What is Botox?
‘Botox’ is not actually the official name for a treatment, but a brand name for a drug made by commercializing botulinum toxin type A. The Botox procedure is collectively used as a treatment method that utilizes the paralysis effect of muscles that appears when such a botulinum toxin is injected locally.
Botulinum toxin is a toxin secreted by an anaerobic bacterium called C. botulinum, and there are seven types in total. Among them, botulinum toxin types A and B are purified and used medically. This toxin inhibits the secretion of acetylcholine at the end of the motor nerve, thereby paralyzing the corresponding muscle.
Botulinum toxin was initially used as a drug to treat muscle tone abnormalities such as eyelid cramps and torticollis (an unnatural condition in which the neck muscles contract to one side). During this treatment, it was found that the wrinkles around the botulinum toxin injection site disappeared, and this was used for cosmetic wrinkle treatment. Botox is currently widely used not only for the treatment of facial spasms, eyelid spasms, muscle stiffness, and strabismus, but also for cosmetic purposes such as wrinkle treatment and square jaw correction.
Preparations for Botox treatment
Drugs that inhibit blood clotting, such as aspirin, should be stopped one week prior to reducing the likelihood of bleeding from Botox injections. Since botulinum toxin is injected into the treatment site, apply a local anesthetic as a pre-treatment to anesthetize the skin surface or apply a cold compress. If the area to be treated is small or the patient feels less sensitive to pain, it is sometimes performed immediately without applying a local anesthetic. The local anesthetic is a cream formulation that is applied directly to the treatment area and waits for about 30 minutes to be sufficiently absorbed. Immediately before the procedure, the procedure is started after washing or wiping off the cream formulation that is still on the skin.
The process of Botox treatment
The muscles related to the patient’s symptoms are checked, and the total amount of botulinum toxin required is calculated by considering the injection location, the total number of times, and the amount of injection at each location. Put the diluted botulinum toxin solution in a 1cc syringe. Botulinum toxin is injected by injection at the planned location. Locally press the injection site with a cotton swab to stop bleeding.
Time required for Botox treatment
Although it is slightly different depending on the treatment site, the treatment is finished within about 10 minutes. After the procedure, it may take additional time for the compression to stop bleeding.
Precautions for Botox treatment
To prevent the spread of botulinum toxin around the area after injection, do not touch or press the injection site excessively, and do not lie down or face down the injection site for 2-3 hours after injection. On the day of the procedure, it is better to refrain from excessive drinking, exercising, or sweating a lot.
Progress and complications of Botox treatment
The effect begins to appear slowly 3-4 days after the injection, and the effect can be known exactly after 7-10 days. Usually, one to two weeks after the procedure, the effect is judged to determine whether to perform an additional procedure. Although there are individual differences, the effect decreases after 1 month, and the effect disappears after 3 months, and additional treatment may be required.
Side effects and sequelae of Botox
People with neuromuscular disorders such as severe myasthenia gravis, Eaton-Lambert syndrome, or hypersensitivity to botulinum toxin should be excluded from Botox treatment. Patients who are receiving or suspected of being given an aminoglycoside antibiotic or spectinomycin should not receive Botox treatment. It is also recommended not to use Botox for pregnant or nursing mothers.
1) The side effects caused by the injected botulinum toxin can be divided into three categories: excessive paralysis of the injected muscle, paralysis of other muscles around, and systemic effect.
- Excessive paralysis of the injected muscles: This can occur at the beginning of the injection, causing difficulty in making facial expressions, difficulty closing eyes, and difficulty chewing food.
- Paralysis of other muscles around: When botulinum toxin is incorrectly injected into another site, when too much dose is administered, or when botulinum toxin spreads to surrounding tissues, paralysis may occur in the muscle that is distant from the injection site.
- Systemic effects: Influenza-like symptoms, fatigue, and other deaths from botulinum toxin-like symptoms have been reported in 16 cases worldwide.
- In addition, scattered skin rash and eyelid swelling have been reported.
2) As a side effect of the injection procedure itself, bruising may occur after injection.
To reduce this, it is advisable to stop taking medications that increase bleeding tendency, such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), 7 to 10 days before the procedure. It is recommended to apply moderate pressure immediately after injection.
3) Specific side effects that may appear for each treatment are as follows.
- -Treatment of strabismus: droopy eyelids (ptosis), vertical deviation, bleeding behind the eyeball
- -Treatment of eyelid tremor: sagging eyelids (ptosis), lacrimation (epilation), irritation (dry eyes, dazzling), rarely clumping of the eyelids (valgus valgus), ulceration of the eyelids (valgus varus), keratitis, overlapping appearance (Double vision)
- Treatment for neck muscle tone abnormalities: Difficulty swallowing (difficulty swallowing), symptomatic systemic weakness/borrows, nausea, drowsiness, numbness, stiffness, bruising, etc.
- Treatment for cerebral palsy: reduction, leg pain, feeling of partial weakness in the leg (localized feeling of weakness, general feeling of weakness, calf cramp, fever, knee pain, post-treatment injection site pain, ankle pain, drowsiness, etc.)
- Treatment for cosmetic purposes: headache, injection site pain, infection, erythema, swelling, nausea, dizziness, local muscle weakness, bruising
Diseases that can be treated with Botox
- Eyelid cramps
- Facial cramps
- Eyelid retraction
- Cerebral palsy
- Focal dystonia
- Muscle stiffness
- Facial wrinkles
- Square jaw
Other points to consider before Botox treatment
Botox treatment has a good therapeutic effect on wrinkles that occur temporarily depending on facial expressions. However, deep wrinkles that always remain in their condition regardless of facial expressions may not be completely improved even after the procedure. Therefore, rather than trying to remove all wrinkles with Botox, it is recommended to try to reduce the habit of wrinkles.