Everything You Need To Know About Botox in 2023

Botox, also known as botulinum toxin, is a protein used in aesthetic medicine to paralyze facial muscles and reduce fine lines. It has become the number one facial rejuvenation treatment in the world for its minimally invasive characteristics and its very natural result.

According to the 2018 ISAPS report , Botox was confirmed for the 16th consecutive year as the most requested aesthetic treatment in the world with more than 6 million applications. If we look at the data for men and women, the former represent 12.3% compared to 87.7% of women who undergo botulinum toxin treatments.

Botulinum toxin history

Botulinum toxin was discovered in 1985  It is a bacterium in charge of making a protein that caused the most powerful neurotoxic substance discovered up to that moment.

Between 1920 and 1946, a renowned group of doctors and biologists demonstrated that botulinum toxin type A produced a blockage in the release of acetylcholine in motor neurons, causing the muscle to relax.

Starting in the 1970s, the effects of botulinum toxin were discovered in medical use, such as in ophthalmology to correct strabismus or blepharopesmam. In 1990 it began to be used to treat neurological diseases such as spasmodic torticollis and in 2001, in the United Kingdom, Botox began to be used to treat excessive sweating (hyperhidrosis). In 2004, this use was also approved in some countries such as Spain, and its cosmetic use was also certified here under the commercial name of Vistabel.

In 2002 the FDA approved its cosmetic use under the trade name ” Botox Cosmetic “. To this day, botulinum toxin to treat neurological disorders has been approved in more than 75 countries and more than 40 have approved its cosmetic use, so this product continues to revolutionize the world of aesthetic medicine, as according ” an adequate use of botulinum toxin is not dangerous since the dose for therapeutic purposes is far from the toxic dose. Today we are not only looking to remove wrinkles but to modify negative expressions, prevent aging and look for natural-looking results ” .

How does Botox work?

To date, the greatest use of botulinum toxin is for aesthetic purposes, it turns out to be an excellent anti-aging that eliminates the signs of aging and guarantees a very natural result. It should be noted that in Spain those approved for clinical use are botulinum toxin A and B, although the most used is type A due to its efficacy. 

• Vistabel® (Allergan)
• Botox ® (Allergan)
  
• Azzalure® (Galderma)
• Bocouture® (Merz Aesthetics)

A British Dental Journal publication on botulinum toxin and its effectiveness states that “Wrinkles are a consequence of the aging of facial tissues, which implies combined changes in the quality of the skin, decreased volume, decreased elasticity of the tissue and gravitational descent. The use of botulinum toxin type A allows to improve these aspects at an affordable price and is, therefore, an accessible alternative to surgery “.

Botox is normally injected into the muscles of the upper third of the face, that is, it can correct the following types of wrinkles:

Frontal wrinkles (expression lines on the forehead)

• Periorbital wrinkles commonly called “crow’s feet”
• Frown lines

According to the botulinum toxin injections prevent and reduce wrinkles, and expression marks on the face as they help to block the nerve signals that make the muscles contract.”

There are two types of wrinkles:

1. Dynamics: They are the expression wrinkles that are seen when we make a facial movement
2. Static: With the passage of time, dynamic wrinkles become static, that is, they can be seen on the face without the need for a facial movement.

According to  “the professional must assess the face and the gestures and expression lines to agree with the patient which wrinkles and expression lines can be attenuated or completely paralyzed so that the final result is satisfactory”.

The treatment

Botulinum toxin is a substance produced by a bacterium, Clostridium Botulinum. The one used for aesthetic purposes is called Type A and is carefully purified in the production process of the product, which makes it absolutely harmless to health. The treatment is carried out by a doctor who specializes in aesthetic medicine , it is a fast outpatient treatment since it is carried out in about 30 minutes. Baby Botox is becoming more and more famous , which is used in very small doses and as a prevention.

The procedure is not painful but if necessary, the doctor may decide to apply a topical anesthetic product, cryotherapy or local cold so that the patient does not feel the discomfort of the punctures. Subsequently, with very fine needles for intramuscular injections (30G), botulinum will be injected into the areas to be treated, previously identified by the doctor.

After the procedure, only these simple recommendations should be followed:

• Do not sleep until 3 hours have passed after the treatment
• Avoid exposure to sunlight or UVA rays
• Avoid energetically massaging the treated area for at least 48 hours, to avoid the migration of toxins in other areas.

