Botox Treatment: Information & Botox® Specialists

Botulinum toxin is a protein produced by certain bacteria of the genus Clostridium botulinum. This protein is capable of blocking 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 the muscles almost completely.

Nerve impulses reaching the sweat glands can also be blocked by means of fine injections of botulinum toxin. This significantly reduces sweating.

Due to these blocking effects, botulinum toxin is an extremely potent “neurotoxin” at very high concentrations.

The effects of botulinum toxin as a neurotoxin were first recognized in southern Germany as early as the late 18th century. After consuming spoiled sausage products, entire groups of people died from symptoms including respiratory paralysis.

The initial term “sausage poison” later evolved into the term “botulinum toxin.” It is composed of the two word elements botulus = sausage and toxin = poison.

Yet even the legendary and visionary physician Paracelsus (1493–1541) posited: “The dose makes the poison.” Today, the therapeutic possibilities and beneficial applications of Botox® are the focus of scientific research.

The high-molecular-weight protein complex known as botulinum toxin exists in seven different subgroups, known as serotypes (types A, B, C, etc.). They differ from one another by minor 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; by 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 brand names:

• Botox® and Vistabel® (Allergan Inc.),
• Xeomin® and Bocouture® (Merz-Pharma),
• Dysport® and Azzalure® (manufactured by Ipsen Biopharm, distributed by Galderma).

Various medical specialties in the fields of

• neurology,
• ophthalmology,
• orthopedics,
• urology,
• dermatology, and
• Aesthetic Medicine

all make use of the effects of the highly potent protein botulinum toxin.

The various established indications for Botox treatment are listed below.

Medical Indications

A medical indication refers to the use of Botox® for medically necessary purposes. Patients suffer from conditions whose symptoms can be alleviated or cured with Botox®.

Doctors use Botox® to treat, among other conditions,

• Strabismus (crossed eyes)
• Various forms of dystonia (pathological movement disorders of central neurological origin), e.g.: Blepharospasm (pathological eyelid spasms), spasmodic torticollis (pathological wry neck), limb dystonia (including 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 disorder such as infantile cerebral palsy in children or following a stroke)
• Various forms of tremor (shaking)
• Spasticity in the area of the urethral opening
• Spasticity in the anal region, e.g., in the presence of anal fissures (tears in the anal mucosa)
• Certain forms of migraine or tension-type headaches
• Certain forms of painful muscle spasms
• Tennis elbow
• Excessive sweating, primarily in the axillary region (under the armpits), but also on the forehead, face, or hands

The medication 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 medication beyond its officially approved indications.

Aesthetic Indications

When Botox® is used without a medical indication, it serves the purpose of cosmetic enhancement. This is referred to as an aesthetic indication.

The goals of Botox treatment in this context are to smooth out expression lines and to correct muscle-related imbalances in the face and neck:

• Forehead wrinkles (so-called “thinker’s lines”)
• Wrinkles between the eyebrows (so-called “frown lines”)
• Subtle lifting of the eyebrows (so-called “eyebrow lift”)
• Slight widening of the eye opening in the lower eyelid area, particularly popular among people of Asian descent (so-called “open-eye look”)
• Excessive formation of lateral laugh lines around the eyes (so-called “crow’s feet”)
• Wrinkles along the bridge of the nose (so-called “bunny lines”)
• Fine lines around the mouth (so-called “smoker’s lines”)
• Excessive exposure of the gums when smiling (so-called “gummy smile”)
• Sagging of the corners of the mouth and so-called “marionette lines” or “Merkel lines”
• Flattening of the lateral facial contour in the lower third due to hypertrophy of the masseter muscle
• Prominence of band-like structures of the platysma muscle, resulting in the appearance of a so-called “turkey neck.”

The desired treatment effect usually begins two to three days after the Botox® injection. It then gradually increases and reaches its full effect after approximately two weeks.

The duration of effect of a botulinum toxin treatment ranges from one to six months, depending on the dose and the indication for treatment.

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 in cases of

• the presence of an underlying condition associated with muscle weakness (e.g., myasthenia gravis) or
• while taking certain antibiotics or
• blood-thinning medications

. Any existing inflammation in the treatment area should be allowed to subside completely before Botox treatment.

When performed by a qualified practitioner, botulinum toxin treatment is a very safe and well-tolerated method.

However, Botox® injections may cause temporary

• mild swelling or small hematomas (bruises),
• headaches,
• fatigue, or
• malaise

. In cases of existing headaches, particularly in the forehead area, there is often a significant improvement.

Extremely rare

• allergic reactions,
• itching, or
• skin rash

.

Very rarely, Botox treatments on the lateral forehead may result in temporary unpleasant side effects such as

• drooping of the eyebrow or even the upper eyelid, or
• short-term visual disturbances.

To minimize these risks as much as possible, Botox® injections should be administered by an experienced, well-trained practitioner.

All side effects are temporary. They typically subside well before the desired effects wear off.

Repeatedly activating the treated muscle areas in the hours following treatment can help the effects set in more quickly. To do this, you should alternately tense and relax the relevant muscles. However, massaging the muscle is not recommended.

During these first few hours, you should also maintain an upright posture.

For three to four days following botulinum toxin treatment, you should avoid exposing the skin to intense heat. Direct sunlight and spending time

• in the sauna,
• in a steam room,
• in a tanning bed, or
• excessive physical exertion

are therefore generally not recommended at first.

Treatment with a botulinum toxin type A offers patients new, effective, and safe therapeutic options.

Approximately half of the botulinum toxin A (Botox®) produced worldwide is used annually for medical treatment. It has become

• numerous medical specialties an indispensable part of their daily practice and
• has become a life-changing medication

.

The other fifty percent of annual botulinum toxin production is used in the field of cosmetic and aesthetic medicine. With several million treatments performed annually, Botox® treatment ranks first on the list of the most popular and most common medical cosmetic procedures. The trend is clearly on the rise.