You’ve probably heard of Botox. It’s the stuff that celebrities rave about, and let’s be honest; it’s often what makes them look so ageless. The number of Botox treatments carried out has soared in recent years, with non-surgical aesthetic solutions to anti-ageing being a lot more normalised, and hence less taboo than it once was. Despite this, not many people actually know much about Botox itself, other than ‘it can get rid of wrinkles’. So what actually is Botox? And what are the ‘Anti-Wrinkle Injections’ advertised on the Fillers & Frowns website? If you’re considering having this treatment, then I’m sure you want to know more about it beforehand. Luckily, this blog post will delve into the history of Botox and what it actually is, before discussing how the modern day applications of this quite remarkable drug work.
So let’s start off with the word “Botox” itself; Anti-Wrinkle Injections are often referred to simply as “Botox”, but did you know that “Botox” is just a brand name? Botox is actually simply a form of ‘Botulinum Toxin Type A’, and it is called Botox simply because this is the product name for the Toxin used by the company Allergan, who first developed it. Along with the original Botox branded form of the Toxin, there are other products available; these include ‘Bocouture’ by Merz, and ‘Azzalure’ by Galderma. To provide an example; the majority of people here in the UK refer to a vacuum cleaner as a ‘Hoover’, despite Hoover just being one of the many brands who manufacture these products (i.e. Dyson, VAX, etc). They all do the same job as the original ‘Hoover’ does – some may say better in fact – but just have a different name. ‘Botox’ – and hence all forms of Botulinum Toxin Type A – works in exactly the same way. Here at Fillers & Frowns, we use the award-winning ‘Bocouture’ toxin from Merz Pharmaceuticals, who are global leaders in the aesthetics industry, and were founded way back in 1908!
As discussed, Botox is derived from Botulinum Toxin, which is a protein produced by the bacteria Clostridium Botulinum. There are different forms of Botulinum Toxin, which are labelled with letters from A-H. Botulinum Toxin Type H is actually considered the most deadly substance known to mankind, with 2-billionths of a gram being enough to kill a typical adult human. As you can imagine, people tend to avoid this one! Botulinum Type A, on the other hand, is much safer, and has been found to have numerous uses in medical practice over the years, from treating migraines to helping those with overactive bladders. The first reported cosmetic use of Botox came in 1989, when Dr Richard Clarke used it to treat facial asymmetry in a patient who had nerve damage following a surgical facelift. At around the same time, a group of other doctors noted how Botox injections around the eye for treatment of blepharospasm (involuntary sustained forced contracture of the eyelid), also resulted in a reduction in the patient’s wrinkles in this area. This was found to be as a result of the relaxation of the surrounding muscles. Eventually, following further trials, the FDA later approved the use of Botox for Anti-Wrinkle Injection purposes.
So now that we know where it came from, what does Botox actually do? Once injected into a muscle, Botox binds itself to the ends of nerves, preventing the release of a substance called Acetylcholine. Acetylcholine is a neurotransmitter, meaning its function is to transmit neurological signals from one place to another inside the body. For example, in order to raise your eyebrows, a nerve impulse is transmitted through the nerves that supply the frontalis muscle in the forehead, instructing it to contract. This works by the intermittent release of acetylcholine along the length of the nerve, to where it joins the muscle itself. As Botox prevents the release of the acetylcholine, the message for the muscle to contract is lost, meaning the muscle is effectively – and temporarily – paralysed. The overall result is that the muscle is relaxed and hence the appearance of wrinkles are reduced; however, this muscle relaxation will have varying effects depending on where it is injected, and for what use, and so Botox can be used in many different areas, for many different issues.
Common areas for Botox treatment include:
- The frown, forehead and around the eyes for the reduction of wrinkles
- The masseter muscle of the lower face for the treatment of Bruxism (teeth-grinding)
- The armpits for the treatment of Hyperhidrosis (excessive sweating)
- Various areas around the face, shoulders and neck for the treatment of Migraines
- Treating a gummy smile (upper gums being visible when you smile)
- The neck area for the treatment of Cervical Dystonia
- The bladder for the treatment of an Overactive Bladder
Despite common misconceptions, use of Botox is therefore not just for anti-ageing purposes such as getting rid of wrinkles. In fact, Botox is actually more useful when used to prevent wrinkles, as opposed to treat them. A good way of thinking about this is the old adage: shutting the barn door after the horse has already bolted. To understand this further we need to first discuss how a wrinkle is created, and the difference between ‘static’ and ‘dynamic’ lines.
Wrinkles are formed through the repeated movement of muscles on a daily basis; the forehead, frown and eyes are good examples of frequently used muscles, as they are utilised in a great number of facial expressions throughout the day. As we age, we develop wrinkles as a result of these movements, which gradually become deeper and more pronounced, meaning that eventually we start to notice them even when our face is at rest. The lines that are present when your face is at rest are referred to as ‘static’ lines. The lines that are created only when you move your facial muscles are referred to as ‘dynamic’ lines. See the below examples to visualise the difference between ‘static’ and ‘dynamic’ lines.
The picture above shows a client’s frown and forehead completely relaxed. As dynamic lines are created when you actively move muscles you will not be able to see any of these in this picture. What we can see, however, is a couple of lines in the frown at rest. These are a good example of a static lines.
