriate
to use Botox in these patient groups.
• Patients taking certain
antibiotics (Aminoglycosides) calcium channel blockers (eg
Verapamil and Nifedipine) and Penicillamine.
• Patients with certain
neuromuscular disorders (eg. Multiple sclerosis) should
not have Botox.
