BoTox Therapy
Introduction
All the doctors
at Dermatology Associates of Atlanta offer BoTox injections that will
rid your face of crow's feet, forehead lines, or frown lines. This has
become our most popular cosmetic procedure because it is safe and patients
love the results. BoTox is a powerful medicine used to treat facial expression
lines and neck banding as well as down-turned smiles and drooping eyes.
Best of all, the procedure takes just a minute.
What Is
BoTox?
Botulism
is food poisoning produced by a bacteria. BoTox is a medicine produced
by the same bacteria. BoTox is not alive but is a protein that weakens
and inactivates muscles. This is another example where natural products
are used for medicinal purposes: fungi produce penicillin, cowpox virus
protects against smallpox, foxglove plant produces the "poison" digitalis
that millions of patients take daily for heart disease. Now with bioengineering
it is common for bacteria to produce the necessary medicine for a specific
disease.
First Clinical
Uses Of BoTox
In 1973,
BoTox was used as a treatment for patients with crossed eyes. By weakening
the overactive eye muscles, this medicine provided an alternative to surgery.
After this "breakthrough," BoTox quickly gained acceptance for other ophthalmologic
disorders including nystagmus and blephospasm (involuntary spasm of the
eyelids) to name a few. Extensive BoTox research confirmed repeatedly
a high success rate with minimal side effects using minuscule amounts
of this new found "medicine."
Safety
While BoTox
is potent medicine in high concentration, it is used in very small quantities
with high margins of safety. After a muscle is injected, its first effects
are not seen for 24 hours and the complete effect on the muscle will not
be complete for two weeks. Fifty units (one half vial) or less of BoTox
per session is generally used. To have toxic effects on a patient, over
2,000 units (costing $6,000) would have to be injected at one time. BoTox
effects are attracted only to muscles, and it has no effect on the central
nervous system or on the body if injected accidentally into a nerve or
blood vessel. BoTox is also safe because complete recovery of the muscle
is possible. Recovery is due to the body's excellent ability to form new
fibers that allow activation of the muscles.
Other Specialties
Use BoTox For Their Patients
Gastroenterology
and neurology have explored BoTox therapy for their patients. It has now
become the mainstay of nonsurgical therapy for spasmodic neck muscles,
spasmodic laryngeal muscles, writer's cramp, certain tremors, tics, multiple
sclerosis, cerebral palsy, post stroke states, spinal cord injuries, nerve
palsies, Parkinson's disease, and facial spasms. BoTox is used in GI cases
involving swallowing and ulcer problems and to treat speech problems including
stuttering. Also, treating genitourinary disorders of spastic bladder
and other disorders with BoTox has been studied. Congenital muscular disorders
or acquired nerve injuries have been greatly improved with BoTox.
Background
Of The Cosmetic Use Of BoTox
Cosmetic
BoTox injections were pioneered in 1988 by a Vancouver ophthalmologist
and her husband, a dermatologist. Since that time, this team of doctors
has performed over 10,000 sessions on its patients. The ophthalmologist
noted that the wrinkles disappeared in her patients with eyelid spasms
who were treated with BoTox. This led to further research, which confirmed
the effectiveness and safety of the BoTox vaccine for improving wrinkles
due to overactive muscles of the face.
In 1996 at
the annual meeting of The American Academy of Dermatology in Washington,
a presentation by dermatologist Dr. Nicholas Lowe showed that BoTox was
useful for improving facial expression lines. Significant improvement
was noted on both forehead frown lines and crow's-feet. No significant
side effects were noted beyond the expected injection discomfort. For
30 patients only 1 experienced a mild drooping of the upper eyelid, which
cleared spontaneously. The length of effective improvement for the forehead
frown lines was approximately 18 weeks. The degree of improvement of the
crow's-feet was generally less than the forehead frown lines. BoTox is
not 100% effective in all patients.
BoTox For
Crow's-feet
Wrinkles
radiating from the corner of the eyes caused by smiling, laughing, or
squinting are especially distressing to some individuals. Previously,
no reasonable medical or surgical solution improved this problem due to
the strong underlying muscles. Even with the deepest chemical peels or
laser resurfacing techniques, rapid recurrence of these lines around the
eyes is inevitable. Now for best results, BoTox injections are used in
conjunction with resurfacing procedures. It is the function of BoTox to
prevent the recurrence of wrinkles by inhibiting the underlying muscles.
Nasolabial
Folds
This area
is not ideal for correction by the BoTox method; it also presents a challenge
in facelift surgery. This area is most dynamic when talking, smiling,
and eating. As one ages, both muscle and fat are lost from this area.
Replacement of fat is now possible, but the real advance in this area
has been the development of a permanent filling agent with a high safety
and satisfaction profile--Gortex. In addition the lips can be supplemented
with these techniques. In summary for the area involving the lips and
around the mouth, BoTox will not help this zone and is not recommended.
Frequently
Asked Questions
What Should
Be Expected After BoTox Therapy?
BoTox is
a remarkably safe therapeutic agent for wrinkles. Complications have been
minor and only transient. Bruising may occur where injected and a brief
pain or 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. Ice helps prevent bruising.
Muscle weakness is first noted at 24 hours; it is not immediate.
How Long
Does BoTox Last?