To work properly, the toxin needs 3 to 4 days, so it is normal not to notice any difference at the end of the treatment.

The results

The results are not immediate, but it is necessary to wait for 3 to 4 days for the botox to take effect and the wrinkles to be more relaxed says the results usually last 3 to 4 months and gradually disappear after. As a general rule, the procedure is repeated every six months although, in specific cases, it can be repeated after four months ”.

According to the key to the final result lies in the experience of the doctor, since he or she must be well trained and specialized to perform the treatment correctly. You must also be honest and in case you agree, ensure the infiltration of a full vial and show it to the patient.

Advantages of botulinum toxin

The advantages , compared to other rejuvenation techniques, are certainly due to the very low percentage of contraindications . In fact, the I SAPS reports that no particular cases of side effects have been recorded with botulinum therapy.

In summary, the advantages are:

• Immediate rejuvenation of the face , the lines of expression appear smoothed and give a fresh appearance to the whole face.
• The results are proportional and natural , the characteristics of the face are improved without transforming it.
• It is not a surgical operation , it is performed on an outpatient basis in a maximum of 30 minutes.
• The application is painless , only light anesthesia is applied to avoid the discomfort of injections.
• It is a quick treatment and can be repeated several times over time.
• It also addresses other problem s , such as hyperhidrosis , and chronic migraine.

Contraindications of Botox

According to the , botulinum toxin is very safe since it has been used for more than 20 years in many medical specialties.

Surely, to date, one of the main advantages of botulinum treatment is the absence of particular contraindications. In fact, botulinum toxin injection is not absolutely invasive and the only side effects could be due to allergic reactions, in addition to the possible presence of inflammation or infection at the injection site.

The side effects of Botox are usually temporary, disappearing with the progressive absorption of toxins. Most are due to a possible spread of the drug to adjacent muscle groups. Some patients report a mild migraine in the hours after treatment, a disorder that tends to go away in a short time. The safety of its use during pregnancy, lactation and childhood has not yet been proven.

Nefertiti Lift and Off Label Applications

In the field of aesthetic medicine, there are two new types of botulinum toxin injection treatment:

• Nefertiti Lift. Named after the famous Egyptian queen, it is used to treat sagging near the jawline and neck. It is carried out through micro injections of Botulinum toxin in precise doses to relax the facial and neck muscles. This causes the paralysis of the contraction of the muscle in the lower third of the face, that is, in the cheeks and jaw.
• Off Label. This term indicates the use of botulinum outside the areas of the upper third of the face. Through this technique it is possible to intervene to treat nasolabial lines, wrinkles or wrinkles at the corners of the mouth. It also improves the gummy smile. Off Label applications require the utmost caution from the physician, excellent knowledge of anatomy, and great patient information.

How do I find my doctor?

The choice of the doctor to perform aesthetic treatments is a fundamental step for the success of the treatment. It is important to establish a relationship of trust between the doctor and the patient, for this reason we suggest that you take advantage of the first visit to expose all your doubts and questions.

According to the , only doctors can apply botulinum toxin . Dentists, nurses, or physiotherapists are not trained to inject this substance for cosmetic purposes.

Who is the ideal patient?

According to the ISAPS report , patients who undergo this type of treatment belong to the age range of 35 to 50 years , which shows how the use of toxin tends to begin after 30 years have passed.

Despite the high percentage of female audiences, today the number of men using Botox to rejuvenate their appearance is increasing . In fact, in the United States there is the term “Brotox” to refer to botox applied to men.

What are the differences between the needs of men and women in the use of botulinum?

• Women: the main reason is undoubtedly aesthetics. Women want to preserve their youthful beauty while maintaining the youthful and fresh appearance of a wrinkle-free face. The applications aim to open the eye more, raise the eyebrow and rejuvenate the eye.
• Men: It seems that the focus of the male world is mainly due to problems related to sweating. In the case of use on the male face, the doctor must preserve the characteristics without altering the shape of the eyebrows to avoid facial feminization. According to  , the forehead, frown and periocular muscles in men are very powerful. With botulinum toxin. muscles are relaxed and crow’s feet and frown lines are minimized.

