Patient Information Leaflet on BOTOX®
What is Botox®?
Botox® is a purified protein derived from Clostridium botulinum.
How does it work?
When we use our facial muscles repeatedly throughtout life, the skin becomes creased or wrinkled in the areas of greatest use. Decreasing the movement of these muscles helps prevent the skin from creasing and causes the lines and wrinkles to soften or even fade away. When Botox® is injected in small amounts into the muscle, it weakens it by stopping chemical messages from the nerve to the muscle. Depending on the individual and the dose used, the results of treatment can vary from relaxation of the muscle to an inability to move the muscle. However only a few muscles are targeted and so normal facial expressions can be maintained.
Botox® can also be injected in the underarm skin to control excessive sweating by temporarily blocking the nerves that stimulate the sweat glands.
How safe is Botox®?
This product has a very high margin of safety. It is FDA (Food & Drug Administration) approved to treat frown lines between the eyebrows, excessive underarm sweating (severe primary axillary hyperhidrosis) and certain neurological conditions.
Can I benefit from Botox®?
Yes, especially if you have horizontal wrinkles in your forehead, between your eyebrows, around the outer corners of your eyes or a constant angry or stern look. Botox® can only treat wrinkles caused by facial muscles.
Botox® can also be used to treat excessive sweating not responding to topical treatment.
Who should not use Botox®?
This form of treatment should not be done in the following situations:
- Active infection at proposed injection site
- Known sensitivity to Botox®
- Pregnancy or breast feeding
- Diseases involving generalized muscle weakness e.g. myasthenia gravis
- Current use of aminoglycoside antibiotics e.g. gentamycin
- Bleeding disorders or anticoagulant therapy e.g. warfarin
Will I look artificial after using Botox®?
The aim of this treatment is not to produce a mask like face. Once it is used properly in small amounts, the result is a more youthful, refreshed appearance with softening of facial creases.
What happens during the treatment?
For the treatment of lines and wrinkles, your doctor will ask you to make certain facial expressions to see how your muscles work. An extremely fine, short needle is used to inject the product into the appropriate muscle.
Before treating underarms, an iodine starch test is done to help determine the areas to be treated. Several tiny injections are then given into the skin. Most patients tolerate this well, describing the sensation as a small pinch. If necessary however, cold compresses and anaesthetic creams can be used to numb the area.
What happens after the treatment?
There is no significant down time with this treatment. There may be redness and swelling in the area injected which usually resolves within a few hours. The following restrictions are recommended after treating facial muscles:
- Do not massage the area or lie or bend down for four hours after the treatment
- Exercise facial muscles for two hours after the injection if possible
- Do not fly for up to 72 hours after the treatment
What are the side effects of the treatment?
Occasionally, after treating facial muscles, there may be a temporary drooping of the eyelid or eyebrow, which may last a few weeks but always resolves. Special eye drops can be prescribed to help lift the lid back to its normal position.
Reported side effects following treatment of the underarms include injection site pain and bleeding, non-underarm sweating, infection, headache, flu-like illness, throat inflammation, fever, neck or back pain, itching and anxiety. Allergies to the product are extremely rare. There are rare cases of resistance to Botox® where it causes little or no effect.
How long does a Botox® treatment last?
Benefits of the treatment of the face are usually seen after 4 to 14 days, but vary with the individual. The effects normally last between three and six months, after which you will be gradually able to move the muscles more freely. It is best if your next treatment is at the first sign of muscle re-activation. With repeated treatments, the time between each treatment usually lengthens until a yearly maintenance may be all that is needed.
After treatment of the underarms, a reduction in sweating is usually experienced within 4 weeks. The effects usually last from three to six months. Another treatment can be done when the effect diminishes.