What is Botox?

Dr. Óscar Máyorga explains the procedure for the application of Botox at the RegenBiocell Clinic in Albir.

The term "Botox" is most often used to refer to injections of botulinum toxin. The correct terminology when referring to Botox injections is actually "injection of botulinum toxin".

Botox® is a brand name (like Azzalure®, Vistabel®, Bocouture®, Dysport®, Xeomin®… for the most commonly used in aesthetic medicine).

Botulinum toxin comes from the culture of a bacteria called "Clostridium Botulinum".

Its use in aesthetic medicine is actually a coincidence. The primary medical use of Botox was for ophthalmological care, more particularly to treat a condition of the eyelids: blepharospasm.

It was while looking at photos of the results of this treatment that the Carruthers couple (Canadian) noticed a side effect that would launch Botox injections into the world of aesthetic medicine.

In fact, patients treated for blepharospasm had fewer wrinkles than before.

Clinical studies were then initiated to validate the results and determine the necessary doses for the treatment of forehead and eyelid wrinkles.

During these trials, another interesting side effect was observed: people suffering from excessive sweating (hyperhidrosis) could get rid of this daily discomfort.

It was in 1992 that Botox began to be used in aesthetics. Only the purified botulinum toxin type A (there are a total of eight other types of toxin) is used for medical purposes to block transmission between the nerve and the muscle that will perform a movement.

When used correctly, it reduces facial wrinkles while maintaining a natural facial expression.

What is the active ingredient in Botox injections?

It is botulinum endotoxin, which has long been used to combat spasms and tics in the eyelids, face, and neck.

The only difference between Botox injections used for therapeutic purposes and those used in an aesthetic medical procedure against wrinkles is the amount of endotoxin used.

The dose used in aesthetic medicine is very low compared to therapeutic use.

The use of botulinum toxin in aesthetic medicine

To speak only of the forehead, botulinum toxin injections can relax, not "stretch the skin" as most people think.

The skin muscles (under the skin) no longer contract (or less), the skin relaxes, and the folds or wrinkles disappear.

Before Botox appeared in aesthetic medicine, surgeons performed a section of the frontal muscle to prevent it from contracting. This was done during an operation such as a facelift or endoscopy.

Today, Botox injection replaces this surgical procedure with similar results without any recovery period or painful side effects.

What areas can be treated?

In aesthetics, we mainly treat specific areas of the face that show expression lines. However, Botox can also be used for "hair Botox," for the lips, etc.

These expression wrinkles are caused by the repetition of facial movements when we express emotions or speak. In young people, the skin regains its smooth appearance after each muscle contraction.

With age, the skin loses its elasticity but also its firmness and radiance, and finally retains the mark of the furrows associated with facial expressions.

From then on, wrinkles will gradually deepen and become permanently visible. The result is a "break" in the dermis that persists.

When used correctly, it reduces facial wrinkles while maintaining a natural facial expression.

There are three main areas that can be treated with Botox injections:

- Crow's feet: these wrinkles form at the corners of the eyes and are caused by smiling or laughing.

- Frown lines: located between the eyebrows. The frown line appears when you furrow your brow to express displeasure or contemplation.

- Horizontal forehead wrinkles which are wrinkles caused by widening of the eyes or surprise.

Additionally, other areas can be treated, but the more difficult technique must be perfectly controlled:

- Fine vertical wrinkles on the lips: appear when speaking and moving the lips forward.

- Nasolabial folds on each side of the mouth towards the chin.

- The wrinkles of the nose.

How does a botox injection session work?

Before any treatment, the doctor will carefully examine your face to make a diagnosis and determine if a botulinum toxin injection is suitable for your actual needs.

It is not necessary to have preconceived ideas, but to take into account the recommendations of the professional who can evaluate the possible results of your facial aging.

For example, you may come for botox injections while hyaluronic acid injections are more appropriate.

First, it is necessary to examine the specific micro-facial expressions of each person, as well as irregularities and problems of facial symmetry. This step will verify that a botulinum toxin injection does not disrupt your facial expressions.

How does a botox injection session work?

The technique is relatively simple as it is performed using very thin needle syringes for injections under the skin, which are not very painful.

- The Botox injection is usually performed at a few millimeters depth (in the skin muscles).

- It is performed at several points distributed throughout the muscles of the treated area.

- It will require about ten injection points for horizontal forehead wrinkles. While for crow's feet wrinkles, the doctor will need 3 to 5 injections for each area.

- After carefully cleaning the skin of the face, the doctor will draw the injection points on your face and then proceed with the injections.

- Each botulinum toxin injection will be administered in minimal amounts.

- Once the injections are finished, it will be necessary to be very careful not to perform any massage to avoid the diffusion of botox and not cause complications.

When do you see the results?

After 4 to 6 days, the effects of the toxin are visible: spontaneous smoothing of the upper half of the face. The forehead is smooth, loses its severe and sad character. Crow's feet wrinkles will be greatly reduced, and the eyes will be opened.

The first few times, the effect of the injections decreases after 4 months. By renewing the session without too much delay, it is usual to achieve (after 3 sessions) results that last from 6 to 7 months or even more.

How long do the results last?

- You will be able to see the first effects after just a few days. This time is necessary for the toxin to work and for the muscles of the face to relax.

- On average, the effect will last between 4 and 6 months depending on your body's reaction to botox. The effect will be longer-lasting after several sessions. On the one hand, the doses of botox will be better calibrated, and above all, the habit of using the muscles that create wrinkles is gradually being lost.

- Attention: Botulinum toxin injections must be monitored over time. It is not necessary to want perfect results at all costs from the first session. It is necessary to see and quantify the effects of the toxin on your wrinkles and better calibrate the botox trials in future sessions.

- The effects of Botox injections begin to fade after 6 months (sometimes more, depending on the patient's reaction). Therefore, it is necessary to practice sessions at intervals of 6 or 7 months on average.

- If the sessions are not spaced out enough in time, there may be an accumulation effect of Botox in the treated areas or addiction. There is a significant risk that your body will generate antibodies against the toxin, which will reduce the effectiveness of the treatment.

- If you want to stop your Botox injection treatment, your muscles will return to their place, they will relax less and your wrinkles will gradually appear again.

What are the risks and side effects?

In fact, there are risks and side effects of Botox used in aesthetic medicine. Complications remain extremely rare. However, reactions remain unpredictable and variable from person to person. Botox has been used since 1993 in the United States and no dangerous side effects have been detected for humans to date.

We have listed the side effects that can sometimes occur:

- Swelling around the eyes, for injection of crow's feet (disappears quickly).

- Headaches sometimes the day after Botox injections.

- Involuntary contraction for a few days.

- Redness or sometimes minor bruising at the injection sites (temporary).

- In very rare cases, it is possible to feel discomfort in the treatment areas.

- The feeling of slight tension in the treated areas. This effect will disappear in a few days.

- Some people who wear contact lenses have reported dry eye sensations. You can quickly improve this with moisturizing eye drops.

What are the contraindications?

Contraindications before undergoing treatment with Botox injections:

- If you are a pregnant woman, even at the beginning of pregnancy.

- If you are breastfeeding.

- If you have a neuromuscular condition such as myasthenia gravis or Lambert-Eaton syndrome.

- If you are on anticoagulant, anti-inflammatory or antibiotic treatment, talk to your doctor.

- We do not recommend Botox injections for elite athletes because there is a risk of muscle tone loss (1%).

Contraindications after a treatment with botulinum toxin injections:

- Do not apply pressure to the treated area for 12 hours after Botox injections.

- Do not take aspirin or anti-inflammatory medications for a week after your session if possible.

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