Botulinum toxin is a purified protein derived from the bacterium Clostridium botulinum and has been researched for more than 100 years. Botox® neurotoxin (Botox® injection) has been approved in more than 75 countries for 20 different indications to provide effective treatment to patients suffering from a range of neurological disorders.
Botox® injections are the most common and successful minimally invasive cosmetic procedure worldwide. Botox® has been used for cosmetic and medical applications and has been considered a safe and efficacious treatment for many conditions. In cosmetics, Botox® is mainly used to treat facial wrinkles. Botox® is also an effective treatment for migraines and excessive sweating.
Botox® is a prescription drug and can only be administered by a medical professional. A Botox® specialist knows which areas should be injected to treat a certain problem. Patients are often confused about which areas of their face they need treated. Most of them think Botox® can smooth out all wrinkles. There are a few areas where wrinkles commonly appear in middle or old age.
In order for physicians to inject Botox®, they must undergo accredited training.
The International Association for Physicians in Aesthetic Medicine (IAPAM) offers Botox training to well-trained and skilled physicians to learn the proper Botox® injection techniques in order to meet the growing demand for aesthetic procedures.
Who Qualifies for Botox® Treatment?
The FDA in the United States recommends that only patients between the ages of 18 and 65 should be administered cosmetic Botox® injections. As with every other medical treatment, the patient’s complete medical history must be reviewed before proceeding further.
Those who are allergic to any of the ingredients in the drug should not use it. This includes people who are allergic to any of the botulinum toxin brands such as Botox®, Myobloc®, Xeomin® and Dysport®. Anyone who has experienced a side effect from using these products should also avoid using them.
Patients suffering from a skin infection or any other type of condition in the area that is to be treated should certainly avoid Botox®. The injections cannot be administered to those with ALS, Lambert-Eaton syndrome, myasthenia gravis or any other type of illness that affects the nerves and muscles.
Patients who have trouble breathing, suffer from asthma or have trouble swallowing are also advised against seeking Botox® treatment. Those who experience excessive bleeding or are planning to undergo invasive surgery any time soon are also not candidates.
It is important to ask patients if they have ever had facial surgery and why. Drooping eyelids are a warning sign relative to Botox® patients.
Even though it is not expected of the drug to travel throughout the body and affect the fetus or breast milk it is still not recommended for a pregnant or breastfeeding women to undergo Botox® injections. There have been no clinical studies conducted on expectant mothers for ethical reasons so there is no proof to support this.
Common Misconceptions About Botox®
Botox® injections are not painful although, like all injections, the needles can hurt but those used for Botox® administration are very small so the pain is almost negligible. The medical professional can numb the area using a topical anesthetic cream or an ice pack. This is done 10 to 20 minutes before injections are administered so there is little to no pain felt. Once the anesthetic wears off, there is some discomfort but it is usually bearable.
There are some misconceptions that getting Botox® treatments done will make the wrinkles look worse. The injections prevent the lines from deepening and it is only when you stop getting treatments that aging of the skin will resume its natural course. Typically, in the past, Botox® was usually popular with women, however, according to published statistics, men are also being encouraged to choose this treatment to improve their appearance and look much younger.
How is Botox® Administered?
Only trained medical professionals can administer Botox® injections even if the purpose of the treatment is purely cosmetic. Botox® is injected directly into the muscle and each treatment is administered after a period of at least 3 months. More than one area can be treated at a time depending on the patient.
Patients who are getting treated for conditions related to the eye muscles might need to use an ointment, eye drops or special contacts to protect their eye. Those who are being treated for excessive sweating in the underarms must shave their armpits at least 24 hours prior to being injected. Also, they should avoid using antiperspirants or consuming warm beverages or spicy food.
Common Side Effects of Botox®
After receiving Botox® injections patients may experience trouble swallowing for a few weeks following the treatment. The muscles near the injected area may also get weaker and in some cases, there is bleeding, bruising, redness, pain and swelling at the site of injection.
It is usual to get headaches, neck pains, stiff muscles and joint pain after Botox®. Some patients may experience nausea and symptoms of a cold. These reactions are also completely normal.
