Botox

Myths and Facts About Botox

Botox is the most used product in the medical esthetics field. It has a high patient satisfaction with its 20 years of history.

The substance called Botulinum which has been known since the 19th century is used for medical treatment for treating various diseases as well as the esthetics field and it yields pleasant results.

Botox goes through safe and high technology steps throughout the production process. When it is performed repetitively and regularly, a long term effectiveness can be achieved. Although the effects of Botox that is performed for the first time vary depending on the individual, they last an average of 4-6 months, and can go up to 6-8 months after the next session, and up to 8-10 months in the next. That is, the effects of each application will last longer than those of the previous one.

It is now ensured with Botox that patients obtain natural results. An expressionless and mimic-free face is not preferred like it used to be. Therefore, the amount of Botox injected has been revised compared to the old one. Thus, the mimics are maintained while the wrinkles and lines are reduced.

Botox application being performed during the years when the lines are just starting to form will lead to more effective results. This way, precautions will be taken before the lines settle and get deeper. In a way, a prophylactic treatment is done. Men also get Botox as much as women in our days. Because Botox applications can now be performed in a way that it is not apparent on the surface, and that does not tamper with the natural appearance of the patient.

Other than medical facial esthetics, Botox has many more indications such as overactive bladder, excessive sweating, migraines, and strabismus. It manifests its effectiveness in these therapeutic areas in addition to medical facial esthetics. The World Health Organization has approved the application of Botox treatment for severe migraines. In addition, the use of Botox has been approved for the excessive sweating of the armpits, hands and feet. With Botox, the results are quite effective in case of both migraines and excessive sweating.

According to the studies, approximately 58.6 million people are interested in non-surgical esthetic treatments. However, only 9% of these people can take action for face injections. Stories that spread around regarding many topics that women are interested in and follow regarding esthetic treatments such as the method of application, the duration of application, the safety of the application for non-surgical esthetic procedures can sometimes contain unrealistic information and cause concerns.

Botox Applications

What is Skin Aging?

The most clinical characteristic of skin aging are wrinkles. A loss of volume and natural skin thinning are seen with the skin due to the decrease in collagen, hyaluronic acid and elastin with time. This process of dermal atrophy speeds up with the impact of external factors like sun exposure and smoking. Moreover, the hyperdynamic, that is, frequently used facial muscles contribute to the formation of visible lines and wrinkles. The lines and wrinkles are initially visible during active facial expressions like while angry or smiling. They are known as dynamic lines. After a while, these lines turn into static, that is, permanent lines which are also visible during rest.

Areas of Use of Botox

• Botox was approved by the FDA (US Food and Drug Authority) as a treatment for adults between the ages of 18-65 with moderate and severe dynamic glabella, that is, the frown lines between the eyebrows.
• Botox was approved by the FDA for the treatment of primary axillary hyperhidrosis (excessive sweating) (2004).
• Other FDA-approved areas of use: blepharospasm (excessive blinking) (1989), strabismus (crossed eyes) (1989), chronic migraine treatment (2010), cranial (inside the head) nerve VII disorders (1989), cervical dystonia (tilting in the neck) (2000), upper limb spasticity (excessive contractions) (2010),
• Other cosmetic uses: Reducing the upper and lower facial, neck and breast wrinkles, procedure of facial lifting and correcting the facial asymmetries.

Mechanism of Action

Botox is a protein that is obtained from the clostridium botulinum bacteria. When a small amount of the botulinum toxin is injected into the target muscles, a chemical interruption of transmission occurs in the connection at the nerve-muscle intersection due to the blocking of acetylcholine release, and the skin wrinkles in the treated area get smoother.

Basic and Advanced Applications

Basic

With Botox, the best response occurs and the least side effects there are in the upper part of the face, in areas with the hyperdynamic muscles (frown lines, crow’s feet and horizontal forehead lines).

Advanced

The application of the Botox treatment in the lower part of the face is known as an advanced application. This region is extremely active and in addition to the facial expressions, the lower facial muscles play an important role in chewing and speaking. Because the muscles that are treated in the lower face require a more practical application ability, the toxin should be injected in small doses and a partial functionality should be left behind in the muscles.

Choice of Patient

With Botox treatment, the best responses are received in patients who have dynamic wrinkles and do not have or minimally have static, that is, settled wrinkles. Therefore, it is recommended to start Botox at your early 30’s before the wrinkles settle.

