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What is BOTOX?

BOTOX Cosmetic is the first and only FDA-approved prescription product that temporarily improves the appearance of both moderate to severe frown lines between the brows and moderate to severe crow's feet in adults. Unlike a face lift or other kind of invasive facial rejuvenation procedure, BOTOX® Cosmetic takes minutes and requires zero downtime. Using a very fine needle, BOTOX® is injected into the facial muscles that are responsible for unsightly wrinkles and fine lines and relaxes the muscles. The ingredients in Botox block the signal from the nerve to the muscle, and therefore reduce it's ability to contract, and form unsightly wrinkles.

Botox, or onabotulinumtoxin A, is used for three main purposes: muscle spasm control, severe underarm sweating and cosmetic improvement. In this article we concentrate on the third use, achieved with the product called Botox Cosmetic, which contains botulinum toxin type A (the active ingredient), human albumin (a protein found in human blood plasma) and sodium chloride. Botox Cosmetic is used for the temporary smoothing of glabellar lines (also called frown lines), which are the lines between your eyebrows that can make you look tired, unhappy or angry.

It is FDA-approved for this use and in this area only. However, it is often used off-label for horizontal forehead lines, crow's feet, marionette lines at the corners of the mouth and smoker's lines around the lips. Don't confuse Botox Cosmetic with injectable fillers. Dermal fillers work differently, plumping up tissues so that lines and wrinkles diminish or disappear (Restylane, Radiesse and Juvederm are examples).

Your practitioner can help you decide which product(s) will solve your particular appearance issues, though as a general rule, Botox is used mostly in the upper portion of the face, and fillers are used mostly in other areas.

Botox® Cosmetic has been successfully used to treat severe glabellar (frown) lines and is approved for use in adult patients up to 65 years of age. Also a form of botulinum toxin type A, when Botox® Cosmetic is injected into the muscles surrounding the brow area for instance, those muscles can not ``scrunch up`` for a period of time. They are paralyzed. So the wrinkles in that area, often referred to as furrows or frown lines, temporarily go away.

The origin of botox

Clostridium botulinum, the organism from which Botox is derived, is found in inactive form in the natural environment, including in the forest and cultivated soils, and in the sediment of lakes, streams, coastal and untreated waters.

The bacterium can also be found in the intestinal tracts of mammals and fish and in the gills and viscera of crabsand other shellfish. Such naturally occurring instances of Clostridium botulinum bacteria and spores are typically relatively harmless. Problems only usually arise when the spores transform into vegetative cells and the cell population increases to the point where the bacteria begin producing botulinum toxin, the deadly neurotoxin responsible for botulism.

Neurotoxins target the nervous system, disrupting the signaling processes that allow neurons to communicate effectively. The neurotoxin involved in producing Botox, botulinum toxin (abbreviated either as BTX or BoNT), is subdivided into eight types A, B, C `{`C1, C2`}`, D, E, F, G 18 and H.19

Of these, types A, B, E and, in rare cases, type F cause botulism in humans, while types C and D cause illness in other mammals, birds and fish.14 Although type G has been isolated from soil in Argentina, no outbreaks have been identified involving this toxin.

How Botox Injections Work

A wrinkle in the skin is typically formed perpendicular to a contracting muscle located directly beneath it. For example, the muscle in the forehead is a vertical muscle, and when it contracts (such as when you raise your eyebrows), the lines that form (wrinkles) will be horizontal.

Botox is not a dermal filler. Instead, it blocks nerve impulses that cause muscles to contract and cause forehead wrinkles.

Likewise, the two muscles that are responsible for the frown lines are positioned slightly horizontally between the eyebrows, so when they contract, the frown lines appear vertical.Botox Cosmetic is injected into muscles, where it blocks nerve impulses to those tissues. The muscle activity that causes the frown lines is reduced, and a smoother look results. Without a contracting muscle beneath it, the skin has a difficult time wrinkling.

Facial lines that exist when your face is totally relaxed are not very good candidates for Botox. These lines are better handled by the dermal fillers. Botox can frequently ``soften`` these lines but not always get rid of them.

The injections take about 10 minutes, and you should have no downtime afterward.

Normally you would see improvement within a few days. Botox requires two to four days for it to attach to the nerve ending that would normally stimulate the muscle to contract. The maximum effect usually occurs at about 10-14 days. Therefore, whatever effect is obtained two weeks after the injections should be considered the maximum effect that is going to occur.

How to Know if You Are a Candidate for Botox

In the United States, the FDA has approved Botox Cosmetic for people aged 18 to 65. But you shouldn't use it if you:
• Are allergic to any ingredients in Botox or Botox Cosmetic.
• Are allergic to another botulinum toxin brand (such as Myobloc, Xeomin or Dysport) or had any side effect from these products in the past.
• Have a skin infection or other condition in the injection area.
• Have ALS (Lou Gehrig's disease), myasthenia gravis, Lambert-Eaton syndrome or another disease that affects your muscles or nerves.
• Have breathing problems, such as asthma.
• Have difficulty swallowing.
• Have bleeding issues.
• Plan to undergo surgery.
• Have had facial surgery.
• Have weakness in your forehead muscles.
• Have drooping eyelids.
• Are taking or have recently taken certain medications, vitamins or supplements.

Botox Cosmetic is not expected to travel far enough through the body to affect a fetus or breastfeeding infant. However, for ethical reasons, clinical studies have not been done on expectant or new mothers, so nobody knows for sure.

Therefore, the manufacturer (Allergan) advises that you should not have Botox injections if you are planning or trying to conceive a child, are pregnant, are planning to breastfeed or are currently breastfeeding. It's better to be safe, and you can always have Botox later on.