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July 7, 2020

What is behind Botox®?

Wrinkle treatment with botulinum toxinIn aesthetic medicine Botox® is a well-known and popular active ingredient for treating annoying dynamic wrinkles (expression lines). The term Botox® has already become part of everyday language. The brand name stands for botulinum toxin type A. It is not only used to treat wrinkles, but is also used in other medical areas. In the following article, we have summarized where Botox® comes from, how exactly it works and what to look out for during a Botox® treatment.

(Image: © Yakobchuk Olena – stock.adobe.com)

Excursus: the history of Botox®

The history of Botox® dates back to the 19th century. It begins with an illness, the life-threatening food poisoning botulism. Meat or sausage poisoning (from the Latin botulus = sausage) is triggered by toxins secreted by the bacterium Clostridium botulinum, which enter the body when spoiled meat or improperly cooked vegetables are consumed. The toxic proteins cause symptoms of paralysis, which usually begin in the head area and in severe cases spread downwards to other muscles and organs. There have certainly been cases of botulism since the earliest times of mankind, but the disease was first described at the beginning of the 19th century.

Botulinum toxin is therefore a very powerful neurotoxin. In fact, it is the strongest known biological toxin. In medicine, an extremely highly diluted form of botulinum toxin A is used which, when used correctly, achieves the desired treatment results without becoming dangerous to humans. Botulinum toxin A was isolated in 1946 by the American Carl Lamanna and approved as a drug in the 1970s.

In 1989, OnabotulinumtoxinA (later renamed Botox®) received FDA approval for the treatment of certain eye conditions, including strabismus and eyelid spasm. In the process, doctors discovered the temporary wrinkle-smoothing effect of the neurotoxin. For some time, the preparation was used off-label (i.e. outside the actually designated and approved area) for cosmetic treatments, until it finally received official approval for aesthetic applications from the FDA in April 2002.

What are dynamic wrinkles and how do they develop?

Botulinum toxin is suitable for smoothing dynamic wrinkles. This refers to wrinkles that are created and activated by recurring muscle movements. They are therefore mainly visible when the corresponding muscle is tensed, for example when raising the eyebrows, smiling or pursing the lips. With the increasing loss of elasticity of the skin, these wrinkles can deepen over time and lead to an unpleasant appearance.

In addition to dynamic wrinkles, there are also static wrinkles, which are visible regardless of facial expressions – i.e. permanently. These include, in particular, wrinkles in the nose and mouth area such as nasolabial folds and marionette lines. Static wrinkles are often treated with derma fillers such as hyaluronic acid are often used to fill and smooth out the unwelcome unevenness in the skin. They also stimulate the formation of new connective tissue, resulting in a harmonious tightening effect.

Effect of botulinum toxin in wrinkle treatment

The smoothing of mimic wrinkles with Botox® is based on the inhibition of stimuli on the muscles. In the tissue, the active ingredient reduces the release of the neurotransmitter acetylcholine, which transmits information from the nerves to the muscle. As a result, the muscle does not contract because the impulse is not sent. This also means that the wrinkle is not activated and the skin then smoothes out.

Botox® does not work immediately after the injection. The effect sets in about one to seven days after treatment. The muscle is blocked for about three to six months (applies to the upper third of the face). During this time, the body gradually breaks down the active substance. As soon as the transmission of information can no longer be inhibited by the botulinum toxin, normal muscle movement is possible again. However, the corresponding wrinkles then become visible again.

Does Botox® cause long-term damage?

No, Botox® is a safe treatment method with no risk of long-term damage when used correctly by an experienced doctor. After the natural breakdown of the botulinum toxin, the nerves are undamaged and unchanged.

What you should consider before and after Botox® treatment

Before treatment with Botox®, it is particularly important to choose the right practitioner, as only an experienced and specially trained doctor can achieve the desired treatment success with the lowest possible risks. When searching for a doctor, patients can use the website of the DGBT (German Society for Aesthetic Botulinum and Filler Therapy). It offers the function of finding certified doctors in the vicinity.

Generally, only mild discomfort is to be expected after the treatment. Most patients are fully fit for social life and work again the following day. Slight swelling and redness may persist for a few days in individual cases. You should avoid rubbing or massaging the treated areas for about five days, as the active ingredient may otherwise spread to unwanted areas.

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