Botulinum toxin (BT) is a therapeutic ingredient isolated from a rod-shaped, gram-positive bacteria Clostridium botulinum. Several BT serotypes have been identified, 2 of which (type A and B) have clinical significance. The use of botulinum toxin type A on the upper face was first documented in the late 1980s. It was later approved by the US FDA for cosmetic use and is now considered as one of the most important contributions to the approach of anti-aging.
Types of Botulinum Toxin
There are currently 3 botulinum toxin type A and 1 botulinum toxin type B preparations available commercially and approved for cosmetic and medical use. These preparations are neither identical nor interchangeable.
Botulinum toxin type A
Out of 2 approved serotypes, botulinum toxin type A is the most commonly used for both cosmetic and clinical purposes.
Known brands: Botox, Dysport, Xeomin
Botulinum toxin type B
Botulinum toxin type B is generally not used for cosmetic indications because of side effects and a shorter duration. Known brands: Myobloc
Benefits of Botox
- Botox can prevent the development of wrinkles created by facial expressions. There is no definitive recommended age to start the treatment, but patients in their 20s can receive Botox treatments to prevent wrinkles.
- It has an excellent safety profile and is proven effective for various cosmetic indications such as glabellar lines, forehead lines, infraorbital and perioral wrinkles, and crow’s feet. Some doctors use it for gingival smile, dimpled chin, and platysmal bands of the neck.
- It can be used in conjunction with other cosmetic procedures (e.g. dermal fillers, laser therapy, and face-lift) to achieve superior facial rejuvenation effects.
- Aside from aesthetic applications, the remarkably potent neurotoxin is useful in more than 50 pathological conditions, from excessive sweating to migraine.
BOTOX Risks and Health Concerns
Despite its temporary effect, Botox injections remain very popular. While most studies confirmed the safety of Botox for long-term use, the drug is not without some risks. The risk of side effects is greatly reduced when the procedure is performed by qualified and experienced medical providers.
Side Effects and Complications
Side effects are mild and usually resolve themselves in a short period of time. Serious complications include impaired vision, infection, and other life-threatening complications. There is also a risk that the toxin will migrate into undesirable areas of the face and neck causing difficulty of swallowing. Potentially lethal complications are associated with:
- Administration of higher doses;
- Administration of fake Botox;
- Improper injection techniques;
- Patients’ underlying comorbidities (cardiovascular or neurological).
Often due to needle trauma, bruising will resolve within a couple of days. Avoiding NSAID pain relievers, aspirin, vitamin E, and some supplements (e.g. ginkgo biloba and ginseng) will reduce the risk of bruising.
Swelling of the Eyes
Eye edemas have higher incidence reports among patients of Asian ethnicity. It is a not a serious complication and often resolves within 2 to 4 weeks. It can be due to allergic reaction, trauma, or infection.
Drooping of the Eyelids and Brows
Eye-related problems such as ptosis, blurred vision, and double vision are often caused by poor injection technique. They may occur within 2 weeks post injection and resolve after another 2 weeks.
Asymmetries and Imbalances
These complications occur at slightly higher rate and is often due to erroneous injection of the drug.
Some patients may experience headache after Botox administration for forehead wrinkles or glabellar lines. This usually goes away within 1–2 days.
Be sure to only receive treatment from a licensed injector to avoid unwanted risks.
The treatment is safe and effective for many patients, but not everyone can be treated with Botox injections. Patients with the following conditions may not be eligible to receive the treatment.
- Patients taking aminoglycoside antibiotics, anti-inflammatories, and Alzheimer’s drugs and heart medicines.
- Pregnant and nursing women.
- Patients with known hypersensitivity to any component of the medication (i.e. human albumin).
- Patients with neuromuscular disorders.
The Journal of Aesthetic Plastic Surgery published a study that evaluated 16 clinical trials consisting of 42,405 individuals who had Botox for facial rejuvenation, and found that most side effects are caused by untrained or inexperienced injectors. Botox injections must be given by a qualified physician with proficient understanding of the neurotoxin and its types, functional facial anatomy, correct dosing, and appropriate indications. Injections can be extremely risky in the hands on an unqualified injector.
The drug continues to be misused and represented despite the manufacturer’s efforts to keep a watchful eye on sales and delivery of legitimate products. Botox complications and poor results are often associated with injection of watered down or fake products being sold at discount prices. Practitioners can purchase genuine products from trusted sources, such as Doctor Medica.
Botulinum toxin injectables are useful in temporarily reducing facial wrinkling caused by muscle activity. It is a safe treatment in the hands of a qualified and competent injector. Patients must be warned of the dangers and health risks of getting Botox from unlicensed practitioners. Adverse events are mostly mild and self-limiting. Risk of serious complications are extremely high from improper technique and unethical administration of the drug. An injector without proper training may end up causing asymmetry and irregularities on an individual’s face. It is mandatory for medical providers to have deep knowledge of the anatomy of facial muscles and the use of proper injection technique to avoid complications and achieve consistent and desirable results.