Botox and Its Mechanism of Action
Botox is short for “botulinum toxin,” the substance that causes botulism, a sometimes-fatal form of food poisoning. It sounds scarier than it is; in small quantities, Botox merely interrupts nerve impulses to muscles in the face causing a local relaxation and weakness. In this way, botulinum toxin acts as a muscle blockade.
Corrections Possible With Botox
The lines that furrow the forehead when you raise your eyebrows, the crow’s feet that appear when you squint and the creases between the eyebrows when you frown are all caused by tension in underlying muscles, which contract and squeeze the skin like an accordion. Frown lines are the result of gathering or knitting the tissue between the eyebrows into a fold. These unattractive folds and furrows are caused by the repeated action of underlying muscles associated with facial expression. Years of squinting and frowning tend to leave deep wrinkles in the skin between the eyebrows and on the bridge of the nose, across the forehead, and at the corners of the eyes. On many people, frown lines produce an angry or sad look that detracts from a pleasant facial appearance. Botox keeps this from happening.
Treatment
Treatment involves injection of very small amounts of botulinum toxin into the underlying muscles to immobilize them. Botulinum toxin is injected directly into the target muscle to treat vertical lines between the eyebrows and on the bridge of the nose, the squint lines or crows feet at the corners of the eyes, the forehead horizontal lines, and the platysmal muscle bands often visible on the neck, commonly known as turkey neck. The actual treatment is well tolerated and takes just a short time with minimal recovery. Botulinum toxin takes effect about 3 to 7 days after treatment. The improvement generally lasts about 3 to 4 months before the effect gradually fades and muscle action returns. It is anticipated that the average patient will require re-injection at various intervals. With repeated treatments, atrophy (thinning) of the muscle may occur which usually produces longer-lasting results.
Side Effects and Complications
Fortunately, Botox is so diluted that serious side effects like allergic reactions are rare. Botox is a remarkably safe therapeutic agent for wrinkles. Complications have been minor and only transient. A bruise can form at the site of an injection. When this happens it is usually quite small, can easily be covered with make-up and resolves within a week.
Side effects include drooping of eyelids, irritation, tearing, lagophthalmos, photophobia, entropion, keratitis, diplopia and diffuse skin rash.
Transient drooping of one eyelid or both is the most significant complication and occurs in 1% to 2% of all injections. This occurs when Botox is injected near the eyelid, a small amount of Botox can migrate to an eyelid and cause a droopy appearance. If this were to occur, it generally resolves within two weeks and may be improved with eye drops during that period.
Drooping may also result due to local dissemination of the toxin in the injection site and can be minimized by accurate dosing, as well as proper placement, and keeping the patient in an upright position for three to four hours after injection. If it occurs, it is usually minimal and resolves quickly without leaving visible sign of drooping eyelid afterwards. One normally doesn’t have to take any medication for it.
The drooping is self limiting and usually resolves in couple of weeks. If it doesn’t improve on its, it is desirable to see a doctor for thorough examination.