With patients who have static (not deepened) wrinkles, the response will develop slowly, and the bets response will be received due to cumulative impact after two-three consecutive treatments. Deep static (settled) lines may not respond to the botulinum toxin treatment by themselves. For the best results in these patients, a combination is needed with treatments like fillers or skin rejuvenation.

Products

FDA has approved two botulinum toxin serotype A products for the glabellar area muscles. These products are OnabotulinumtoxinA (OBTX) (Botox Allergan, Inc, Irvine, CA) and AbobotulinumtoxinA (Dysport Medicis Pharmaceutical Company, Scottsdale, AZ).

Contraindications (Conditions Where It Should Not Be Performed)

• Pregnancy or breastfeeding
• Active infection in the treatment area (for example; herpes simplex, pustular acne, cellulitis)
• Hypertrophic or keloid scar tissue
• Bleeding disorder (thrombocytopenia, using anticoagulants)
• Disorders of wound healing (due to immunosuppression)
• Skin atrophy
• Active dermatosis in the treatment area (psoriasis, eczema)
• Sensitivity or allergy to botulinum toxin components
• Milk allergy with AbobotulinumtoxinA
• Large muscle weakness in the treatment area (polio, Bell’s palsy)
• Neuromuscular diseases
• Inability to actively contract the muscle in the treatment area before the treatment
• Having had eye or eye surgery done in the last 6 months (LASIK, blepharoplasty)
• Drugs that inhibit neuromuscular transmission and increase the effects of the botulinum toxin
• Uncontrolled systemic conditions
• People who need perfect facial expressions (actors, artists)

 Advantages

• Technically a simple method with a short treatment duration
• Safe and effective, especially in the facial area
• High patient satisfaction

Disadvantages

• Short lived effect compared to the other cosmetic applications despite the cumulative effects with repeated applications

Results and Follow-up

• A partial loss occurs in the function of the treated muscles 2-3 days following Botox treatment, and maximum loss occurs 1-2 weeks later. The effect is best visible in the treatment of dynamic lines. Static lines respond more slowly, and better results can be obtained with several successive treatments or with accompanying minimally invasive esthetic interventions (dermal filler) and reshaping procedures.
• If the desired muscle function loss has not been achieved, an adjustment can be made 2 weeks after the procedure. The botulinum toxin touch-up dose depends on the muscle function in the target muscle.
• The results of the Botox treatment are not immediately visible in the lower part of the face, while more dramatic changes are observed in the upper part of the face. Minimal or more functional changes can be seen in the mouth for the desired esthetic impact in the lower face.
• The muscle function in the affected area returns 4-6 months later depending on the dosage that was applied, the area of application and the patient physiology. It is recommended that the next application is done once the muscles in the treated area start contracting again, before the facial lines go back to their former states.

Botulinum Toxin Treatment in Multiple Facial Areas

The botulinum toxin treatment performed on one third of the upper face can be safely and easily combined with the treatment of the lower part of the face in one visit.

Let’s all take a look at the myths about Botox injections in order to ensure that the correct information is obtained and the right decisions are made.

Botox Indications (Conditions Where It is Approved)

• Botox was approved by the FDA as a temporary treatment for adults between the ages of 18-65 with moderate and severe dynamic glabellar (the area between the eyebrows) frown lines.
• Botox was approved by the FDA for the temporary treatment of primary axillary hyperhidrosis (excessive sweating) (2004).
• Other FDA approved indications: blepharospasm (excessive blinking) (1989), strabismus (1989), cranial nerve VII disorders (1989), cervical dystonia (2000), upper limb spasticity (2010), chronic migraine prophylaxis (2010).
• Other cosmetic uses: Reducing the upper and lower facial, neck and breast wrinkles, procedure of facial lifting and correcting the facial asymmetries.

1- Is Botox snake venom?

No. Botox is a medication. It is a natural, purified protein-based medication made from a special bacteria.

2- Is Botox safe?

Yes. Botox is a medication that has been approved by the Ministry of Health in Turkey and in over 70 countries worldwide and which had over 2000 scientific studies done about it. It has been used for 20 years. Every year, millions of people safely prefer these applications.

3- How long does the effects of Botox injections last?

The effects of BOTOX might vary depending on the patient and the dosage applied, but the average duration of effects is 4-6 months. The effects of the medication start appearing 2-3 days after the injection, and fully appear in 1-2 weeks.

4- Will Botox become less effective as it is repeated?

