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Botox is the trade name for a purified protein produced by the bacterium Clostridium Botulinum. There are 7 different toxins produced by the bacteria, and Botox is made from toxin A. Toxin B was recently approved in the US as Myobloc, but is only approved for cervical dystonia (torticollosis) at this time. Myobloc is also sometimes used in the rare instances when people develop immunity to Botox. Botox produces a temporary weakening of muscles by interfering with the release of the neurotransmitter acetylcholine. We can inject it into muscles of the face and neck to prevent their movement. If injected carefully into the proper muscles, wrinkles aren’t produced with movements (such as smiling). When done continuously over the long term, it is possible that wrinkles will never form. When a person smiles, creases are formed at the eyes (crow’s feet), and nose. Making an angry expression will also put creases at the bridge of the nose, and raising the eyebrows will give horizontal lines on the forehead. Over a span of many years, repeating these movements will cause the creases to become permanent, which we call wrinkles. If we weaken (or paralyze) the muscles that cause these lines-while leaving all the other surrounding muscles intact-we lose the creases while still keeping the ability to have an expressive face. That is the goal and challenge of Botox therapy. Wrinkles present at rest will not respond, these are called static lines. Dynamic lines appear with muscular effort and vanish when muscles are at rest. These will be most likely to respond. Safety Botox is extremely safe, as long as some basic precautions are used. There are less expensive versions of botulinum toxin available on the internet, but Botox is the only one approved by the FDA for cosmetic use in the US. It is carefully made by the manufacturer to be pure, free from contaminants, and of consistent dosage. Before being injected, make very sure you know what you are getting. Adverse reactions to Botox are rare, and generally mild. There have been no documented allergic reactions to Botox. A mild headache that may last a few days is sometimes seen. Possible reactions at the injection site include pain, bruising, bleeding, swelling and numbness. Even when injected properly, sometimes the Botox will weaken muscles we don’t want to be weakened. When that happens there can be a droopy eyelid or brow. Fortunately, since the Botox wears off in 3 months, this is only a temporary problem. Finally, it would take an enormous amount of Botox to kill a person, which would be ridiculously expensive and not really worth considering as an adverse reaction. Schedule We can inject any muscle with Botox, but cosmetic Botox is used mostly in the face and neck. After injection you should avoid lying down for 4 hours. It will take up to 2 weeks for the Botox to take effect, and I ask my patients to come in for a quick visit at that time (at least after the first injection) to see if they are happy with their treatment, and to do any touchups that may be necessary. If an adequate amount is injected, the effect should last 3 months initially. After a few treatments this can be extended out to 4, and then 6 months. If this schedule is followed, most people can be on an every 6 month schedule within 18-24 months of the first treatment. At that time the amount of Botox can usually also be decreased somewhat. Long-term treatment is being encouraged in many centers throughout the world. Even young people (in their 30’s) are using it, mostly to prevent the formation of wrinkles. Current thinking is that if creases never form (due to the weakened muscles from Botox) wrinkles will never form either. Who can have Botox Almost anyone can be injected. Is should be avoided in pregnancy and breastfeeding (although there is not evidence that it would be harmful). People with myasthenia gravis, ALS and other myopathies should also not be injected. Please call for a
consultation, we’d be happy to explain more, and to discuss whether
Botox can give you the results you are looking for. |
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