Botulinum toxin is a protein that is produced by certain bacteria of the genus Clostridium botulinum. This protein is able to block the transmission of nerve impulses to smooth and striated muscle fibers for a certain period of time. Depending on the dose, botulinum toxin can reduce muscle activity or even paralyze it almost completely.
The nerve impulses arriving at the sweat glands can also be blocked using fine injections of botulinum toxin. This can significantly reduce sweating.
Botulinum toxin is an extremely strong "neurotoxin" due to these blocking effects in very high concentrations .
The effect of botulinum toxin as a neurotoxin was discovered in southern Germany at the end of the 18th century. After eating spoiled sausage products, whole groups of people died with symptoms including respiratory paralysis.
The initial term "sausage poison" later became "botulinum toxin". It is made up of the two word components botulus = sausage and toxin = poison.
But even the legendary and visionary physician Paracelsus (1493 - 1541) postulated: "The dose makes the poison". Today, the therapeutic possibilities and beneficial applications of Botox® are the focus of scientific research.
The high-molecular protein complex botulinum toxin exists in seven different subgroups, so-called serotypes (type A, B, C etc.). They differ from each other in small details at the molecular level.
Botulinum toxin type A (BTX-A) is the most suitable serotype for both medical-therapeutic and aesthetic-cosmetic purposes. It is used millions of times worldwide with great success and new indications are constantly being added.
Botulinum toxin serotype A; from own work - adapted from http://www.pdb.org/pdb/files/3BTA.pdb using Accelrys DS Visualizer 2.01, Public domain, Link
In Germany, three different manufacturers offer this serotype under the following trade names:
- Botox® and Vistabel® (Allergan Inc.),
- Xeomin® and Bocouture® (Merz-Pharma),
- Dysport® and Azzalure® (Ipsen Biopharm, distributed by Galderma).
Various medical specialty groups from the fields of
make use of the mode of action of the highly potent protein botulinum toxin.
The various established indications for Botox treatment are listed below.
Medical indications
A medical indication is defined as use for medically necessary purposes. Patients suffer from diseases whose symptoms can be alleviated or cured with Botox®.
Among other things, doctors use Botox® to treat
- Strabismus (crossed eyes)
- Various forms of dystonia (pathological movement disorders of central neurological origin), e.g: Blepharospasm (pathological eyelid spasms), torticollis spasmodicus (pathological torticollis), limb dystonia (e.g. writer's cramp), hemifacial spasm (unilateral facial muscle spasm), Meige syndrome = idiopathic orofacial dystonia
- Sialorrhea (abnormal salivation)
- Bruxism (teeth grinding)
- Various forms of spasticity (e.g. due to a neurological disease such as infantile cerebral palsy in children or after a stroke)
- Various forms of tremor (trembling)
- Spasticity in the area of the urinary bladder outlet
- Spasticity in the area of the anus, e.g. in the presence of anal fissures (tears in the anal mucosa)
- certain forms of migraine or tension-related headaches
- certain forms of painful muscle cramps
- tennis elbow
- Excessive sweating, especially axillary (under the armpits), but also in the forehead/face area or on the hands
The product is used partly within the scope of its official approval, but also partly "off-label". Off-label use refers to the appropriate medical use of a drug beyond its official area of application.
Aesthetic indications
If Botox® is used without a medical background, it is used for the purpose of cosmetic optimization. This is referred to as an aesthetic indication.
The objectives of Botox treatment in this case are the smoothing of mimic wrinkles and the harmonization of muscular imbalances in the face and neck area:
- Forehead wrinkles (so-called "thinker's wrinkles")
- Wrinkles between the eyebrows (so-called "frown lines")
- Discrete lifting of the eyebrows (eyebrow lift)
- Slight widening of the eye opening in the lower eyelid area, particularly popular with people of Asian origin (so-called "open-eye look")
- Excessive development of the lateral smile lines on the eye (so-called "crow's feet")
- Wrinkles in the area of the bridge of the nose (so-called "bunny lines")
- Fine wrinkles around the mouth (so-called "smoker's lines")
- Excessive visibility of the gums when laughing (so-called "gummy smile")
- Lowering of the corner of the mouth and so-called "marionette lines" or "Merkel lines"
- Flattening of the lateral facial contour in the lower third with hypertrophy of the large chewing muscle(musculus masseter)
- Protrusion of band-like structures of the flat neck muscle (= platysma) with the appearance of the so-called "turkey neck".
The desired treatment effect usually sets in two to three days after the injection of Botox®. It then slowly increases and has its full effect after about two weeks.
The duration of effect of a botulinum toxin treatment is between one and six months, depending on the dose and treatment indication.
Botox® can be used to treat wrinkles, for example © Africa Studio | AdobeStock
Botulinum toxin treatment is not recommended during pregnancy or while breastfeeding. However, there is no evidence of any risk to the unborn child or infant.
Likewise, Botox® should not be used
- the presence of an underlying disease associated with muscle weakness (e.g. myasthenia gravis) or
- during the intake of certain antibiotics or
- blood-thinning agents
should not be used. Any existing inflammation in the treatment area should be completely resolved before Botox treatment.
Botulinum toxin treatment is a very safe and well-tolerated method when carried out by a qualified practitioner.
As a result of Botox® injections, however, there may be temporary
- slight swelling or small hematomas (bruising),
- headaches,
- tiredness or
- discomfort
may occur. Existing headaches, particularly in the forehead area, often improve considerably.
Extremely rare are
- allergic reactions,
- itching or
- skin rash
occur.
It is very rare for Botox treatments on the side of the forehead to result in temporary unpleasant side effects such as
- drooping of the eyebrow or even the upper eyelid, or
- short-term visual disturbances.
In order to largely rule out these risks, Botox® injections should be carried out by an experienced, well-trained therapist.
All side effects are temporary. They usually subside much sooner than the desired effects last.
Repeated activation of the treated muscle regions in the hours following treatment can accelerate the onset of the effects. To do this, you should alternately tense and relax the corresponding muscles. However, massaging the muscle is not recommended.
During these first few hours, an upright posture should also be favored.
For a period of three to four days after botulinum toxin treatment, excessive heating of the skin should be avoided. Direct sunlight and time spent
- in the sauna,
- in a steam bath,
- in a solarium or
- in the context of excessive sporting activities
are therefore initially rather harmful.
Treatment with a botulinum toxin type A active ingredient provides patients with new, effective and safe treatment options.
Approximately half of the botulinum toxin A (Botox®) produced worldwide is used for medical treatment every year. It is indispensable for
- an indispensable part of the daily treatment practice of numerous medical specialties and a
- a beneficial drug for countless patients of all ages.
patients of all ages.
The other fifty percent of the annual production of botulinum toxin is used in the field of cosmetic-aesthetic medicine. With several million treatments a year, the Botox® treatment is in first place in the hit list of the most popular and most frequent medical beauty treatments. The trend is clearly rising.
