The Basics of Botox
A quick note before we start. You know how Kleenex and tissue are used interchangably even though one is a brand and one is the actual thing? Well, Botox is a brand of injectable botulinum neurotoxin, but it having been the first to the market, got all the fame and notoriety. Today we also have Juveau, Xeomen, Daxxify, Dysport, etc, but all are essentially a distillate of neurotoxin of type A botulinum and all work the same. For convenience, I will use the term Botox collectively.
In the 1800s, a mysterious illness started showing up in some European countries in people who had eaten preserved sausages. An astute physician identified the link and was then able to identify the Clostridium Botulinum bacteria. The bacteria was shown to produce a neurotoxin that caused a progressive paralysis that proved fatal in many people who contracted it. Skipping forward to World War 2, botulinum toxin was identified as a potential candidate for use in chemical and biological warfare. A large quantity of botulinum toxin was distilled, but the war ended before it was weaponized. Having this large quantity and nothing else to do with it, they started looking for medical uses.
One of the enterprising physicians was Dr. Jean Carruthers, an opthamalogist. She was using the botox to relax the eye muscles to help people with a lazy eye. She noticed that patients who received botox injections didn’t get wrinkles around their eyes. She was married to a dermatologist - Dr. Alastair Carruthers - and together they worked out how to use botox for cosmetic purposes and wrote the intial groundbreaking research papers.
So, how does it work? Botox binds the receptors in the nerve endings for the muscle in which it is injected. The muscle is then unable to contract and because it stays relaxed, the skin overtop the muscle is not repeatedly “folded” and wrinkles fade. The deeper the wrinkle, the longer this will take and it may not fully fade, but more improvement will continue the longer you continue the treatment. The key is that this is a temporary treatment. Eventually, the body will metabolize all of the botox away. For most people, at most doses, this takes about 3 months. For some it will take less time and for some it will take more. There are some things you can do to help - supplements with elemental zinc and vitamin D, regular treatment allowing the muscle to atrophy a little more over time, and of course, good skin care to encourage collagen production.
What are the downsides? The good news is that because all botox treatment is temporary, any negative effect of the treatment is temporary! The biggest downside is that in the attempt to treat a specific muscle - say the glabella (the muscle of the brow) - you accidentally treat another muscle - the levator palpebrae superioris - and can’t fully open your eye. This happens because many of the muscles of the face are thin and very close together. It can also happen because if you do something like lay down and take a nap right after treatment, then the medicine can migrate into another muscle. We also encourage you to avoid working out, excessive heat and anything that puts pressure on your face for at least 6 hours after treatment, so if you have massage and hot yoga session scheduled, it’s not the day to get your tox done.
What are the upsides? There are the nice effects of not getting wrinkles and therefore looking young and beautiful. But, there are other good effects and medical uses. It is notable that botox injections are generally only approved for treatment in the area of the glabella (brow) and for some the frontalis (forehead) muscles. It works in many places though and so we will also discuss some off label uses. If one has hooded eyes and is nearing the point of losing some peripheral vision due to excess eyelid skin (as I was a few short months ago), then using botox to relax the brow and outer corners of the “crows feet) gives one a bit of a brow lift and “opens” the eyes. For those that suffer migraines and tension headaches, botox can be injected in certain patterns to relax overly tight muscles. For those with TMJ, botox can be used to relax the jaw and masseter muscles. For those that are permanently frowning, you can relax the frown muscles and have less “resting b**** face.” For those whose top lip disappears when they smile or whose entire mouth can’t help but open, minor treatments in the lip and even the smile - and keep the lipstick off your teeth. It can also be used to relax the muscles in the sweat glands of the armpits and palms.
This is just the beginning and there is more to say, but if you have questions or think this might be right for you, then give us a call and let’s have a consult about it.