Hyperhidrosis and bruxism

In recent years, the use of botulinum toxin has spread to treat some non-aesthetic disorders. Botox injections are particularly necessary for the treatment of bruxism and hyperhidrosis.

• Bruxism: It is a disorder that involves involuntary grinding of the teeth during sleep. Involuntary jaw movement involves damage to the teeth, jawbone, and gums. The treatment 2 times a year helps to relax the muscles helping to control the jaw movements.
• Hyperhidrosis: As theexplains , “it is a chronic pathology characterized by abnormal sweating in one or more areas of the body.” Botulinum toxin injections made in the hands, feet, or armpits, temporarily inhibit sweat activity, limiting the effect of excessive sweating.

According to a study on the effect of Botox on bruxism published in PubMed, “The available research is inconclusive and does not show sufficient evidence that bruxism can be treated with injections of botulinum toxin type A. However, promising results have been shown in studies. individuals and more research is needed in this area. ”

Other uses of botox

Botulinum toxin is not only used for aesthetic purposes , but it is also used in other medical specialties to combat problems mainly related to muscle and endocrine activity:

• Neurology: Cases of torticollis, spasms, cramps, tremors and tics, contractures and muscle dysfunction have been successfully treated .
• Ophthalmology: One of its first medical uses was for the treatment of strabismus.
• Orthopedics-physiatry: It can be used as a treatment for headaches, migraines, back pain, myofascial pain syndrome, neuropathic pain in the knee or shoulder.
• Urology: It is used for the treatment of benign prostatic hypertrophy and urinary incontinence.
• Gastroenterology: It is used successfully to combat hemorrhoids, chronic anal fissures, stomach and bile duct dysfunctions.
• Dermatology: Its use for the treatment of hyperhidrosis is particularly well known , but it is also used for salivary disorders. In addition, recent studies consider it valid to combat acne and rosacea.
• Allergology: It has been shown useful to combat allergic rhinitis.
• Scars : Several medical studies demonstrate the drug’s potential in the prevention and treatment of hypertrophic and keloid scars.
• A pioneering study published in 2006 by Dr. Eric Finzi, “Treatment of depression with botulinum toxin A: a case series. “, Pioneered a possible new use of botulinum toxin. According to Botox’s ability to inhibit the contraction of facial muscles improves symptoms of depression like any antidepressant medication , by reducing the signals that muscles send to the amygdala normally, the area of the brain predisposed to control. our emotions.

Frequent questions

• Is its application painful? It is a practically painless procedure because very thin needles are used, although in people sensitive to pain it can be minimally annoying.
• How is the application carried out? Botox is previously diluted with physiological saline and applied by injections. A certain amount of product is applied in each area according to the needs of each patient
• When we can see the resultes? Once the injections are applied, you should wait about 1 week to start seeing the results on the face.
• When can you get back to the routine? Treatment requires minimal downtime or recovery time. You will be able to continue with your normal routine immediately after leaving your specialist’s office
• What are the most common side effects after its application? They are really few and temporary but there may be discomfort at the application site such as redness, swelling, itching, slight pain or small bruises. In rare cases there may be an allergic reaction
• At what age is it recommended to apply this substance? In aesthetic medicine, from the moment expression wrinkles begin to appear.
• What are the differences between botox and hyaluronic acid? Botox is used for the treatment of expression wrinkles, that is, wrinkles that appear or increase when a person gestures, while hyaluronic acid is a filler product whose function, as its name suggests, is to treat wrinkles that appear over the years. thinning of the skin and loss of collagen.

• Facial botox and escitalopram medication, is it contraindicated? it is not contraindicated, but if you go to the consultation of the aesthetic doctor who is going to inject the treatment, you must indicate the treatment you are currently following and he will take it into account, as well as advise you on everything that you can or cannot can you do.
• When can I hydrate my face with cream after botox? there is no problem to proceed to apply your creams normally from the day after the application of Botulinum toxin. We try to avoid massaging the treated area during the first hours after application, just to prevent the infiltrated material from moving or diluting around the exact area of application because if it is dispersed it loses effectiveness and the result of relaxation is not optimal. . But of course after waiting a few hours there is no problem in applying your creams and serums in the infiltrated area. It is not a bad thing to do it with books, little touches without squeezing too much, or with a very superficial light massage and, voila.