After the
first set of injections, reinjection after two weeks allows for an accurate
localization of any resistant functioning muscles. With this method, 90%
or more patients do respond to BoTox. This leaves 10% who do not respond.
Successful therapy is signed by muscle weakness that begins at 24 to 48
hours after injection with a peaking weakness at seven days. Paralysis
after the initial injection lasts between four and seven months for most
patients.
How Often
Is Reinjection Needed?
Reinjection
is suggested every three or four months to keep the muscles paralyzed
and allow the furrows to completely smooth out. Once an area is smooth,
patients are instructed to return for therapy only when they notice a
return of muscle movement, which may not occur for four months to one
year or even longer.
Who Should
Not Use BoTox?
- Although
there have been no reports of birth defects with this medicine, no pregnant
patients will be treated. It is also our policy not to inject BoTox
in nursing mothers.
- Patients
with a history of neuromuscular disease (multiple sclerosis and myasthenia
gravis) or other types of diseases involving neurotransmission should
avoid this medicine.
- Patients
taking the following medicines should not receive BoTox: aminoglycoside
antibiotics (Streptomycin, Tobmamycin, and Garamycin injections), penicillamine,
and calcium channel blockers (Calan, Cardizem, Dilactor, Norvasc, Procardia,
Verelan).
What Are
Alternatives To BoTox?
Alternatives
to BoTox are filling agents including fat, Collagen, Fibril and Gortex;
resurfacing procedures with acids or lasers; and lifting operations of
the forehead, temporal, neck, and midface regions. If no treatment, the
lines and wrinkles persist.
What Unexpected
Benefits Have Come From The Use Of BoTox?
Tension headaches
have disappeared for some patients. These headaches occurred in patients
who were recruiting forehead and brow muscles during periods of stress
and tension. When these muscles were relaxed, the headaches faded.
How Exactly
Does BoTox Inactive The Muscle?
BoTox inhibits
the release of acetylcholine at the joining site of the nerve to the muscle
so that the muscle never gets the message to contract. Remember, muscles
only have the ability to contract: An opposing muscle contracts to produce
movement in the opposite direction. To rejoin the nerve to the muscle
the body organizes and produces new motor endplates, which reestablishes
connection.
Does The
Body Make Antibodies To The BoTox Protein?
Yes, especially
if enough toxin is injected often enough. The crucial amount is about
100 units (less than the usual cosmetic dosage) and booster injections
placed within one month of the initial injections. Antibodies have been
more of a problem for neurological disorders where larger amounts of BoTox
is required. When significant amounts of antibodies are formed, the therapeutic
effects of BoTox are greatly reduced.
Have There
Been Any Reported Cases Of Allergic Reactions Or Hives To BoTox?
There have
been no reported cases of a true allergic reaction in nearly 20,000 treatments.
People who are known to be allergic to Botulism toxin or albumin should
avoid BoTox.
What Happens
If A Female Patient Becomes Pregnant Shortly Before Or After Treatment?
A number
of neurological and ophthalmologic patients have delivered normal children
after receiving their injections. For safety reasons no pregnant or nursing
females will be treated.
How Painful
Are The Injections?
The smallest
needles are used and the medicine itself does not sting as much as the
usual local anesthetic. Most patients feel it less than collagen. Pain
can be minimized by the use of ice cooling the skin just prior to injections.
Some patients find that two Tylenol tablets before the injections reduce
the discomfort.
What Can
Be Done For The Drooping Eyelid If This Occurs?
There are
two opthalmological preparations that are helpful: The first is 10% phenylephrine
drops and the second is lopidine. Transient drooping of one eyelid or
both is the most significant complication and occurs in 1% to 2% of all
injections. This drooping is a result of the local dissemination of the
toxin in the injection site and can be minimized by accurate dosing, as
well as proper placement, and keeping the patient in an upright position
for three to four hours after injection. If drooping eyelids occur, it
is usually minimal and is usually resolved within two weeks.
As A Patient,
After Receiving My Injections How Can I Help BoTox Be More Effective And
Avoid Side Effects?
First, do
not massage the area of the injection. Second, do not lie down for a nap;
keep upright. Third, use the muscle; intentionally making the muscle contract
helps localize the protein to the selected muscle for ablation.
When Injecting
Muscles At One Site Will This Effect Remote Muscles?
BoTox spreads
along muscle fibers and does not spread to distant areas by way of the
blood stream.
Can BoTox
Be Used To Weaken Not Totally Paralyze A Muscle?
Yes, in fact
this is done so that the face will not be left expressionless. It can
also be used to balance a weak muscle on the opposite side. By injecting
medicine into the subcutaneous tissue not the muscle, and by using a smaller
dosage, a weakening of the muscles is more likely occur.
For The
Deepest Frown Furrows What Is The Recommended Method To Get These Deep
Lines To Disappear?
In one study
paralysis after the initial injection lasted 4-7 months. Reinjection every
3-4 months is recommended rather than waiting for the muscle to recover.
This keeps the muscle paralyzed. It takes approximately 12 months for
the skin to completely smooth out. It is usually 4-12 months before a
return of muscle movement occurs and additional treatments are necessary.
What Accounts
For The Fact That No Treatments May Be Necessary In Some Patients After
Repeated Injection Sessions?
What happens
is that the patient is broken of the bad frowning habits and may not relearn
them for some time in the future.
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