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Botulinum toxin has potent poison properties, but it does not harm health when used for cosmetic purposes and most possible complications subside over time.
This procedure has few contraindications, but it’s important to note that Botox doesn’t smooth out all types of wrinkles, and the effect of one injection lasts no longer than three to six months.
How Botox smooths out wrinkles
What is Botox?
Botox is a general term for various injectable preparations based on type A neurotoxin produced by the bacterium Clostridium botulinum. This substance is a potent poison that affects the nervous system and causes muscle paralysis in botulism.
Where wrinkles come from
The facial muscles control facial expression. In contrast to chewing muscles, which attach to the bones of the skull, most facial muscles attach to other muscles.
Facial muscles contract and cause dynamic wrinkles to form on the skin when a person expresses emotions such as happiness or sadness. Dynamic wrinkles usually appear on the forehead, between the eyebrows, at the corners of the eyes, and in the nasolabial fold.
Giving the face a calm neutral expression completely smooths out dynamic wrinkles in younger individuals. However, as a person ages, collagen fibers, the protein responsible for skin elasticity, are damaged by UV radiation. This damage causes the skin to become less elastic, and facial wrinkles gradually become deeper and less smoothed out. When skin folds persist even in a person with a calm facial expression, cosmetic doctors refer to these wrinkles as static wrinkles, as they are no longer dynamic.
How Botox smooths out wrinkles
Facial nerves are responsible for controlling the movements of facial muscles. When a person’s mood changes, nerve endings in the muscles release acetylcholine, a neurotransmitter that signals the muscles to contract.
The doctor administers Botox to active facial muscles during the procedure. The drug penetrates nerve endings and obstructs the release of acetylcholine. As a result, some facial muscles remain relaxed for about four to six months. This causes dynamic wrinkles to be fully smoothed out and static wrinkles to become less prominent, but the procedure does not completely eliminate them.
Why are Botox injections considered a safe procedure?
Do not lead to poisoning
Despite being derived from a dangerous neurotoxin, Botox is considered safe for cosmetic use, as the dose administered is small enough to prevent any risk of poisoning. In the case of treating frown lines between the eyebrows, the recommended amount of Botox injection typically ranges from 10 to 25 units, which is well below the toxic dose.
In fact, an adult would need to receive 40 units of the toxin per kilogram of body weight to experience toxicity. To put this into perspective, an average-weight adult would require an amount of 2800 units of botulinum toxin to get poisoned, which is 70 times greater than the amount typically used during a cosmetic procedure. Therefore, the risk of botulinum toxin poisoning from a cosmetic procedure is extremely low.
Do not deprive a person of normal facial expressions
The objective of Botox treatment is not to induce complete facial paralysis but rather to weaken specific facial muscles temporarily. By targeting the muscles that stretch the skin, the medication reduces the appearance of wrinkles and fine lines. Consequently, while the effects of the medication are in place, facial expressions become less pronounced, yet they do not vanish entirely.
Do not damage nerve cells
Even though botulinum toxin restricts the release of acetylcholine from nerve endings, it does not cause damage to either the nerve or the neuromuscular synapse. The neuromuscular synapse is the region where the nerve makes contact with the muscle. Once the effects of the medication subside, the nerve resumes its normal function, and the neuromuscular synapse is restored to its pre-treatment state.
Do not cause muscle atrophy
When muscles are left unused for an extended period, they can atrophy, resulting in a loss of strength and volume. However, the effects of a single Botox injection last no longer than six months, with an average duration of three to four months. Therefore, most individuals’ facial muscles do not have adequate time to significantly weaken during this period. To prevent potential problems in the future, it is advisable to take breaks between injections, ranging from six months to a year.
While there have been rare cases of facial muscle atrophy occurring as early as one month after the initial Botox injection, such occurrences are infrequent. Furthermore, individuals who experience this problem typically regain full muscle strength and volume within one year after the injection.
Undesirable effects quickly disappear
In some cases, Botox can inadvertently spread to muscles beyond the intended target, causing temporary paralysis not only of the desired facial muscles but also of those that should remain active. For instance, individuals seeking wrinkle reduction around the eyes may experience ptosis, where the muscle of the upper eyelid becomes paralyzed for two to four weeks between the second and tenth day after the injection.
Fortunately, α-adrenergic eye drops can be used to counteract the effects of the medication during this period. These drops cause the muscle of the upper eyelid to contract, resulting in the eyelid rising again.
As the effects of botulinum toxin dissipate, the tone of the eyelid muscles is restored, and the ptosis disappears completely.
What are the potential complications associated with Botox injections?
Severe side effects of botulinum toxin, such as arrhythmia, allergic reactions, breathing difficulties, and seizures, are exceedingly rare. In the United States, only 36 such cases were reported from 1989 to 2003. It is also important to note that 13 of these patients had pre-existing medical conditions, such as asthma and arrhythmia, which may have contributed to their complications. Therefore, it is possible that breathing problems and arrhythmia were related more to the underlying medical conditions than to the use of Botox.
However, mild complications are more commonly reported by individuals receiving Botox injections for cosmetic purposes.
Irritation at the injection site
Similar to other injections, Botox injections can result in redness, minor bleeding, swelling, and pain at the injection site. Fortunately, these side effects are typically mild and resolve within a few days, even without treatment. To alleviate these symptoms, applying ice to the injection site for several minutes before and after the procedure can reduce redness and swelling.
Headaches
Approximately 1% of patients treated with botulinum toxin report experiencing severe headaches lasting from two weeks to a month.
The exact cause of this side effect is not fully understood. Some experts speculate that relaxation of facial muscles may trigger tension in other facial muscles, leading to headaches. Others suggest that the cause may be related to improper administration of the drug or impurities in a specific batch of the medication. The treatment for these headaches is similar to that of a regular headache, with systemic painkillers such as ibuprofen.
Are Botox injections worth considering?
Botox injections are generally considered safe for most healthy individuals, with the exception of children, pregnant women, and those who are breastfeeding. However, it is important to note that there are certain contraindications associated with the procedure.
- Wrinkles not related to muscle contractions. With age, facial muscles gradually weaken and stretch, causing the soft tissues of the face to sag under the force of gravity. This, for example, leads to deep furrows between the nose and mouth. It is impossible to correct them with botox injections: usually, in this situation, either surgical intervention or filler injections are required.
- Some neuromuscular diseases, such as myasthenia, lateral amyotrophic sclerosis, and multiple sclerosis.
- In addition, certain infectious diseases like colds, tuberculosis, and fungal skin diseases.
- Allergy to botulinum toxin.
Individual contraindications may exist for some individuals.
For instance, individuals who have had plastic surgery on their lower eyelids recently are advised against receiving Botox injections. Therefore, it is crucial to seek advice from a medical professional and thoroughly evaluate the potential advantages and disadvantages before opting for the treatment.
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