Botox-should I or should I not?

Botox-Azzalure

04 May Botox-should I or should I not?

Many of my clients ask me what is Botox, and how it works.

Before you go under the needle, it is a good idea to know what exactly the drug is and what it does in your body.
That is why I decided to put some information together so that my clients can make a more educated decision before undergoing the treatment.

What exactly is Botox?
Botox is the trade name of a brand of Botulinum toxin type A, which is a neurotoxin or in simple language a nerve poison. This sounds scary, but don’t worry, I have explained it more clearly here.

The drug is made from the toxin produced by a bacteria named Clostridium Botulinum.
The toxin blocks the nerve conduction to muscles in our body, which causes a temporary muscle paralysis. It mainly affects the nerves to muscles of movement (motor muscles). In addition, it affects the nerves supplying some of the glands-for eg: saliva and sweat). Hence it cause dryness and stops sweating. Some of these features has been used in the therapeutic use of an extremely dilute preparation of the toxin. The effect on the muscles makes it useful to stop some of the muscles in the face from causing the wrinkles.
It is also used to weaken the muscles of grinding in patients who grind their teeth during sleep. The effect on the sweat glands makes it useful in patients who have excessive sweating-especially from arm pits. It is also very effective in some patients who get migraines. In fact, NICE recommends that Botox can be considered as an option for the prevention of headaches for people who have chronic migraine (headaches on at least 15 days of every month, at least eight days of which are migraine) that has not responded to at least three prior preventative drug treatments.

The effect of toxin lasts for around 3-4 months. During this time, the body repairs the effect caused by the toxin and the muscles will start working again. Hence, to continue the effect, the treatment needs to be repeated every 3-4 months. Some effects like that on sweat glands lasts longer-for around 6-9 months.

When it is injected correctly, this drug is extremely useful, but when it is done incorrectly, it can go very very wrong.

At what age can I start?
You should be at least 18 years old to have it done.
If you are younger, and is considering it for medical reasons, you can consult us and we will give the best advice.

UK regulations
In UK, Botulinum toxin is a prescription only medicine (POM) and hence can be administered only by doctors, dentists or experienced nurses who have completed a prescribing course. Anybody else who injects botox in UK is doing it illegally.
The practitioner also need to have appropriate indemnity insurance to cover them against adverse claims.
You can understand why it is not the best idea to go bargain hunting for Botox injection.

How is it injected?
It comes in powder form, and your doctor dilutes it with saline to make it injectable. By using saline, they’re also “watering it down,” effectively taking out any noxious capabilities.

How does it work?
When injected into the muscles locally, the nerves which supply those muscles are blocked, and hence the muscles will not contract. As the muscles do not contract, the wrinkles will smoothen and eventually disappear. As the drug is injected into the specific muscles, the effect is localised and hence will not cause any other effects elsewhere in the body. The dose needed to produce cosmetic results are significantly lower than the dose needed to cause a systemic effect. In simple language, you will need about 30 times the dose normally injected to cause any systemic effect.

Although effect is localised, most expressions like wrinkles on forehead are caused by more than one muscle. Hence to effectively treat wrinkles, you will need to inject the toxin into more than one muscle. If not carefully done, the injected drug can spread into nearby muscles which are needed for other functions. For eg: muscle fibres which keep the eyes open and eye brows raised travels very close to the muscles which cause the forehead wrinkles. Hence, in inexperienced hands the wrong muscles can get blocked causing drooping of eyebrow. As explained previously, as the effect of the toxin lasts for around 3-4 months, these complications also last that long.

Once injected, the toxin takes around two weeks to take full effect. Hence you will not see or feel any difference few days after the injection.

As the toxin mainly affects the muscles of movement, you will not feel any difference in sensation in the area. That means, the area will not feel numb.

What are the complications?
Minor complications like bruising, redness etc are very common, but will resolve quickly. Some bruises might last several days if the needle hits a blood vessel. Again, good technique in the hands of an experienced doctor will reduce the risk of these complications.
You will be able to resume your normal activities straight after the treatment, but take care not to rub or massage the area at least for 48 hours. In 3-7 days, you will start noticing some difference, but be patient for 2 weeks to see the full effect.

Can I have it done as prophylaxis?
Botox can prevent the wrinkles from forming in the future. That means, it does have a prophylactic effect-especially the forehead and frown areas.
As explained before, the treatment needs to be repeated every 3-4 months. Again, bigger, bulkier and stronger the muscles, quicker you will see the movement returning.
Likewise, smaller the muscles, longer the effect lasts.

Will I develop tolerence?
Another question I frequently get asked is if the drug has any tolerance effect.
The toxin does not have any tolerance effect and hence the body does not get used to the drug. In my experience of treating grinding with botulinum toxin, I have noticed that some of my patients stop grinding altogether after few sessions due to the habit breaking effect.

What are the other uses of the toxin?
The toxin has been used effectively in many other conditions like muscle spasms, overactive bladder muscles or loss of bladder control, crossed eyes-also called strabismus, cerebral palsy, myotonia etc.

Conclusion…..
In essence, botulinum toxin is a very effective drug to treat a variety of conditions. It is very safe in experienced hands, but can be very dangerous if not used correctly.

Hence before taking the final decision to go under the needle, research about the practitioner and find out how experienced he/she is. Do not go searching for deals and discounts and certainly not for “botox parties” where you get it cheaper. It might be cheaper because they share the drug between clients or they may not be injecting the correct dose.

Dr. Biju Philip

Dr. Philip (GMC No: 6072826) is a medical doctor with more than 20 years experience, of which 13 years has been in the field of Anaesthetics and Critical Care. He has also undergone extensive training in Dental Sedation and Facial Aesthetics, including Botox and dermal filler treatments, which he now practices in our dental surgery in Exning. He also works as an Anaesthetist at West Suffolk Hospital, Bury St. Edmunds.