‘A lot kills, A little cures’, wrote one of the most deadly toxins known to man: Botulinum toxin A (BTA). It is capable of causing a paralyzing death or serving as a wildly popular wrinkle antidote, harnessed and wielded in the pursuit of a younger look.
Introduction :
Botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum. C. botulinum produces 8 antigenically distinguishable exotoxins (A, B, C1, C2, D, E, F and G). All serotypes interfere with neural transmission by inhibiting acetylcholine release at the presynaptic neuromuscular junction, causing muscle relaxation and paralysis. Serotype A is the only commercially available form for aesthetic use.
Why is Botulinum toxin known as “Sausage Poison” ?
In the late 18th century, a group of Belgian musicians attending a funeral had a meal consisting of smoked and pickled ham, which would ultimately lead to their untimely deaths. Following this tragic event, the ham was sent for analysis, leading to the discovery of the pathogen Clostridium botulinum. The bacterium was named due to its pathological association with sausages (the Latin word for sausage is 'botulus').
Early Clinical Use :
In the 1970s, an ophthalmologist, Dr Alan Scott first demonstrated the effectiveness of botulinum toxin A to treat strabismus(crossed eye) in humans. By 1989, BTA was approved by the US Food and Drug Administration (FDA) for the treatment of strabismus, blepharospasm (abnormal blinking or twitching of eyelid), and hemifacial spasm in patients aged younger than 12 years. In 2000, BTA received the FDA approval for cervical dystonia (involuntary neck muscle contraction) treatment. In 2004, the FDA approved BTA to treat severe primary axillary hyperhidrosis (underarm sweating) and prophylaxis for chronic migraine in 2010.
The Journey to Cosmetic Use :
Botulinum toxin A (BTA) has a wide array of cosmetic uses. It is the most common cosmetic procedure performed in the world today. It was approved by the FDA to improve glabella rhytides (frown lines) in 2002 and lateral canthal lines (crow’s feet) in 2013. However, the indications for BTA injection continue to grow including off-label indications. For example:
● Forehead wrinkles
● Periorbital lines
● Eyebrow lift
● Bunny lines
● Perioral line
● Marionette smiles
● Gummy smile
● Chin puckering
● V-shape face
● Neckline and platysmal band
Remember this. BTA injections are only beneficial to dynamic wrinkles ‘wrinkles in motion’, but it is not beneficial for static wrinkles (‘wrinkles at rest’). However, it may help to prevent wrinkles in motion from becoming wrinkles at rest.
Who is a good candidate for BTA injection?
Botulinum toxin A (BTA) is an ideal option for individuals developing wrinkles or lines on their upper face due to the repetitive expressions of daily life. It's also suitable for those experiencing premature aging in their 20s to 30s, even with excellent skincare routines and healthy lifestyles. BTA offers a perfect way to maintain a youthful appearance. Additionally, BTA injections are popular among men who may worry about appearing 'angrier'; because of the bulkier muscles between their eyebrows (the glabellar region). This is why it's sometimes referred to as 'BROtox'. If you haven't yet noticed wrinkles or lines but are concerned about enlarged masseter muscles leading to a square jaw, BTA can provide a solution, helping you achieve a more defined V-shaped jawline.
BTA Is Not For You
BTA injections are generally considered safe for most patients. However, you should not get BTA injections if you are :
● Pregnant or breastfeeding
● Having neuromuscular disorder
● Having myopathies
● Having an active infection in the treatment area (pustular acne, Herpes-Simplex, cellulitis)
● Allergic to the ingredients of BTA ( kindly let your doctors know what you are allergic to)
● Uncontrolled systemic condition
Tell your doctors if you are on any medications for your health issues too!
How long does it last?
Treated muscles typically show a response within 3-5 days and reach their maximum effect within 2 weeks of BTA injections. These injections yield natural-looking results that can last from 4 to 6 months. When administered with the correct dosage into the appropriate muscles by highly trained aesthetic doctors, you can maintain a natural appearance and express yourself freely. Generally, 2-3 visits per year are recommended to sustain your youthful look.
Combination of aesthetic treatment
Facial aging is a multifaceted process involving not only the formation of facial lines and wrinkles but also contour changes, skin laxity, formation of dyschromia, and vascular lesions. The superiority of BTA when used with other cosmetic procedures will achieve optimal rejuvenation results through their synergistic effects.
● BTA and Dermal Filler to treat static lines and volume loss
● BTA and Laser resurfacing to treat dynamic lines and enhance skin tone & texture
● BTA and face threads
● Chemical Peels and BTA
Does BTA injection Bring you Complications?
Complications arising from cosmetic BTA injections are rare, usually temporary, and reversible. The most common adverse event is bruising at the injection site, which can be minimized by avoiding substances like aspirin, anticoagulants, NSAIDs, green tea, vitamin E, omega fatty acids, ginseng, gingko, evening primrose oil, and garlic supplements for at least 10 days prior to treatment. The more serious adverse effects associated with BTA injections in the upper face include eyelid ptosis, very rarely ectropion, and diplopia, which result from local dispersion. However, when administered by a trained doctor with proper toxin placement and injection technique, the incidence of these temporary side effects is significantly reduced.
Myths of BTA Resistance?
Patients often wonder if BTA will become less effective with regular use and if they will look worse when they stop treatment or when the effects wear off. The answer to both questions is no. While you may have heard of 'neutralizing antibodies'; which can develop when high doses of BTA are used for medical conditions like cerebral palsy, this occurrence is extremely rare in cosmetic BTA injections. When you stop treatment, the treated muscle gradually returns to its normal activity, and wrinkles may reappear over time due to your daily facial expressions.
DOs and DON’T post BTA injections
1. Do not rub or massage the treated areas for 24 hours after the treatment
2. Do not excessively bend down on the day of treatment
3. Do not carry out exhaustive physical exercise on the day of treatment
4. Do not apply makeup immediately after treatment
5. Do not carry out activities that can cause facial flushing (e.g., application of heat to the face, tanning, alcohol consumption)
You can cleanse your face gently that evening. Gently apply a cool compress to the treated area for 15 minutes if there is injection-related bruising and swelling, You need to follow up with the doctor 2 weeks after the first treatment for an assessment if the dosage and results are optimal.
Nutshell
One of the best things is that BTA injection is a customizable treatment. Choosing a certified doctor for any aesthetic procedure is of utmost importance. The doctor should conduct a thorough evaluation, including a review of your medical and cosmetic history, as well as both static and dynamic assessments, before administering BTA injections to achieve your desired results. If you have concerns about a dramatic change in your appearance, a conservative approach can be taken, starting with a minimal amount of BTA and adjusting as needed over time.
Future of Botulinum Toxin
Botulinum toxin has undergone a remarkable transformation over the last 200 years, transitioning from a deadly poison to a versatile treatment for a wide range of conditions. Looking back just 35 years ago, the idea of using the world's most dangerous neurotoxin to address cosmetic lines and wrinkles would have appeared implausible. Today, the medical and scientific communities remain dedicated to exploring new horizons, continually investigating the potential applications of botulinum toxin beyond its current uses, and catering to patients'; diverse needs and preferences.