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Botox™ is an increasingly common phenomenon in American society. From celebrities to CEOs, supermodels to soccer moms, women to men, everybody is looking, well, a little less crinkly and a lot more smooth lately.
Thankfully, lots of great information is available on Botox. Here, I share everything I believe the savvy patient would want to know:
There are seven different serotypes of Botox™.
They are lettered A to G, with A being the most commonly used serotype as Botox (by Allergan), and B being used as Myobloc (by Ipsen Products). For more on the differences between the serotypes, please click here.
…But the person behind the needle ultimately matters as much as the chemical itself.
According to some records, Miami and New York City derm and “Baron of Botox™” Dr. Frederic Brandt™ administers more procedures per year than any other. But the reason for his popularity isn’t just the fact he reportedly has Madonna as a client: Brandt pioneered “the Botox™ Face Lift,” a series of injections that result in a face so lifted, it looks like a face lift. Botox is truly an art, so leave your face in the hands of a true master: according to DocShop.com, find a board-certified, fully licensed cosmetic dermatologist, cosmetic surgeon, or facial plastic surgeon who has conducted the procedure extensively, and do not be afraid to ask for photographs of other patients. However, do be wary of over-instructing the physician; for instance, some patients instruct the physician which part of the muscle to inject or how much injectable to use, and even though the patient may be very savvy, sometimes, the doctor really just does know best! In other words, once you find a trustworthy physician, let him/her do his/her job!
How Botox™ works:
According to Dr. Leslie Baumann’s Cosmetic Dermatology textbook, the most commonly used type of Botox™ is serotype A. When Botox™ serotype A is injected, it cleaves a protein that is necessary for a neurotransmitter release, effectively preventing the neurotransmitter from binding to cellular membranes to cause muscle contractions. (Hence your relaxed appearance afterwards!) And, for you science geeks, the exact protein that is cleaved is SNAP-25, the complex is the soluble N-ethylmaleimide sensitive factor attachment protein receptor, and the neurotransmitter is none other than acetylcholine.
Results are not instant.
Results generally take between 12 to 96 hours to fully appear, with the optimal effect occurring 7 days after the procedure.
The price may vary by physician and by patient.
According to Baumann, “the amount of botulism toxin needed per site depends on the musculature of the individual patient. Therefore, Botox™ and Myobloc should be priced by the number of units used, and not by the area treated…The price also varies according to the area of the country one lives in.” So don’t always expect to pay the same price as a friend or family member, and definitely don’t expect to cough over the same amount in, say, Cleveland and New York City.
The recent Botox™ scare is nothing to raise your brow over.
(Pun alert!) But seriously, no deaths in adults undergoing a cosmetic procedure have ever occurred from Botox™. A 2008 FDA investigation questioning the safety of Botox™ found that all of the serious events were in children exposed to extremely high doses of botulism toxin. The doses ranged from 6.25 to 32 units per kilogram of bodyweight — that is the equivalent of 460 to 2,400 units for an adult — a huge dose. The approved dose of Botox for cosmetic purposes is 20 units. Put simply, you would need to have a dermatologist inject you with 23 to 120 times the normal dose for toxic effects to occur. Not only is that about as likely as it to start raining elephants, but it has never happened to date – a sign you can surely rest assured of the procedure’s safety.
But there are documented side effects in some individuals…
According to the Botox™ Cosmetic website, patients with certain neuromuscular disorders such as ALS, myasthenia gravis, or Lambert-Eaton syndrome may be at increased risk of serious side effects from Botox. Aside from those patients, the most common side effects following injection include temporary eyelid droop and nausea. In addition, localized pain, infection, inflammation, tenderness, swelling, redness, and/or bleeding/bruising may be associated with the injection. Dr. Leslie Baumann recommends avoiding aspirin, green tea, nonsteroidal anti-inflammatory drugs (NSAIDs), and vitamin E 10 days prior to treatment, and topical vitamin K (as in one of my favorite formulations, Peter Thomas Roth Power K eye cream) afterwards. Ice packs may also help.
…including addiction to Botox!
Believe it or not, according to über dermatologist Dr. Patricia Wexler, “People with addictive personalities can get addicted to anything, and it’s up to the doctor to say ‘no’. That word should be in their vocabulary.”
…and there is the remote possibility that Botox use may change your brain structure.
This Italian study in the Journal of Neuroscience found that Botox™ injected into rats is not localized in the rats’ skin, but rather, travels to the rats’ brains, shutting off nerves there. My retort to this matches that of dermatologist Dr. Benabio, of the Derm Blog: “The study was done in rats, not people. We do not know if it would do the same thing in humans. Even if some botox did get into the brain, there is no evidence at all that it has any meaningful effect, good or bad.” Still, if the idea of Botox™ potentially altering your brain structure freaks you out too much to keep using the stuff, Dr. Benabio recommends retinoids as tretinoin, and I particularly love non-prescription retinol formulations.
And you should NEVER make your own Botox™.
I got this one from The Derm Blog as well: don’t try to make your own homemade Botox from WikiHow, as this only leads to trouble. Remember, Botox is a prescription drug, and must be administered by a responsible physician!
No creams that are “better than Botox™” work quite as well as Botox™.
For instance, a 2006 study compared the efficacy of botulinum toxin type A (Botox™), placebo injection, StriVectin-SD®, Wrinkle Relax™, and HydroDerm™ (with palmitoyl oligopeptide), and found that none of the topical preparations were better than Botox in efficacy and overall patient satisfaction. This is most likely due to the fact that topical preparations of peptides increase collagen production over time, whereas Botox relaxes muscles and makes wrinkles very much less apparent within 1-7 days and stimulates collagen production over time. Another type of cream contains a GABA (inhibitory) neurotransmitter. Although companies claim that “100% of women” in their study experienced the 50-90% reduction in fine lines and wrinkles, the main ingredient, gamma aminobutyric acid, does not always have these types of results. GABA, an inhibitory neurotransmitter, may temporarily inhibit nerves and reduce the appearance of wrinkles when applied topically, but this effect varies from woman to woman, and is not usually anywhere comparable to Botox or other professionally-administered wrinkle reducers, particularly because topically applied GABA cannot affect synaptic transmission at the cellular level, whereas injected Botox certainly can.
Botox™ is only getting more popular…
According to Science, it’s one of the fastest growing cosmetic procedures in the world in 2008, with an estimated 1 million Americans undergoing the procedure. Before making the decision, find an experienced board-certified, licensed dermatologist or plastic surgeon or cosmetic surgeon, and, of course, stay informed with the latest news on FutureDerm.com, 😉 (Shameless, I know…)