The history of Botox® began when a toxin called Botulin was first discovered connected to a very rare form of a paralytic illness. This toxin, Botulin, was caused by the bacteria Clostridium botulinum is known for producing the most potent of toxins ever known to man. One gram of the toxin produced by the bacteria is lethal for human beings because it blocks the nerve impulses and leads to respiratory and also musculoskeletal paralysis. Although very dangerous, scientists began to do in-depth study and research on the substance and eventually purified it to create a very helpful tool used widely in cosmetic surgery today. These days, Botox® injections are used widely to help reduce signs of aging. As well, it is used in other medical applications. Do you know the effects of Botox® injections?
Botox® was first used to treat medical conditions like muscle stress, disorders, lazy eye, uncontrolled blinking and muscle-related problems before doctors realized it had amazing potential for cosmetic and other medical uses as well. Botox® injections are now used to treat excessive sweating, migraines, overactive bladder – to name a few.
In order for physicians to inject Botox®, they must undergo accredited Botox training.
Botox® training offered by the International Association for Physicians in Aesthetic Medicine (IAPAM) is specifically Botox injecting for cosmetics, however, the benefits, risks, procedural strategies and rules and regulations of other applications are covered as well.
Who Is Suitable To Receive Botox® Treatment?
Botox® treatment is suitable for most individuals. Results vary from person to person, therefore a physician needs to be well informed about the patient’s medical history and also their present health condition. Botox® injections are not recommended for people who have nervous system issues, muscle disorders, breastfeeding mothers or women looking to become pregnant soon. Age also happens to be a decisive factor in whether you are eligible to receive Botox® injections or not. Patients who do not have sun damage to their skin and are between the ages of 18 to 50 can be considered an ideal candidate to receive Botox® injections.
What Do You Need To Know About Botox®?
Since people have heard about the powers of Botox®, they have set unrealistic expectations towards its outcomes. Botox® results will not be miraculous, as the injections cannot work wonders on the face. However, Botox® can enhance features and momentarily to prevent aging.
Medically, Botox® injections are used to treat conditions like misalignment of the eyes, neurological disorders and also facial spasms that can be a result of muscle contraction abnormality. In cosmetic procedures, Botox® injections are used to smooth frown lines and prevent signs of aging by paralyzing or weakening the muscles which cause wrinkles in the skin. Botox® results can last up to six months and need to be repeated over time to maintain its results.
What Happens During Botox Treatments?
Tiny Botox® injections are directly injected into the skin and muscles in the face. The procedure takes less than an hour and there is no need to administer anesthesia. Botox® injections are always administered using a very fine needle and there is very little or no discomfort at all. Botox® takes about a week to exhibit its full effects and the patient is advised against the consumption of alcohol prior and after the treatment for at least a week. Anti-inflammatory medicines and aspirins are prohibited for use almost two weeks before the treatment takes place so that bruising can be reduced.
Botox® injected into the muscle blocks the release of acetylocholine and hinders muscle contractions in the area. The nerve endings are bound and the muscles become paralyzed or weakened so that they do not age with time or change shape. The healing process is a week, after which the muscle becomes relaxed and smooth for a period of four months or more, after which it regains its original shape and strength. When Botox® wears off it leaves behind lines that are not as severe as the original ones prior to treatment. As Botox® treatments are repeated the results will last longer.
Botox® vs Botox® Cosmetic: What is the Difference?
There are actually two types of Botox®: Botox® and Botox® Cosmetic. They are both technically onabotulinumtoxinA, but each has its own FDA approvals. As you will see the approved uses for Botox® Cosmetic revolve around facial aesthetics, whereas the approvals for Botox® are more medically-based. For example currently, Botox® Cosmetic is FDA-approved for:
- Treatment to temporarily improve the appearance of both moderate to severe frown lines between the brows and crow’s feet in adults.
- Improving the look of moderate to severe frown lines between the eyebrows (glabellar lines) in adults for a short period of time (temporary).