The next photograph shows the same client frowning. What we see here is the static lines that were present in the first image are now much more pronounced, due to the movement of the forehead. As muscles are actively moving to create these deeper lines, they are now referred to as dynamic frown lines.
The client is now raising her eyebrows. In the first image there was not any static forehead lines visible. Now that she is raising her eyebrows, however, she has created several horizontal lines across the forehead, giving a ripple appearance. These are dynamic forehead lines.
As I’m sure you can gather from reading our description of how Botox relaxes the muscles, it is therefore most effective when treating dynamic lines. This is because Botox’s mechanism is to reduce the ability of muscles to move, which in turn reduces the development of dynamic wrinkles, as the muscles no longer move to the same degree as before. Unfortunately, treating static lines with Botox is more difficult and is not as effective, although it can often improve the appearance of them to a certain extent. Static lines generally form over time, and as discussed are not related to direct facial movements, as they are present when the face is completely at rest. In simple terms, a form of ‘muscle memory’ has caused them – the dynamic lines have appeared so many times through repeated movement, that static lines are then created in the place that they appear. As Botox’s mechanism is to reduce the movement of muscles, static lines are therefore not directly targeted. However, with repeated treatments over a prolonged period of time, these static lines can improve in appearance, although in some people they may never go. It is therefore better to have Botox treatment before your dynamic lines turn into static lines, to prevent this from occurring at all. Prevention is always better than cure! The following images demonstrate the results that can be achieved for both static and dynamic lines following Botox treatment.
This image shows a client’s at-rest before and after picture following a two-area treatment of anti-wrinkle injections (frown and forehead). As you can see, in the top photo the client had a significant number of static forehead lines that she was concerned about. Following a single treatment the appearance of these lines has dramatically reduced, with several of them disappearing altogether.
The above image demonstrates the same client raising her eyebrows before and after her treatment. Again, there has been a significant decrease in her dynamic lines, with several of them vanishing completely.
So what about the actual treatment itself, what happens during the appointment, and what results can you expect? Receiving Botox injections is a relatively pain-free experience, and is generally very quick, with the procedure often taking just 10 minutes. Results can usually be seen after 3-4 days, but the maximum effect can take up to 2 weeks post-treatment. The length of time that Botox will continue to work for varies from person to person, as a lot of this is down to individual metabolism. However, as a rule of thumb, we generally advise that it should last anywhere between 3 and 6 months (most commonly 4). To continue to see the benefits of Botox, it should be administered intermittently every 4 months, or sooner if you find the effects to be wearing off. If you do not keep on top of the Botox injections, then you can expect your wrinkles to eventually revert back to how they were prior to getting the injection. On a related note as we are often asked this question – not keeping up with Botox injections will not make your pre-existing wrinkles worse if you do decide to stop, so please ignore any information contrary to this.
We cannot stress enough that you should go to a reputable clinic/practitioner to receive this treatment. As mentioned above, Botulinum Toxin can often be a very dangerous substance in the wrong hands, and so it must be used only in safe circumstances. To ensure this during your appointment, always ask to see your practitioner’s credentials, and never receive the injections unless they have gained your full consent through informing you about the treatment, and assessing your medical history.
As it can be dangerous, Botox is currently a prescription only medication, and as such requires a prescription to be completed by a medical professional prior to it being administered. In order for this to happen, whoever is prescribing the drug must have a face-to-face consultation with the patient prior to treatment taking place. Doctors and Dentists are legally allowed to ‘pre-prescribe’ Botox medication and have it in ‘stock’ for use provided it is stored correctly and they have given evidence of their professional registration license and training to the pharmacy they purchase it from. This means that if your treatment is being personally carried out by the doctor or dentist who is prescribing the Botox, as is the case here at Fillers & Frowns, the consultation and treatment can be done on the same day, in the same appointment (if you wish). Practitioners who use a third party prescriber cannot do this, as individual prescriptions related to each patient must be submitted to the pharmacy by the prescriber after a pre-treatment consultation – and hence at least 2 appointments are required. Similarly, even nurse prescribers will be required to see their patients twice as they are not able to legally stock Botox without individual prescriptions. Therefore – the best advice that we can give alongside checking your practitioner’s credentials, is that if you are ever offered both a consultation and Botox treatment in the same appointment by anyone other than a qualified, registered doctor or dentist, please refuse and seek the procedure elsewhere!
Despite the restrictions and regulations surrounding the medication, many practitioners are providing Botox injections by obtaining the drug through questionable means, which has included buying unlicensed product from overseas, or through gaining prescriptions from ‘doctors’ who are struck off. This of course increases the profit margin for the practitioner and may mean that they can offer it to patients for a much cheaper price, but please remember that there is a reason for this – the risk to your health is increased at the same time as their profit margins are! Remember – if it seems too good to be true, that’s usually because it is! This is currently a very hot topic in the aesthetics world, with cases of unsafe practices having been in the news recently – one of our upcoming blog posts, ‘The Great British Botox Scandal’ will focus on this – stay tuned!
If you would like any further information on the use of Botox at Fillers & Frowns, or you would like to book in for a consultation/treatment at either our Liverpool or Wirral clinic, then please don’t hesitate to get in touch! If you have any general questions, please feel free to ask in the comment sections below. You can also read more about the specific Botox treatments we offer, some of which have been mentioned in this blog, by visiting both our Anti-Wrinkle Injections and Advanced Procedures pages.
– Dr Robinson
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