Botulinum Toxin

What is Botulinum toxin?

Botulinum toxin A is a very successful medical treatment for facial lines and wrinkles. It is delivered by injection directly into the facial muscles

A topical form of botulinum toxin A is under investigation.

How does it work?

BOTOX®, a registered trade mark of Allergan Inc., and Dysport®(Ipsen's product) are different forms of purified botulinum toxin A (onabotulinumtoxinA), and are produced by the bacterium Clostridium botulinum, the cause of a dangerous disease called botulism. Botulinum toxin is a neuromuscular blocking agent, which means it causes paralysis of the injected muscle by preventing the release of acetylcholine from motor nerve terminals. Without its nerve supply, the muscle fibre withers away. The muscle strengthens again as the nerves regenerate.

Botulinum toxin reduces sweating by blocking the sympathetic nerve fibres that control sweat glands.

What can botulinum toxin be used for?

Botulinum toxin treatment was originally introduced to treat muscle spasms, including blepharospasm (spasms of the eyelids), strabismus (squint), cervical dystonia (torticollis of the neck) and spasticity due to cerebral palsy or other muscular diseases.

In patients treated for facial spasms it was noted that facial wrinkling decreased over the treated muscle. This experience lead to the development of botulinum toxin for the treatment of dynamic facial wrinkles.

People often dislike their central scowl lines (called glabellar lines), which are caused by the corrugator and procerus muscles contracting when concentrating, squinting, or frowning. Botulinum toxin injections into these muscles weaken them and successfully reduce the prominence of the line.

Botulinum toxin can also be used to lessen crows' feet, bunny lines, marionette lines and smoker's lines. The treatment can be combined with implantations such as collagen or hyaluronic acid to further improve the appearance. It can also be used to shape the eyebrows into an arch or flare and to correct facial asymmetry.

Botulinum toxin is very successful at reducing excessive localised sweating (hyperhidrosis), especially in the armpits. Multiple superficial injections are given in a grid-like pattern over the affected area. It may also prove helpful to reduce flares in those with pompholyx (a form of hand dermatitis) or Hailey-Hailey disease, when these are provoked by sweating.

It has also been successfully used to control anal fissuring, postherpetic neuralgia (shingles pain) and some forms of headache

How is botulinum toxin administered?

Tiny quantities of the toxin are injected directly into the affected muscles. It takes three to five small injections between the eyebrows to treat the frown line. The injection is almost painless. The treated muscles weaken over the following week or so. Most people do not notice anything. They simply become aware that they are no longer able to contract the frown muscles. They can still lift their eyebrows normally and blink without problems

You can frown as often as you like in the first day or so, but the treated areas should not be touched. Don't have a facial massage!

To reduce sweating, tiny injections are placed in the affected area at about 1cm intervals; this can be quite painful especially if the hands are injected, so local anaesthetic may be required.

The effect of botulinum toxin starts wearing off within a few weeks but retreatment is not usually needed for three to six months. It can be repeated as required. Many people find after three or four treatments to glabellar lines that they don't need another one for a long time; the muscle has markedly weakened or they have broken the bad habit that led to the frowning or squinting originally.