Botulinum toxin

What is botulinum toxin and how does it work?

It is a substance produced by the bacterium clostridium botulinum, purified and extracted under controlled conditions.

Botulinum toxin is authorized on the French pharmaceutical market (Vistabel® in France, and Botox® in the United States) for a very specific use. It must only be used judiciously and under strict medical supervision by a trained physician.

It was already being used by ophthalmologists, neurologists and ENT doctors to correct certain disorders (strabismus or abnormal movements) before being officially authorized in France on 20/02/2003 for aesthetic purposes in specific indications.

Its use is exclusively reserved for specialists in plastic, reconstructive and aesthetic surgery, dermatology, facial and neck surgery, maxillofacial surgery and ophthalmology.

Several types of toxins are available in France

Botox®  Vistabel®  Allergan 100 U

Dysport® Ipsen (Reloxin® pending MA) 500 U

Xeomin® type A toxin

BotoxinA® Mobilab PM 50 and 100 U
topical and injectable form

Neurobloc® type b toxin 5000 U

By relaxing the muscles in a given area, botulinum toxin limits muscle contraction, which has the effect of temporarily erasing expression lines and giving a more relaxed, serene and rested appearance .

Is botulinum toxin dangerous?

The bacterium Clostridium botulinum produces a toxin that, when ingested in large quantities, can cause botulism, a rare form of food poisoning. Doses at least a thousand times higher than those used for treatment are required. By comparison, aspirin, although considered a safe medication, can be fatal if the ingested dose is ten times higher than recommended. Botulinum toxin, therefore, has a much greater safety margin than most medications.

What are the applications?

Not only in the treatment of wrinkles, but also in the treatment of facial asymmetries, particularly post-paralytic, i.e. after facial paralysis, post-traumatic, in hypersalivation, muscle spasms or hypersudation or the after-effects of certain treatments such as cervical radiotherapy.

In facial paralysis, the toxin allows for a symmetrization of the face, especially in its upper part.

For cosmetic purposes, certain movements in the upper face, such as frowning, blinking, and wrinkling the nose, strengthen the muscles they engage and are the cause of expression lines. Crow's feet, forehead wrinkles, and lines between the eyebrows fall into this category. Botulinum toxin targets the source of the problem by relaxing the muscles, thus rejuvenating the face and giving it a more relaxed, serene, and rested appearance.

INJECTION PROCEDURE:

You do not need to fast on the day of your injections. Do not take aspirin, anti-inflammatories, or vitamin C for 7 days before and 7 days after the injections. Women should arrive without makeup or remove it before the injections.

The procedure itself takes approximately 15 minutes. The doctor injects small amounts of product into the muscle. The injections, which are not very painful, create a "forehead lift" effect, thus avoiding the need for surgery under anesthesia.

For the four hours following the injections, it is recommended to avoid strenuous exercise and lying down. You should also avoid any manipulation (massaging the treated areas) for 24 hours after the session . However, you can continue most of your usual daily activities. Contracting the treated muscles for two to three hours after the treatment (frowning, looking up, for example) promotes intramuscular absorption of the product.

The injections do not leave marks on the face. Redness may be present at the injection sites, but it disappears in less than an hour, and makeup can be applied afterward.

The beneficial effect on the severity of wrinkles, although noticeable 72 hours after treatment, reaches its maximum 10 to 15 days later.

EFFECTS AND FREQUENCY OF INJECTIONS:

Results will be visible after a few days, but for about two weeks, the effects on the face may vary (even appearing asymmetrical at times) before stabilizing. After the first session, the effects will normally have disappeared after 4 to 6 months. The results last longer with repeated injections. Injections should be performed 2 to 3 times at 5 to 8 month intervals to achieve stable results.

It is recommended never to place injection sessions less than 4 months apart to avoid creating resistance to the products ("vaccine effect" by production of anti-toxin antibodies).

In cases of thick skin or “deep breaks”, it may be necessary to perform other techniques (filling) to optimize the result.

A consultation is recommended between 8 and 15 days after the injections to assess the result.

If you wear contact lenses, you may need to put a few drops of artificial tears in each eye for a few days (injections can sometimes decrease tear production).

Information on the potential risks of botulinum toxin:

ARE THERE ANY RISKS OR CONTRAINDICATIONS FOR BOTULINUM TOXIN?

UNDESIRABLE EVENTS MAY OCCUR

Frequent: One in five patients will experience transient side effects (headaches, bruising, facial pain, slight drooping of the eyelid, feeling of frontal tension) related to the diffusion of the product.

In exceptional cases: If the product reaches the levator palpebrae superioris muscle, the patient may develop a drooping eyelid (ptosis). If the eye muscles are affected, vision problems may occur (strabismus, dry eyes, excessive tearing, etc.). These adverse events, which are reversible within a few weeks, are extremely rare if the injection technique is precise and performed by well-trained physicians.

No cases of systemic toxicity (through diffusion in the body) resulting from injection have been recorded because it would require doses a thousand times higher than those used for treatment.

WHAT ARE THE CONTRAINDICATIONS FOR BOTULINUM TOXIN INJECTIONS?

The product is prohibited for pregnant or breastfeeding women, people with neurological diseases such as myasthenia gravis, and is not recommended for patients taking anticoagulant treatment or suffering from coagulation disorders.

This treatment is not recommended for people under 18 years of age.

In general, if you are currently receiving Botulinum Toxin injections for pathological spasms, if you have experienced an episode of facial muscle paralysis, or if you or a member of your family suffers from a neuromuscular disease such as myasthenia gravis or a coagulation disorder, you must inform Dr. Xavier Lachiver. He will discuss with your primary care physician the suitability of the injections for you and the best course of action, if applicable.

NOT RECOMMENDED ASSOCIATIONS

Aminoglycoside antibiotics should be avoided due to the risk of increasing the effects of botulinum toxin, based on extrapolations from effects observed in botulism. If necessary, an alternative antibiotic should be used.

No other clinically significant interactions have been described.

If you are taking any medication such as anticoagulants or aspirin or any other medication (e.g. Aminoglycosides, Tetracyclines, Quinine, Penicillamine, Calcium Inhibitors, Benzodiazepines, muscle relaxants) between now and the injections, or if you have any health problem (including infection, flu, dental abscess, allergy to egg or albumin, etc.), you must inform the Doctor before the injection.

Being pregnant, even for just a few days, absolutely requires postponing the injections until after the pregnancy and any breastfeeding. Therefore, if you have the slightest doubt, you must undergo the necessary tests and inform your doctor of the results.

IN CONCLUSION

Botulinum toxin treatment allows one to present a rested and relaxed appearance to others in modern society, regardless of the circumstances.

It's an investment in preserving your youthful capital with maximum security and maximum results.