What is Botulinum Toxin?

Botulinum toxin is a neurotoxin made by the bacteria clostridium botulinum; an anaerobic bacteria found in soil. Botulinum toxin is purified for clinical and cosmetic use. Botulinum toxins are divided into 7 serotypes by their differences in potency and duration of action. Botulinum toxin type A is the most potent of the serotypes and therefore is used for clinical and cosmetic purposes.

There are several product brands under the different Botulinum toxin A subtypes including Azzalure®, Dysport®, Bocouture®, Xeomin®, Botox® and Vistabel®. Botulinum toxins contain albumin, which comes from human blood. No cases of contamination of licensed botulinum toxin products with infectious diseases have been reported.

All botulinum toxins are prescription only medicines (POM) and can only be prescribed by registered prescribers, following a face-to-face consultation.

How Does Botulinum Toxin Work?

Once injected into the muscle, the mechanism of action of botulinum toxin is to cause temporary muscle paralysis by blocking the signal from the nerve to the muscle telling the muscle to contract. The muscles enter a resting state, which creates the desired cosmetic effects. With time, the body learns to bypass the blockage leading to the reoccurrence of muscular contractions and hence the ‘wearing off’ effect of botulinum toxin. This recovery takes 8-12 weeks to occur.

The treatment may not completely paralyse the muscle and often some movement is retained. The aim is to reduce the amount of movement of the muscle and therefore the number and depth of lines visible on movement. It does not treat lines that are present with no muscle movement (static lines).

What can Botulinum Toxin be used for?

Botulinum toxin can be used for many medical purposes such as migraines, muscle spasm and bladder overactivity. Most brands of Botulinum toxin are only licensed for use in frown lines but have been proven to be safe and effective in many other “off-label” uses including:

• Upper face: Traditionally known as the “3 Areas of Botox” this encompasses treatment of horizontal forehead lines, frown lines and crow’s feet.
• Brow lift: These are injections targeted just under the brow to lift the brow, open up the eyes and reduce dark shadows.
• Bunny lines: Lines on the nose that appear on wrinkling the nose like a bunny can be treated with an injection into the nasalis muscle.
• Gummy smile: When we smile, our upper lip rests around the level of the top of the upper teeth. If our muscles are overactive, then this can lift the lip too high and expose more of the upper gum. Botulinum toxin can be used to lower the upper lip.
• DAO: The depressor anguli oris (DAO) muscle is responsible for bringing down the corners of our mouth. Paralysing this muscle provides a lift to the corners.
• Mentalis: The muscle of the chin, botulinum toxin in this area smooths out the chin and prevents it from puckering on facial expression.
• Masseter/Jawline slimming: Botulinum toxin into the masseter muscle treats jaw clenching and grinding (bruxism) and over time can slim the jaw.
• Neck: Paralysing the platysma muscle of the neck can get rid of neck “bands” visible on straining and provide a slight lift to the neck. It cannot address neck “bands” that remain visible on relaxing the neck muscles.
• Hyperhidrosis: Botulinum toxin administered into the skin of the armpits, hands and feet reduce sweating.

What to expect during your treatment?

When you arrive for your treatment, you will get settled onto a treatment couch and your medical history will be checked. You will then have the opportunity to discuss any specific concerns you have with your practitioner, and, with them, you will formulate a treatment plan. Once the treatment plan is agreed and you have signed your consent form, your skin will be cleaned using a cleansing solution. Please inform us if you have any allergies prior to this point. Your skin may be marked with a non-permanent skin pencil
and the injections will be performed. A little pain is not uncommon and depends on several factors including hormones, tiredness, stress, and distraction and vary from treatment to treatment and person to person.

What to expect after your treatment?

You may notice small red lumps at the injection sites which tend to settle within an hour. Bruising is common but not normally extensive and you should be able to cover this with make-up from the day after your treatment. You are encouraged to sit upright for the first hour after treatment. For 24 hours after the procedure, we recommend exercising the affected muscles, avoiding makeup, exercise, alcohol, and hot
environments, and not touching the injection sites. You will start to notice a difference after a few days but sometimes it can look irregular as the toxin beings to paralyse some muscles but not others. This should even out as the rest of the muscle relaxes and the final result will be visible at 2 weeks. The effect normally lasts for 3 months (up to 6 months for sweating).

Is it safe?

Botulinum toxin has been proven to be safe for human use at the low doses used in aesthetics. However, all treatments have side effects that can occur. Swelling, redness, bleeding and bruising are common with botulinum toxin treatments and are considered part of the normal recovery process rather than true side effects. The side effects that can occur are as follows:

• Headache: Some people describe a headache or feeling of forehead “heaviness” in the days after treatment. This is treatable with simple painkillers and usually resolves by one week.
• Asymmetry: We aim to deliver toxin in a symmetrical manner but sometimes one side of our face has stronger muscles or the toxin spreads in an unexpected direction. This can lead to asymmetrical results affecting the brow, smile or facial expression depending on the area injected. This is managed either by waiting for the toxin to wear off or by injecting toxin in specific areas to address the asymmetry if suitable.
• Drooping of the brow or eyelid: Sometimes the toxin can spread towards the brow or eye causing drooping to occur. This normally resolves by itself over 6-8 weeks. Occasionally small doses of botulinum toxin may be used to lift the brow and for eyelid droop an eyedrop can be prescribed.
• Over- or under-treatment: The response to botulinum toxin can vary and for this reason we cannot guarantee the results you will see. Whilst we aim to give you the results you desire sometimes you may see more or less paralysis of the muscle. Under-treatment can be easily rectified with a top up, but over-treatment normally requires waiting until the toxin has worn off.
• Unexpected response: Sometimes botulinum toxin can cause unexpected effects on surrounding muscles. Rest assured that if this happens it is almost always temporary and will resolve as the toxin wears off.

Am I suitable for Botulinum Toxin?

You will be asked a series of medical questions and the target area(s) will be examined prior to treatment to assess your suitability. Botulinum toxin cannot be given if:

• you have had a pervious allergic or hypersensitivity reaction to botulinum toxin
• you are under 18 years of age
• you are pregnant or Breastfeeding
• you are on certain medications
• you have certain neurological disorders

You may not be suitable for treatment with botulinum toxin if

• you have had botulinum toxin treatment within the last 3 months
• you have deep fixed lines that will not be treated with toxin
• you are over 65 years of age
• you have an active infection
• you are unwell

Caution must be taken if you are on blood thinners or certain antibiotics.

What happens if I am not happy with the result?

We do everything we can to give you the best result possible but in the rare situation you are not happy with your result please get in touch and we will do everything we can to fix the issue.