Botox® is a completely safe, medically and FDA approved cosmetic treatment. The International Association of Physicians in Aesthetic Medicine (IAPAM) states that Botox® injections should only be performed by a properly trained Botox® administrator who has all the necessary certifications, information on the side-effects and interactions of the treatment. For more information on how to become Botox certified, visit IAPAM’s Botox training courses and certifications!
Where Should Botox® be Injected?
Forehead, Temples and Eyes
Starting from the top of the face, there are three major types of wrinkles that appear in this area:
- Surprise lines that appear on the forehead as horizontal creases, and become more prominent when the eyebrows are raised.
- Frown lines, the vertical wrinkles between the eyebrows and they are more pronounced when a person frowns. They are also referred to as “the number 11 lines”.
- Crow’s feet are small fan-shaped lines that begin at the outside corner of the eye and extend upward toward the forehead. They are called crow’s feet because they are similar in appearance to the bird’s feet. These lines are visible when a person is squinting.
Surprise lines, crow’s feet and frown lines are the areas that clients mostly ask to be treated and they also produce the most successful results as well.
When treating frown lines, one common side-effect is the frozen forehead. This entails the face not moving at all and the patient appearing emotionless and unnatural. The corrugator muscle that is associated with frown lines is completely relaxed in the beginning to reduce the wrinkles. However, once they are gone the Botox® dose should be altered to allow some movement of the face. The goal of the Botox® administrator should be zero wrinkles, not zero movements for the Botox® patient.
A larger dose of the Botox® injection to the forehead can result in a heavy feeling on the eyebrows. The frontalis muscles in the temples, which are employed while raising eyebrows are over-Botoxed resulting in this side-effect. The forehead is too relaxed and therefore the weight of the eyebrows feels like a mountain. The administrator has to accurately judge how much Botox® is needed to correct the frown lines or worry lines.
One other side-effect of Botox® in this area is the eyelid drooping, making the eyebrow drop and the lid feel heavy. This is the most unappealing complication and if this happens immediate action should be taken. A possible option is to give prescription drops to the patient to reduce the dropping until the effect completely wears off.
Injecting the eye and brow area to remove crow’s feet can result in one or both eyebrows being raised too high. Part of the eyebrow is elevated to an angle bigger than what it normally should be giving the person a perpetual surprised look. This also promotes the formation of wrinkles over the brow. To prevent such a thing from happening, Botox® is strategically injected into a specific Botox® location.
Mouth and its Surroundings
The mouth and its surroundings are another prime Botox® location and the common problems faced by patients in this area are:
- Smile lines that start at the outside edge of the nose and go down to the mouth. They form significant creases in the face when a person is smiling. The medical term for these lines is nasolabial folds.
- Marionette lines are creases that appear around the mouth and extend towards the chin. The lines resemble the jaws of marionette dolls which allow their mouths to open and close.
- Smoker’s lines are defined as vertical creases around the lips. These wrinkles are commonly found in smokers’ faces as the action of puckering up the mouth to inhale a cigarette makes the lines more significant.
Smile lines and marionette lines that form deep creases even when the face is at rest cannot be diminished by Botox® injections. Injecting the muscles responsible for these lines can lead to serious complications and not make any difference on the wrinkles either.
Smoker’s lines can also be reduced by Botox® but if the individual is a chain smoker then there will be little or no effect because the constant act of puckering the lips is what creates the lines in the first place.
It is important to note that Botox® smooths wrinkles by relaxing the muscles. It does not tighten the skin and only affects the facial muscles. Wrinkles form when the muscles are constantly in use and pull at the skin. The injection minimizes the motions of the muscles in the Botox® location.
When the muscles are less active, the skin does not come under motion stress, therefore, reducing the number of lines and wrinkles on the skin. Botox® has a better effect on elastic and well-hydrated skin. The younger the person is, the faster the results will be. Botox® does not tighten sagging or drooping skin. Neither can it stretch out wrinkles. It only relaxes the muscles responsible for those wrinkles and lines.
Because Botox® relaxes the muscles, those facial muscles that are in frequent use benefit from the injections the most. However, care must be taken so that muscles are not involved in creating facial expressions and other important functions or unpleasant side-effects such as drooping, frozen expressions and asymmetric features may occur.
Botox is a trademark of Allergan Inc.
For more information, visit the IAPAM’s Aesthetic Medicine Symposium with Botox Training website