Botox® (botulinum toxin type A) is approved by the FDA for aesthetic use and the treatment of frown lines. It has also extra facial uses and has been applied in persons with hyperhidrosis (sweaty axilla and palms of hand). For cosmetic purposes, Botox® can provide temporary improvement of frown lines (referred to as glabellar lines in medicine). Safety profile is good in experienced hands. Side effects are few, but may rarely include redness, swelling, nausea, allergy and lid lag. Precautions should be taken to avoid these. Lid lag is called blepharoptosis and recovers within a few months.
Botox® is given by tiny injections, into the focus area on the face. It cannot be given if active infection is present. It must be given by a medical practitioner. More details are available at www.botox.com . Patients must provide details before Botox® is given regards their present health status, recent illness, underlying systemic disorders and allergies. Localized pain and bruising may be associated with injection. The age group is 18-65 years and the drug works out after 3-6 months. Response is seen within days (80%). Time for the procedure is about 10 minutes. If you are unsure, contact a healthcare professional. Dysport® is available as competition to Botox® in England .
The botulinum polypeptide can relax muscles by acetylcholine release blockade at the neuromuscular junction. This inhibits muscle contraction. Especially on the face, this facilitates smoothing of the overlying skin and temporary improvement of wrinkles ranging from 2-6 months. Knowledge of facial muscle anatomy is important to correctly focus the injections. This includes anatomical background of:
- M. procerus
- M. orbicularis oculi (palpebral and orbital part)
- M. occipitofrontalis
- M. corrugator ( corrugator supercilli)
A purified neurotoxin complex is now available as Botox® cosmetic. It is FDA approved and effective in ameliorating the moderate to severe glabellar lines associated with corrugator and / or procerus muscle activity in adults.
The manufacturer provides special treatment precautionary warnings and these should be considered before injection and during informed consent.
- Hypersensitivity reactions (anaphylaxis, urticaria, oedema, dyspnoea).
- Avoid targeting patients with neuromuscular junctional disorders (dysphagia can last for several months necessitating insertion of a nasogastric feeding tube).
- Dysphagia following treatment of cervical dystonia.
- Cardiovascular: arrhythmia and rarely myocardial infarction.
- Transmission of viral disease (remote).
- Reduced blinking, may in susceptible subjects, result in corneal ulceration.
- Paralysis of an extra ocular muscle can result in spatial disorientation, double vision and past pointing.
- Needle related pain and vasovagal responses (syncope, hypotension).
- Care must be taken in persons with marked facial asymmetry, ptosis, excessive dermatochalasis, deep dermal scarring and thick sebaceous skin.
- Drug interactions can occur with aminoglycosides, quinidine, anticholinesterases and magnesium sulphate.
Check list before giving botulinum toxin: precautions for practitioners
- Know your anatomy, think of the facial muscles of expression you want to block
- Remember the small arteries and central forehead vein in the region of the glabella ( inter-brow region)
- Exclude underlying neuromuscular disorders (myasthenia gravis).
- Exclude underlying cardiovascular disorders.
- Keep in mind drug interactions.
- Beware of allergies
- Be cautious in epileptics.
- Ascertain if patients have had acute angle glaucoma.
- When injecting glabellar lines, persons may complain of post-injection headache, respiratory infection, flu syndrome, blepharoptosis and nausea, facial pain, erythema, paresthesia.
- Repeated injections of botulinum may result in the formation of neutralizing antibodies that will reduce the efficacy of subsequent treatments.
Genop Healthcare, distributes Botox® in South Africa . A success rate of about 80% can be expected. Inconsistent results may occur in persons with unrealistic expectations, incorrect dosage or suboptimal injection technique. More details are available on health-24.com