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Botox and How it Works

doctor botoxBotulinum toxin, more commonly known as Botox, is a neurotoxin created by the Clostridium botulinum bacteria.  Botox is used to treat some types of muscle-related conditions and to remove wrinkles by temporarily paralyzing the tiny muscles in the face.  While Botox is the most well-known form of botulinum toxin type A, it is also available under the names Dysport and Bocouture.  A second type of botulinum toxin, type B, is available under the name Myobloc.

Some important points about Botox

Botox is used more than 6 million times every year in cosmetic procedures, making it the most popular cosmetic treatment.  It works by paralyzing the small muscles responsible for formation of wrinkles.

Botox can also be used to treat migraines, excessive sweating, some muscle-related  disorders, and some bladder and bowel conditions.

The bacteria that produces botulinum toxin is found in the environment, especially the soil.  Environmentally, it is largely inactive.  However, it can cause botulism, a potentially fatal infection that causes respiratory failure.  A single gram can kill more than a million people, while two kilograms would be sufficient to kill the entire human population.

History of Botox

The bacteria that produces botulinum toxin is found in an inactive state in the soil and in sediment of untreated bodies of water.  It also lives in the intestinal tracts of many mammals, in the gills of fish, and in the organs of many shellfish.  The bacteria and its spores are generally harmless.  They only become a problem when the bacteria cells begin producing the toxin, usually when cell populations increase to a certain point.

Neurotoxins are so named because they target the nervous system and disrupt communication between the neurons.  botulinum toxin is divided into eight different types.  Of those, subtypes A, B, E, and occasionally F are the types that cause botulism in humans, while the others illness in other animals.

Botulinum toxin is thought to be among the most highly poisonous substances known.  It has been estimated that one gram could be lethal to approximately a million people.  Untreated, botulism can cause respiratory failure and can be fatal.

Botulinum toxin is a classic example of the idea that it is the dose that makes a substance poisonous.  Botulinum toxin has been used to treat a variety of muscle-related conditions, including cerebral palsy, as well as migraines and certain bladder and bowel conditions.  However, the most popular use of the toxin is to paralyze the small muscles under the skin of the face to minimize wrinkles.  

Clinical use of botulinum toxin is based on the ability of the toxin to block nerve signals from reaching the targeted muscles so they are unable to contract.

Muscle contraction is caused when nearby nerves release the neurotransmitter acetylcholine.  The acetylcholine binds to receptors on the cells of the muscle, telling it to shorten.  Botulinum toxin prevents the neurons from releasing acetylcholine.

Uses of botulinum toxin

Most people know of Botox as a cosmetic procedure for reducing wrinkles, especially around the eyes, but Botox has been approved for many other uses, including:

  • Eyelid spasms,
  • Muscle spasms in the neck or shoulder, especially when the cause is unclear,
  • Migraines, especially those linked to craniofacial nerve compression,
  • Excessive sweating,
  • Leaky bladder,
  • Crossed eyes,
  • Spastic limbs after a stroke
  • Some cases of urinary incontinence, and
  • Overactive bladder.

Aside from these FDA approved uses, botulinum toxin has also been used off-label for:

  • Difficulty swallowing due to Achalasia (a problem with the esophagus,
  • Anal fissures and dysfunction,
  • Excessive salivation,
  • Nasal allergies,
  • Dysfunction of the Sphincter of Oddi (a band of muscle that controls flow of juices from the liver and pancreas into the intestines)
  • Muscle spasticity associated with cerebral palsy, and
  • Uncontrolled spasms in the jaw, face, tongue, or vocal cords.

Botulinum toxin powder is given in minute doses.  A powder is diluted in saline and injected directly into the target muscles.  In most cases, the toxin begins to work in 24-72 hours, though in rare cases it can take up to 5 days before the full effects are noticed.  Botulinum toxin is not recommended for use in women who are pregnant or breastfeeding, or by anyone who has previously experienced an allergic reaction to botulinum toxin.

Safety and side effects

Treatment with botulinum toxin is usually well-tolerated by most people with few side effects.  In rare cases (about 1%), patients develop antibodies that make further treatments ineffective.  Some patients may experience additional side effects after treatment, including:

  • Discomfort, swelling, redness, or fluid retention near the injection site,
  • Numbness,
  • General feeling of illness,
  • Nausea,
  • Temporary weakness or paralysis of muscles beyond the treated area,
  • Temporary drooping of the upper eyelids,
  • Temporary weakness of the lower eyelid or muscles controlling eye movement,
  • Difficulty swallowing,
  • Weakness in the neck,
  • Flu-like symptoms,
  • Damage to the nerves in the neck,
  • Dysfunction of the gall bladder,
  • Double or blurred vision,
  • Bleeding,
  • Vision problems,
  • Dry mouth,
  • Rash or hives,
  • Fatigue, or
  • Wheezing.

New research is being conducted and new uses for Botox are being discovered all the time.  Following are some recent developments on Botox.

Botulinum toxin offers some relief to migraine sufferers, but does not seem to be quite the miracle cure that some believe, according to researchers from the Medical College in Milwaukee, WI in a study published in the (JAMA) Journal of the American Medical Association.  The researchers noted that Botox was not significantly more effective than a placebo.

Researchers in Australia have discovered a new way to block the toxin’s action, which could lead to the development of new treatments for botulism.  The study is published in the International Journal of Biological Chemistry, August online edition.

The journal JAMA Facial Plastic Surgery recently published a study that found Botox may effectively improve skin elasticity for as long as 4 months.

Botulinum toxin has been steadily increasing in popularity as a minimally invasive cosmetic procedure.  Since 2000, procedures have increased 700%.  In 2013, Botox was administered 6.3 million times for cosmetic procedures alone.

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