About Botulinum Toxin (Botox, Vistabel, Dysport)
Botulinum toxin's first application was to treat strabismus (a condition in which the eyes are not properly aligned with each other). Later on, it became common practice in neurology, plastic surgery and as a treatment for excessive sweating.
Botulinum toxin's main action is to selectively paralyze the muscles that cause wrinkles. Thus, they can no longer react by excessive contraction. The transmission of nerve impulses at the synapses is blocked, the mucles become flaccid and the skin above them flattens.
In our practice we have used the following preparations, depending on their legalization/certification status:
- DYSPORT (manufactured by Ipsen in the UK);
- BOTOX (manufactured by Allegran in USA). Since 2006, Botox has been sold in the UK under the name VISTABEL, with identical formulation.
The concentration of toxin between the two is quite similar and most surgeons agree that there is no significant difference between them.
Botulinum toxin can be injected to the following areas:
- The glabellar muscles of the forehead (they give an angry look);
- The orbicularis oculi (it creates the wrinkles around the eyes):
- The frontalis (it creates the wrinkles of the forehead).
Detailed knowledge in anatomy is required in order to prevent unwanted side effects and blocking different mucle groups. The injection itself takes a few minutes. The surgeon uses a special syringe and injects a small amount of botox to the muscles involved. Men usually require a larger amount, due to larger muscles. The pain involving the injection is usually well tolerated by most patients and there is no need for local anesthetics. In selected cases a sedative drug or local anesthetics can be used.
Effect and Duration
The effect takes place a day or two after the procedure and reaches its maximal effect about 10 days later.
The full effect duration of the treatment is usually 3 months, and a partial effect lasts for 8 months. Longer action causes muscle fibers to degenerate and it is therefore recommended to repeat the treatment in 3-4 months. After several treatments, the periods of time with full effect last longer and usually much less botox is required to achieve it each time. Many patients enjoy even the partial effect for long periods of time. There is no permanent effect.
Permanent effect of blocking the glabella mucles can be achieved via Dr. Serdev's scarless suture method for glabella muscle ligation.
Precautions and Side Effects
The treatment with botulinim toxin proved to be relatively safe.
Precautions include: known allergies to botox or albumin, muscle weakness, use of aminoglicozide antibiotics, pregnancy or breastfeeding.
Common side effects include: bleeding around the injection sites, headache, flu like symptoms and local pain. Another unwanted effect is paralysis of adjacent muscles which may cause eyelid drop (usually partial), double vision and difficulty swallowing. Because only part of those muscles are paralyzed, there is usually a full compensation of the remaining muscle after 2-4 weeks.