- Improving the look of moderate to severe crow’s feet lines in adults for a short period of time (temporary).
Botox® has the following FDA-approved indications:
- to treat overactive bladder symptoms such as a strong need to urinate with leaking or wetting accidents (urgent urinary incontinence), a strong need to urinate right away (urgency), and urinating often (frequency) in adults 18 years and older when another type of medicine (anticholinergic) does not work well enough or cannot be taken
- to treat leakage of urine (incontinence) in adults 18 years and older with overactive bladder due to neurologic disease who still have leakage or cannot tolerate the side effects after trying an anticholinergic medication
- to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting 4 or more hours each day in people 18 years or older
- to treat increased muscle stiffness in elbow, wrist, finger, and thumb muscles in people 18 years and older with upper limb spasticity
- to treat increased muscle stiffness in ankle and toe muscles in people 18 years and older with lower limb spasticity
- to treat the abnormal head position and neck pain that happens with cervical dystonia (CD) in people 16 years and older
- to treat certain types of eye muscle problems (strabismus) or abnormal spasm of the eyelids (blepharospasm) in people 12 years and older
- BOTOX® is also injected into the skin to treat the symptoms of severe underarm sweating (severe primary axillary hyperhidrosis) when medicines used on the skin (topical) do not work well enough in people 18 years and older.
How Botox® Cosmetic Works: Face
Botox Cosmetic’s® popularity will account for the majority of your aesthetic patient base, so if you want to add aesthetics to your practice, you must master the injection of Botox® (or other FDA approved Botulinum Toxins, like Xeomin® and Dysport®). If you are new to offering Botox®, please make sure you complete a comprehensive hands-on CME-approved training program. If you are an experienced injector, it is important to stay up to date with the latest Botox® injection techniques.
We all use our facial muscles a lot. All of that talking and emoting and eating and everyday living gives the facial muscles a great workout all day long. This is great for the health of those muscles but can cause problems with your skin. For example, frown lines, the little lines that show up between your eyebrows, can result if you are someone who scrunches your face up when you are unhappy or very focused.
For the “Botox® Virgin,” you will need to be prepared to explain how Botox® works on the face. It is important that you understand where the most requested areas are for injections, they are: forehead lines, crow’s feet around the nose, and those “angry 11’s” between your eyebrows.
One of the most requested procedures is to remove the wrinkles in the forehead. Many times these lines are genetic and you can see them in children as well as adults (Reminder: never inject Botox Cosmetic® in anyone under 18!). Other times, they are seen in people who are very expressive with their faces. It’s important to ask your patient what they want, some people don’t want any wrinkles in their forehead, others are fine with wrinkles, they just don’t want deep looking ones. You can provide any of these results by increasing or reducing the amount of the Botulinum toxin you inject in the muscles.
Allergan has done a wonderful job educating the public on the “angry 11’s,” these are the lines that appear between your eyebrows. Again, these can be genetic or caused by excessive facial movements in expressive people. Not everyone has these, but most people do not want to look angry, so if they have them, they most likely want to get rid of them! This is an easy home-run procedure, which can be done quickly, and looks great!
Crow’s feet (which are also called smile lines) are the small lines that occur around the eyes as a result of the skin wrinkling to accommodate smiling and squinting–they are the third most popular region of the face. You may find that men are fine with having these lines, but women generally want them gone! Again, this is a quick procedure that typically erases the wrinkles between 3-10 days.
It is also important to tell your patients that cosmetic injectables only treat lines that are caused by muscle movements. Explain that lines and wrinkles caused by sun damage will not respond to these treatments. As well, some patients think the deep wrinkles around their mouths (marionette lines) and nose (nasal labial fold) can be treated with Botox®, unfortunately, they cannot. One will need to use a dermal filler like Allergan’s Juvederm/Voluma, Merz’s Boletero, or Galderma’s Restylane.
