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BOTULINUM TOXIN TYPE A (botox) – All About

Preface and disclaimer

In this essay I compiled the very good and authoritive information on the websites of American Society of Plastic Surgeons
and Better Health Channel produced with assistance from Australian Society of Plastic Surgeons and their website.
After reading this you are welcome to find more detailed information from the links here, but you must not decide on any action until after you have consulted a medical professional. The source sites all say this, and I repeat, that information here is not personal medical advice for you. That can only come from a medical professional after consultation with you.

Injectable Dermal Treatments

Facial wrinkles and lines can be reduced with cosmetic injections into the skin. The two main types of injectable substances used are botulinum toxin type A (commonly referred to as botox) and dermal fillers. To treat deep lines, the surgeon or cosmetic practitioner may decide to use both types of injectables to achieve the best result.

What are dermal fillers?

Dermal fillers are natural or synthetic substances which bulk up thinning skin, and so reduce creases and wrinkles. You will often see botox and dermal fillers discussed on the same page. Both are “injectables” but botox is not a “filler” as are the dermal fillers. It is a muscle relaxant that paralyses the tiny muscles in the skin which cause creases and lines such as frown lines and “crow’s feet”. For more information about dermal filler facial treatments see my page Dermal Fillers – The Whole Story

Botulinum Toxin Type A

It is the most lethal poison known. It is the agent that causes (often lethal) botulism. One gram could if dosed out and injected kill about 3000 people. So why is it used in cosmetic treatments? Because it is such a good muscle paralyser (ie relaxer) and it can safely be used in minute quantities. The first medical were in the 80s when it was found to alleviate crossed eyes, squinting and excessive blinking. It was approved reducing frown lines in 2002. More medical uses are being found for it – such as for treating excessive sweating, aesophageal spasm, cerebral palsies, teeth grinding, and severe migraine.

There are several brands of are botulinum toxin type A (Botox®, Xeomin® and Dysport®). Australian Government regulations do not allow these brands to be promoted or talked about in general publications. Botulinum toxin type A is often referred to as botox, and that is distinct from Botox® the brand. The authority to prescribe or use botulinum toxin type A varies from country to country. In Australia it is a restricted drug (class 4) and must be prescribed (only) by a medical doctor. The procedures using must be performed by a medical doctor, or a registered nurse under the supervision of one. It is not legally available to beauty therapists or nurses working outside the supervision of a medical doctor. In US the restrictions are less, and in some countries much less.

Botulinum toxin type A is given by intramuscular (IM) injection to weaken muscles in the face and lessen the lines associated with facial expression. The toxin relaxes the underlying muscle and allows the skin to flatten out. This is the same effect that the toxin has that causes botulism poisoning (and death), but in minute quantities.

Botulinum toxin type A is approved for treating frown lines between eyebrows and above nose, and then only by a qualified doctor or a nurse under the supervision of one. It is being used for other treatments that are not approved and by persons not qualified. The treating doctor or clinic is responsible and you must be made aware and consent to this. It is a dangerous product if not used with skill. Inform yourself of the risks.

The wrinkle-preventing effect of Botox normally lasts about three to four months, but can last up to six months. Following treatment, visible results of Botox Cosmetic are usually seen within 3–5 days, however it can take up to 2 weeks to see full results.

Like other restricted drugs there is a black market for it and you may see botulinum toxin type A (or brand name) offered for sale on the internet, or unusual places. Note that it can only be legally sold if prescribed by a doctor and sold by a pharmacist.

  • Choose treatment well – from appropriately qualified surgeons – and satisfy yourself about their training, expertise and experience.
  • Know the possible risks, side effects and complications.
  • Be realistic about your expectations.
  • Can you afford it ? In most cases it is not rebated by Medicare or private health insurance.
  • Don’t be impulsive. Cool off and ponder on it for a while.
  • Ask and ask – about any questions and concerns, and if not satisfied get a second opinion before going ahead.

The decision to use botulinum toxin is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. These risks will be fully discussed prior to your consent.
It is important that you address all your questions directly with your plastic surgeon. Although good results can be expected there is no guarantee.
Your plastic surgeon and/or staff will explain, in detail, any risks. And you must satisfy yourself that all your questions are answered and that you have concerns because….
You will be asked to sign consent forms to ensure that you fully understand the procedure, as well as the risks and potential complications. The fine print will try to remove any risk to the surgeon of any “did not know” claims from the patient.

Botulinum toxin type A (Botox) – Precautions

The treating doctor must know if you

  • are allergic to any of the ingredients listed in the formulation
  • have an infection in the muscles where it would normally be injected
  • have any muscular disorders in other parts of your body
  • are taking, or likely to take, any other medications
  • are scheduled to have surgery using a general anaesthetic
  • have inflammation or severe weakness in the muscles where the product would be injected
  • are pregnant or intend to become pregnant
  • are breastfeeding or are planning to start breastfeeding
  • have ever had facial surgery
  • have angle closure glaucoma
  • have problems with your heart or circulation
  • are taking drugs that may interfere with muscle function.

Side effects from using botulinum toxin type A (these are usually temporary) are :
drooping of the eyelids, headache, face pain, redness, swelling or bruising at the injection site,
skin tightness, muscle weakness, numbness or a feeling of pins and needles, nausea.

More Information

Descriptive Illustrated PDF

To see a good descriptive illustrated PDF prepared for American Society of Plastic Surgery all about botulinum toxin type A (botox) (and copy it if you like)look here on the downloads page.

before and after photos

American Society of Plastic Surgeons Botulinum Toxin

Videos

Botox Procedures (unauthorised)
American Society of Plastic Surgeons Botox Breast Lift *
American Society of Plastic Surgeons Purtox Use *
* not permitted to be promoted in Australia