Although it is theoretically possible to develop antibodies against Botox, no antibody developments against Botox to reduce the clinical effects have been encountered so far in the facial esthetic applications.

5- Do the effects last for a shorter duration than the past because of the changes in the production process of Botox?

There have been no changes in the production process of Botox. High technology production has been ongoing for many years in the same standards compliant with the FDA and European Medicines Agency criteria.

6- Is Botox painful?

The area of application is numbed with a local anesthetic cream before this application, so the injection is quite pain-free.

7- What should one watch out for after a Botox injection?

There can be a temporary sensitivity, swelling or bruising on your skin after the application, but this will not prevent you from returning to your social life. No makeup should be applied for 12 hours, and direct sunlight and hot environments such as Turkish baths, sauna, solarium, steam bath, and hot showers should be avoided for 2 weeks.

8- They say you lose your facial expressions after Botox injections, is that true?

No, this is not true. This is an application that is performed under the physician’s control and with the patient’s request. It is possible to both eliminate wrinkles and use mimics with the dosage applied and the choice of area.

9- Will my wrinkles get worse if I discontinue Botox applications?

No. Your wrinkles will slowly go back to their pretreatment states.

10- Are Botox and dermal fillers used for the same purpose?

BOTOX is used for dynamic wrinkles, while dermal fillers are used for static (settled) wrinkles and facial shaping. The mechanisms of action and areas of applications are different. A patient might need both Botox and dermal fillers. Dermal fillers consist of hyaluronic acid, a natural substance.

11- Can Botox used for lips?

No. BOTOX is used for dynamic wrinkles. Dermal fillers are used to plump lips.

12- Is it possible to equally eliminate wrinkles with creams instead of Botox injections?

No, that is not possible. Botox is a treatment that is injected into the muscle by a doctor and that effectively eliminates dynamic wrinkles. As for creams, they work to nourish and moist the skin, protect it from the Sun and eliminate mild superficial wrinkles.

13- Where can you get Botox injections?

This application can be performed by an authorized and experienced doctor of medicine. It is illegal for people who are not doctors of medicine to perform these injections.

What is Botox?

Botox is; the botulinum substance which is applied in order to eliminate wrinkles which factors such as direct exposure to sunlight, stress, incorrect skin care leave behind on our skin and which is released by a bacteria. The muscle in the area with the wrinkle is entered with Botox and the muscle there is made to contract less, thus reducing the wrinkles. The effects last between 4 to 6 months. If the person comes back for a second session when the effects of Botox are going away, these effects go up to 6 to 8 months. Botox is used for; forehead, crow’s feet, glabella, chin wrinkles, chin and also for medicinal purposes of jaw/teeth clenching and teeth grinding, hand, feet, armpit sweating and treating migraines.

What is Migraine Botox?

The Botox injections that are performed today for cosmetic purposes used to be used for treatment purposes in the past. Elimination of the pain from migraine is intended by applying this method for people whose migraine does not go away with medication. The quality of life is increased, a regular sleeping pattern is ensured and serotonin is released. Migraine Botox whose effectiveness has been scientifically proven; is performed by intensely using a Botox tube. Starting from the base of the neck, it is applied into many muscles in the head, in the temporal area and the forehead.

What is Masseter Botox?

It is a Botox that is performed for esthetic purposes to bring out the jawline and thin the face for people with wide jawlines and faces. Masseter is the name for the chewing muscle. Masseter Botox which is done for teeth grinding and teeth clenching in addition to bringing out the jawline and thinning the face yields extremely effective results. Not only will your jawline get a smoother shape a short while after getting Masseter Botox done; but the facial line will also get thinner and the teeth grinding will be minimized. There will be a doctor follow-up in 15 days. The effects of Botox vary between 4 to 6 months. The duration of the masseter Botox will be longer if you reapply the procedure between 4 to 6 months and will last up to 1 year with time. The effects are felt more after 2 to 3 applications.

Botox for Sweating

Almost everyone experiences a sweating problem due to various reasons. However, for some, sweating is extremely beyond normal. This is where Botox steps in. There might be a sense of discomfort due to excessive sweating.  The sweating problem which is mostly seen in the armpits, hands and feet can be reduced with Botox. Results are achieved after the first session. The effects vary between 4 to 6 months. The person is numbed with a numbing cream before the procedure. During this procedure which lasts about 20 minutes, results are obtained starting from the first session. No serious side effects are expected.