How Botox® Works: Other Areas of the Body
Many patients think Botox® is purely a cosmetic treatment, but botulinum toxins can also be an effective treatment option for those who suffer extreme sweating, migraines, muscle spasms, tremors, etc. Here are a few popular medical treatments and how to explain them to your patients.
Primary Hyperhidrosis can be especially difficult to cope with when it is concentrated at the patient’s palms, feet, and armpits. Botox® can shield sweat glands as well, which effectively renders the sweat glands at those injection sites inactive (for about six months). Make sure your patient understands that he or she will still sweat from other areas of their bodies but hopefully it will only be a normal amount.
First and foremost it is important that your patients understand that Botox® will not cure a migraine completely. Instead, explain that if the treatment is successful, it will reduce the symptoms of the attack like sensory sensitivity and nausea. It does this by, again, stopping the areas most affected by the migraine (forehead, temples, neck, etc.) from being able to communicate with the brain. They will still get migraines but the headaches should be much easier to manage.
Tremors and Muscle Spasms
These are probably the easiest bodily treatments for your patient to understand. Explain to them that their tremor or spasm is simply a miscommunication or “misfire” of the brain that causes the muscle to contract without outside stimuli. Since Botox® treatments will keep those misfires from reaching the affected muscle, the condition should clear up relatively quickly.
Long Term Side Effects
Immediate side effects of the injections may be flu-like symptoms that are accompanied by nausea and headaches. There may be facial pain and muscle weakness which at times might make eyelids droop and cause the vision to become double. These side effects disappear after continued use.
Although FDA approved, Botox® injections like all other cosmetic procedures do not come without side effects. With Botox® the side effects might not show immediately but are rather long term and can prove to be very dangerous as well. Here is a rundown of possible long term side effects of Botox® injections:
Muscle weakening leading to paralysis
According to FDA and medical research, Botox® injections paralyze muscle functions to stop signs of aging and this, in the long run, can cause people to experience loss of muscle control and also decrease of strength in the muscle area which has been injected with Botox®. Over time, repeated injections of Botox® to a particular area in the body can also cause permanent paralysis of the muscle.
Spreading of toxins in the tissues
This is by far one of the most important and dangerous side effects of using Botox® injections. The toxins can spread into the surrounding tissues and this can prove to be fatal. Although the spread of toxin hasn’t been noticed in cosmetic procedures, it tends to happen occasionally when the drug has been administered in large doses for non-cosmetic medical reasons.
Some patients who receive regular Botox® treatments have complained about experiencing allergic reactions that can lead to hives, chest pain, difficulty in breathing, bleeding abnormally, abnormal heartbeat, seizures, speech alterations and bleeding from the site of injection. These reactions, while uncommon, can also prove to be fatal if they remain unnoticed or left untreated.
Irritation in the eye
Patients receiving Botox® treatments near the area surrounding their eyes can develop a number of eye-related side effects. The eyes can become irritated or completely dry thus appearing bloodshot. Patients also reported developing blurred vision or eyelid drooping along with swelling with watery eyes. Such side effects should immediately be discussed with a physician as they can result in permanent vision loss and problems of the eyes.
Botox® has been used safely and successfully for decades. It is fast, effective, and the side effects are usually barely noticeable and gone within a few days. Despite the long term Botox® effects, it is a safe way to minimize signs of aging and enhance features.
In summary, it is important to manage your patients’ expectations and to explain these treatments to them in the language with which they are the most comfortable. You learned a lot about this when you learned about bedside manner. The better your patients understand how and why a treatment is administered, the more likely they are to opt-in to the procedure.
For the best results, constantly strive to improve your injection technique. Remember, the number one reason patients don’t come back is because of injection pain, so make sure the treatment is as painless as possible for them! (check out our article on Pain Management for Botox® and other Cosmetic Injectables for more tips!).
Botox is a trademark of Allergan Inc. Dysport is a trademark of Galderma; Xeomin is a trademark of Merz Aesthetics
For more information, visit the the IAPAM’s Aesthetic Medicine Symposium with Botox Training website