BOTULINUM TOXIN

What is botulinum toxin?

Botulinum toxin in cosmetics (onabotulinumtoxinA) is the most popular and well-known injectable neuromodulator. This form of botulinum toxin, patented by Allergan, relaxes facial muscles and softens expression lines.

Originally, it was developed to treat conditions such as schizophrenia and eyelid spasms. Cosmetic botulinum toxin is approved by the U.S. Food and Drug Administration for treating crow's feet, wrinkles, and horizontal forehead lines.

The FDA has not approved this treatment for softening lip lines, treating nose wrinkles (known as “bunny lines”), enhancing chin shape, or softening the neck area (known as the “Nefertiti lift”), lifting eyebrows, lifting the upper lip (known as the “Lip Flip”), enhancing the jawline, preventing teeth grinding, or narrowing the neck by injecting the trapezius muscle (known as “TrapeTox” or “Barbie Botox”).

Many doctors use large doses of botulinum toxin, which often results in patients' faces becoming expressionless masks. At the MESQ aesthetic clinic, doctors and practitioners strive to achieve a more subtle and natural result, preserving enough facial expressions for emotional communication.

In addition to aesthetics, botulinum toxin has medical benefits, such as treating excessive sweating (hyperhidrosis), temporomandibular joint disorder (TMJD), lazy eye (medically known as strabismus), chronic eyelid twitching (blepharospasm), neck spasms (cervical dystonia), chronic migraines, and vaginismus. Botulinum toxin is also being researched for treating chronic pain, scars, and depression.

Botulinum toxin is often mistakenly referred to as a filler, but in reality, these injectable treatments are very different and complement each other. While botulinum toxin targets dynamic lines, fillers add volume to reduce wrinkles and folds. Fillers can also be used to shape and contour the face.

How does botulinum toxin work?

Botulinum toxin temporarily blocks nerve signals to the muscles, reducing the strength of muscle contractions. The injected muscle's mobility decreases, and wrinkles caused by movement smooth out and become less noticeable. This can prevent existing lines from worsening over time and prevent the formation of new lines.

What is microbotulinum treatment?

Microbotulinum treatment is a method where botulinum toxin is injected into the surface of the skin instead of into the muscles. It is mainly used to tighten pores, reduce oiliness, and achieve a smoother skin appearance, but it can also help treat redness associated with rosacea.

However, MESQ doctors recommend other treatment methods, such as laser treatments and microneedling, either alone or in addition to microbotulinum treatment for the best results. The dilution and units used are the same as in traditional botulinum toxin injections, but the botulinum toxin is distributed over a wider area. It is typically injected into the T-zone and various parts of the face, such as the forehead, cheeks, nose, and chin. Microbotulinum treatment does not last as long as traditional botulinum toxin, and maintenance treatments are required every two to three months to maintain its effect.

What are the pros and cons of botulinum toxin?

Pros

This injectable treatment is quick and relatively painless. In some cases, it takes only a few minutes, and there is virtually no recovery time.

• An experienced medical professional who does not exceed the dose and injects at the right points – which vary for each patient – ensures that the face looks natural and not frozen or angry, avoiding the so-called “Mephisto” face.
• Botulinum toxin has been used for over 20 years, and our doctors and practitioners have over a decade of experience in treating patients with it.

Cons

The results of botulinum toxin are not permanent. To maintain them, the treatment needs to be repeated every three to four months.

• Unlike plastic surgery, non-surgical treatments like botulinum toxin cannot achieve the same anti-aging results.
• The most common side effect of botulinum toxin is mild bruising at the injection site.
• Temporary muscle weakness is an expected side effect, but some patients may be concerned when certain muscles do not function normally.
• Botulinum toxin is not recommended during pregnancy or breastfeeding, as its effects on the fetus or infant have not been sufficiently studied, and therefore its safety in these situations is uncertain.
• If using the services of inexperienced “specialists” without medical supervision, low-quality analogues of botulinum toxin are often used. This can lead to situations where urgent medical care is required.

How to prepare for botulinum toxin treatment?

Before botulinum toxin treatment, you can minimize the likelihood of bruising by discontinuing blood-thinning medications (if not medically necessary) one week before the treatment. Specifically, the use of non-steroidal anti-inflammatory drugs, such as ibuprofen or omega-3 fatty acids, should be stopped.

When should you start botulinum toxin treatment?

Botulinum toxin treatment can be performed on patients over 18 years old. Although some doctors recommend starting it between the ages of 20–30 for “preventative rejuvenation,” doctors at MESQ Clinic believe that treatment is only necessary when wrinkles start to become visible. Before that, there is no need to consider botulinum toxin treatment.

Who should avoid botulinum toxin treatment?

Botulinum toxin is not recommended during pregnancy or breastfeeding, as its safety has not been properly studied. It should also be avoided if you have previously had an allergic reaction to any botulinum toxin product, have an infection at the injection site, or have a neuromuscular disorder (such as myasthenia gravis).

Is botulinum toxin safe? What are the side effects?

Clinical studies have shown that botulinum toxin is safe, and its side effects are minimal. The most common side effects are mild bruising at the injection site and drooping of the eyelid after forehead treatment. There is also a risk of the toxin spreading unintentionally to other areas, causing effects such as drooping eyelids, uneven eyebrows, or a distorted smile. The best way to prevent this is to avoid touching the treated area for at least 4 hours after the procedure.

Less common but serious side effects include difficulty swallowing, breathing, or speaking, especially when large amounts of botulinum toxin are injected into the neck muscles.

Allergic reactions can also occur. If you notice hives, itching, shortness of breath, weakness, or swelling of the face, tongue, or throat, seek immediate medical attention.

If you are concerned about these risks, discuss them with your doctor before starting treatment.

How does botulinum toxin treatment proceed?

Botulinum toxin injections are a routine procedure that takes about 15 minutes. You and your doctor or nurse will discuss your concerns, goals, and medical history to ensure the treatment is safe for you. Pictures will be taken before the procedure to track the effectiveness of the treatment. Then, the face will be cleansed, and the doctor or nurse will inject botulinum toxin into the problem areas. After the treatment, you can continue your normal activities. Any redness or bruising can be covered with makeup.

What should be avoided during recovery after botulinum toxin treatment?

Remember one simple rule: do not rub the treated areas for at least four hours and avoid anything that may cause pressure, such as using an ice pack, wearing a tight hat, or washing the face vigorously.

How soon does botulinum toxin start to work?

The effects of botulinum toxin begin to appear on the second or third day, but the maximum effect may take up to two weeks to develop. Botulinum toxin needs to bind to the receptors of nerve cells before it starts to relax the muscles, which takes time.

How often should botulinum toxin treatment be repeated?

The effect of botulinum toxin lasts an average of three to four months. The effect typically wears off first from the forehead, then from the crow's feet, and finally from the glabella. You can have maintenance treatments approximately every four months. The duration of the effect is individual.

Will you look older when the effect of botulinum toxin wears off?

If you stop the treatment, the effect will wear off, and your muscles will return to normal movement. This may include wrinkling and lines that could make you appear older.