Botulinum toxin is a protein and neurotoxin produced by the bacterium Clostridium botulinum. Three forms of botulinum toxin type A are used commercially for various cosmetic and medical procedures and have been FDA approved. One of these is known as Xeomin, which we use here at The London MediSkin Clinic.
Chemical structure and action of Botulinum toxin:
The toxin is made up of two chains of amino acids, with a ‘heavy’ chain joined to a ‘light’ chain. The ‘light’ chain is an enzyme that attacks one of the proteins within the nerve ending, known as ‘SNAP-25’.
SNAP-25’ functions to facilitate the release of a chemical that is required for muscle contraction known as acetylcholine. If this action is blocked then the muscle will not be able to contract and therefore becomes weak, flaccid and/or paralysed.
In this way, over-expressive lines/ wrinkles can be reduced by relaxing their activity and preventing their contraction. This is an irreversible block however, is temporary and recovers after 3-4 months.
Medical conditions treated with botulinum toxin:
- Cerebral palsy
- Cervical dystonia (spasmodic torticollis) (a neuromuscular disorder involving the head and neck)
- Blepharospasm (excessive blinking)
- Primary axillary hyperhidrosis (excessive sweating / focal hyperhidrosis)
- Strabismus (squints)
- Achalasia (failure of the lower oesophageal sphincter to relax)
- Migraine and other headache disorders
- Diabetic neuropthy
- Bladder conditions
Why do I have facial wrinkles and lines?
There are two types of wrinkles –
- The animation lines due to habit and expression
- The static lines due to the natural process of aging
Static lines result from a combined loss of fat and collagen, and muscle and ligament laxity. It is important to note that the aim of botox treatment is to combat the first type of wrinkles; to reduce the habit of over-expressive facial animation.
Factors that can influence wrinkles and lines:
- Ethnic background
- Sunlight/ UV irradiation
- Chemical substances and drug interactions
- Lifestyle – sleep, exercise, healthy balanced diet
What are the areas that are usually treated?
Here at The London MediSkin Clinic we specialise in the following areas:
- The forehead (frown lines)
- In between the eyebrows (the glabella)
- Around the eyes (crow’s feet)
- Bunny Lines (bridge of nose)
- Platysmal Bands (neck lift)
- Hyperhidrosis for axilla, feet, hands (control sweating)
- Migraine management
What will happen when I come to see the doctor?
You will have a free consultation with the doctor. Here you will discuss what you desire and what you would like treating. In order to ensure that you are safe to have the treatment, the doctor will take a full medical history. If you decide to proceed with the botox treatment then the doctor will ask you to sign a consent form and you will move to the medical couch for treatment. We aim to ensure maximum comfort and ease for accessibility during the treatment and you will be asked to lie in a reclining position.
You will be asked to accentuate your facial expressions to highlight the ‘problem areas’ and a photo may be taken for your ‘before treatment’ reference.
Your face/ areas to be treated will be cleaned with antiseptic wipes and the doctor will then mark the areas that will be injected with a removal make-up pen to ensure targeted precision of the muscle groups. You will then be injected with a very fine needle tip to the areas allocated; the treatment should take no more than a few minutes, depending on the number of areas to be treated. If the client requires anaesthesia, we can apply a topical cream to the skin 30 minutes prior to treatment to numb the area.
Following treatment, what should I do?
Usually there is no immediate difference. You may notice mild redness at site of injection but depending on the individual this should disappear within a few minutes to hours of treatment.
- Exercise your face: we advise all clients to exercise your face, in particular the treated muscle groups, by mildly accentuating your facial expressions for the first few hours after treatment (e.g. raising your eyebrows, smiling, frowning etc). This helps distribute the botox into the treated muscles evenly.
- Do NOT exercise your body: we advise all clients not to exercise, lie down or bend excessively for at least 4 hours post treatment. These activities increase blood supply to the face and may affect the botox toxin dissemination.
- When washing your face do NOT massage or rub the treated areas for at least 48 hours post treatment. Simply pat face down with towel/ wipe.
- Do NOT wear make-up for the first 12 hours post treatment.
- Avoid any facial treatments, massages, laser therapy, IPL therapy or any other facial beauty therapy for 1 to 2 weeks post treatment.
- Avoid extremes of temperature (strong sunlight, sauna, steam room, very cold climate) for 2 weeks post treatment.
When will I notice a difference?
Clients will start to notice the effects of botox within 3-4 days, although it can take up to 14 days to achieve the maximum effect. For this reason, we usually advise clients to wait till this point before having any additional treatment if required.
What if I want more treatment after 14 days?
If the client feels there are still visible lines then we will offer you another free consultation to review the area you want topping-up. If the doctor feels it is appropriate and safe then you may have further botox treatment (top-up) of the area free of charge.
What if I don’t like the effect of the botox treatment?
Although botox is known to be irreversible, there are some techniques the doctor can perform to counteract an unwanted action of the botox. e.g. if one eyebrow arches too much, or if one eyebrow droops down too much. However, it is important to note that if an area is treated and you decide you want to recover the muscle activity sooner than the natural recovery time, there is no available reversal treatment.
In the rare event of eyelid droop, eye drops can be used to help quicken the reversal.
Nonetheless, remember botox treatment only lasts 2-4 months before you regain full movement in that muscle group again, so often you may want to leave it to settle over its natural course.
How long does the treatment last?
Botox treatment is temporary and lasts on average between 2-5 months. All patients respond differently and you will know after your first treatment how long the effects last with you.
How long shall I wait before my next treatment?
This depends on what you personally desire, and it is important to bear in mind that duration can vary and is dependent upon your body’s own metabolism, genetics and lifestyle. To ensure optimal maintenance of treatment, a follow up appointment is advised at 2-3 months for a review and guidance for next treatment.
What are the side effects?
As with any medication it is important to recognise any adverse side effects.
Mild side effects include:
- Bruising/ redness/ swelling at site of injection
- Mild allergic reaction
Rarer but more serious side effects include:
- Anaphylaxis reaction
- Blurred vision
- Eyelid drop
- Brow drop
Anaphylaxis is a severe potentially life threatening medical emergency caused by an overwhelming allergic reaction. It is characterised by a rapid onset within minutes but can be delayed, presenting after a few hours. Signs and symptoms include an itchy rash (hives, flushing), swelling and redness of the eyes, tingling and swelling in the throat/ tongue and lips, difficulty breathing, chest tightness, racing heart and low blood pressure (can make you feel light-headed). If you are not in the presence of the doctor when any of the above occurs then you must seek immediate medical attention; if severe and involves airway compromise, call an ambulance on 999).
The other serious side effects usually settle within 1-4 weeks from treatment. Please consult the doctor if any of the serious side effects occur and management options can be discussed.
Who is NOT allowed Botox treatment?
During your pre-treatment consultation, you should thoroughly discuss your medical history with the doctor.
The following are contraindications to botox treatment:
- Acute illness
- Infection at proposed injection site
- Allergy to any ingredient in botox (particularly to toxin or albumin)
- Disease of muscle activity (e.g. Myasthenia Gravis, Motor neurone disease)
- Bleeding disorders
- Use of anticoagulant medication, NSAIDs, steroids and vitamin E (relative contraindication, discuss bruising)
- Concomitant use of aminoglycosides (certain antibiotic)
If there are any further questions you want addressing that have not been covered in this section please do not hesitate to ask your doctor during the consultation and we will make every effort to address your needs.