Cosmetic Botulinum Toxin Treatments

Botulinum toxin type A (BtA) is a neurotoxin produced by Clostridium botulinum bacteria. The action is to paralyse the injected muscles by irreversible blockage of the cholinergic transmission at the presynaptic nerve terminals. In facial aesthetics, it is commonly used to treat forehead wrinkles, frown lines, crows’ feet, to lift eyebrow, ‘bunny lines’, gummy smile, correct a down-turned corner of the mouth and even platysma bands in the neck.

The administration of botulinum toxin is accomplished by injecting a small amount of toxin into the muscles. Dosage of botulinum toxin injections is tailored based on an individual basis. Some individuals may require ‘top-up’ injections (especially if they are having this treatment for the first time, those with hyperkinetic muscles and/or those with asymmetric muscle hyperactivity).

Any benefits resulting from botulinum toxin tend to wear off after about 3 months; a repeat injection is required if the desired outcome is to be maintained. Injections are usually done every 3 to 4 months with the maximal peak effect achieved by about 2-3 weeks.

The potential side effects of cosmetic botulinum toxin injections are dependent on the treatment areas and include:

• Transient, and usually mild, facial weakness with facial injections

• Eyelid drooping (ptosis)

• Brow droop

• Asymmetric smile

• Pain at the site of the injection or ecchymosis (black and blue mark) at the site of injection

• Dry eye

• Double vision

• Potential unknown long-term risks. It is also possible that as with any injection, there may be an allergic reaction or no effect from the medication. There have, however, been no serious injuries or deaths resulting from its use.

All care will be taken to prevent these side effects. Occasionally patients become refractory to treatment because they develop antibodies to the botulinum toxin, and in this event, therapy needs to the modified.