You may have read about Botox Cosmetic in advertisements, blogs and celebrity gossip magazines, or heard about it from your friends. But there are a lot of misconceptions about Botox treatment and how it is used.
Botox Cosmetic has been available by prescription in the United States since the FDA approved it in 2002. The exact same Botox injected for medical purposes (such as uncontrolled muscle spasms) was first approved by the FDA in 1989.
In 2017, botulinum toxin was the top nonsurgical cosmetic procedure in the U.S., with 1,548,236 injections (of Botox, Dysport and Xeomin) performed by physicians and their physician assistants and nurse injectors. That is up 30 percent from the 1,190,995 botulinum toxin injections performed in 2012.
What Is Botox Cosmetic?
Botox, or onabotulinumtoxinA, is used for three main purposes: muscle spasm control, severe underarm sweating and cosmetic improvement. In this article we concentrate on the third use, achieved with the product called Botox Cosmetic, which contains botulinum toxin type A (the active ingredient), human albumin (a protein found in human blood plasma) and sodium chloride.
Botox Cosmetic is used for the temporary smoothing of glabellar lines (also called frown lines), which are the lines between your eyebrows that can make you look tired, unhappy or angry.
It is FDA-approved for this use and in this area only. However, it is often used off-label for horizontal forehead lines, crow’s feet, marionette lines at the corners of the mouth and smoker’s lines around the lips.
Don’t confuse Botox Cosmetic with injectable fillers. Dermal fillers work differently, plumping up tissues so that lines and wrinkles diminish or disappear (Restylane, Radiesse and Juvederm are examples).
Your practitioner can help you decide which product(s) will solve your particular appearance issues, though as a general rule, Botox is used mostly in the upper portion of the face, and fillers are used mostly in other areas.
How to Know If You Are A Candidate For Botox?
In the United States, the FDA has approved Botox Cosmetic for people aged 18 to 65. But you shouldn’t use it if you:
Are allergic to any ingredients in Botox or Botox Cosmetic.
Are allergic to another botulinum toxin brand (such as Myobloc, Xeomin or Dysport) or had any side effect from these products in the past.
Have a skin infection or other condition in the injection area.
Have ALS (Lou Gehrig’s disease), myasthenia gravis, Lambert-Eaton syndrome or another disease that affects your muscles or nerves.
Have breathing problems, such as asthma.
Have difficulty swallowing.
Have bleeding issues.
Plan to undergo surgery.
Have had facial surgery.
Have weakness in your forehead muscles.
Have drooping eyelids.
Are taking or have recently taken certain medications, vitamins or supplements (see below).
Botox Cosmetic is not expected to travel far enough through the body to affect a fetus or breastfeeding infant. However, for ethical reasons, clinical studies have not been done on expectant or new mothers, so nobody knows for sure.
Therefore, the manufacturer (Allergan) advises that you should not have Botox injections if you are planning or trying to conceive a child, are pregnant, are planning to breastfeed or are currently breastfeeding. It’s better to be safe, and you can always have Botox later on.
How Botox Injections Work?
A wrinkle in the skin is typically formed perpendicular to a contracting muscle located directly beneath it. For example, the muscle in the forehead is a vertical muscle, and when it contracts (such as when you raise your eyebrows), the lines that form (wrinkles) will be horizontal.
Likewise, the two muscles that are responsible for the frown lines are positioned slightly horizontally between the eyebrows, so when they contract, the frown lines appear vertical.
Botox Cosmetic is injected into muscles, where it blocks nerve impulses to those tissues. The muscle activity that causes the frown lines is reduced, and a smoother look results. Without a contracting muscle beneath it, the skin has a difficult time wrinkling.
Facial lines that exist when your face is totally relaxed are not very good candidates for Botox. These lines are better handled by the dermal fillers. Botox can frequently “soften” these lines but not always get rid of them.
The injections take about 10 minutes, and you should have no downtime afterward.
Normally you would see improvement within a few days. Botox requires two to four days for it to attach to the nerve ending that would normally stimulate the muscle to contract. The maximum effect usually occurs at about 10-14 days. Therefore, whatever effect is obtained two weeks after the injections should be considered the maximum effect that is going to occur.
Botox Side Effects
Potential Botox side effects include pain at the injection site, infection, inflammation, swelling, redness, bleeding and bruising. Some of these symptoms may indicate an allergic reaction; other allergy symptoms are itching, wheezing, asthma, a rash, red welts, dizziness and faintness. Tell your doctor immediately if you have any breathing issues or a faint or dizzy feeling.
You may have heard of other side effects as well, such as numbness, droopy eyelids, muscle spasms or twitching, and migration of the substance.
Numbness as an absence of physical sensation is not really an issue with Botox, because Botox is not an anesthetic. Numbness as the result of the inability to move a muscle is an issue for some people.
Muscle spasms in the area of the Botox injections do not occur while the Botox is effective. After all, Botox is used to treat spasms related to benign essential blepharospasm, hemifacial spasm, cerebral palsy, fibromyalgia and temporomandibular joint disorder.
It is possible for the Botox to spread a little beyond the intended injection site and affect surrounding tissues. For example, if you receive injections into the forehead close to your eyebrows or your upper eyelids, they could be affected and may droop temporarily.
The best practitioners know the correct sites of injection to avoid side effects such as droopy eyelids. A small, highly concentrated dose of Botox dose is less likely to spread from the injection site than a large diluted dose.
This underscores the importance of finding a practitioner who has long experience with giving Botox injections. Also, if you have any questions about your Botox treatments, your doctor is the one who knows the specifics of your regimen to best assess any reactions or concerns you may have