What Is Botulinum Toxin?
Botulinum toxin is a neurotoxic derivative of Clostridium botulinum. There are eight distinct antigenic serotypes of exotoxins, and among these, only A and B are used for various medical indications. Exotoxin A is the most commonly used, and it is more potent than exotoxin B.
Clostridium botulinum bacteria are present in many natural settings, like soil, forests, lakes, and the intestinal tracts of fish and mammals.
Naturally occurring Clostridium botulinum bacteria and their spores are harmless, and the problems only arise when these spores transform and increase the cell population. To a certain extent, the bacteria start to produce Botulinum toxin, a deadly neurotoxin responsible for botulism.
Botulinum toxin is hazardous, and some scientists have found that a crystalline form of the Botulinum toxin can kill 1 million people, and a couple of kilograms can kill every human on the planet.
How Does It Work?
Botulinum toxin is a neurotoxin that targets the nervous system to disrupt the nerve signaling process that stimulates muscle contraction; thus, the drug causes temporary muscle paralysis.
In order to contract the muscle, the Botulinum toxin inhibits the release of neurotransmitters, a chemical messenger (acetylcholine) at the nerve terminal. It impedes the nerve impulse and leads to paralysis of muscles. This is due to the attachment of the acetylcholine to the receptors on the muscle cells, and this causes the cells to contract or shorten.
Thus, Botox injections prevent the release of acetylcholine, which stops the contraction of the muscle cells.
What Are the Uses of Botox?
a) Cosmetic Use of Botox:
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Elimination or cosmetic correction of wrinkles and rhytides on the upper face like crow’s feet wrinkles at the side of our eyes, frown lines or angry lines on the forehead and mid and lower part of the face like the line below eyes, lines around the mouth, chin irregularities and correction of mouth corner.
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Eyebrow lift - Due to aging, if there is a descent of eyebrows, then it can be raised back.
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Horizontal necklace lines or vertical platysmal bands can be corrected.
b) Other Uses of Botox:
Also, Botox is used to treat a variety of medical conditions. The FDA has approved Botox for people above 18 years of age for the following uses.
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It is utilized for the treatment of muscle spasms like in torticollis, palmoplantar and axillary hyperhidrosis (excessive sweating).
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Upper limb spasticity (people older than 2 years of age).
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Neurological movement disorder called cervical dystonia, affecting the head and causing neck pain.
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Crossed eyes, or strabismus (people older than 12 years of age).
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Preventing migraines in people whose headaches last for at least 4 hours for 15 days a month.
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Severe sweating of underarms or hyperhidrosis.
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Eyelid spasms, due to dystonia.
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Reduces symptoms of an overactive bladder when anticholinergic medications do not help.
c) Unapproved Uses:
Some people also have Botox injections for unapproved uses; they are,
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Vulvodynia, discomfort, and pain in the vagina with unknown cause.
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Alopecia.
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Achalasia (difficulty in swallowing).
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Sialorrhea (producing too much saliva).
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Psoriasis.
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Raynaud’s disease (affects circulation).
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Post-herpetic neuralgia.
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Dyshidrotic eczema (affecting the palms of the hands and soles of the feet)
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Anismus (dysfunction of the anal muscle).
d) Used in Other Conditions:
Botox is used for other issues, off-labels, and medical conditions, they are,
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Facial redness and flushing, also during menopause.
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Scars and keloids from wound healing.
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Hidradenitis suppurativa, an inflammatory skin disease.
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Blistering lesions due to Hailey-Hailey disease, which is a rare genetic disorder.
Botox is safe for off-label uses, but scientists should establish the appropriate way to deliver treatment in each case.
What Are the Contraindications of Botox?
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In the case of neuromuscular disorders like myasthenia gravis, autonomic dysfunction, muscle weakness, etc.
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History of hypersensitivity to this toxin.
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Local infection at the injection site.
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Pregnancy and lactation.
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Individuals on treatment with aminoglycoside antibiotics like Amikacin, Gentamicin, Kanamycin, Neomycin or Spectinomycin, antimalarials, D-Penicillamine, and Cyclosporine in the past three days as these drugs accentuate the effects of Botox.
What Is the Procedure for Using Botox?
Preparation of Botox:
Your treating doctor will mix 1 to 2.5 mL of preservative-free normal saline to reconstitute the 100 units of neurotoxin. This prepared solution can be stored at 2 to 8 degrees Celsius for up to four weeks. Its 0.1 mL contains four units of Botox.
Doses:
For forehead wrinkles and frown lines, use 10 to 25 units; for crow’s feet, use 9 to 15 units per side; for bunny lines, 3 to 5 units per side; for chin correction, use 5 to 15 units and neckbands 20 to 50 units.
The Technique of Injection:
Usually, local anesthesia is not required for cosmetic correction of the face, but in the case of palmoplantar or axillary hyperhidrosis, it is required. The toxin is injected with an insulin syringe, which causes very minimal pain. The needle should be used at 45 degrees to a depth of 2 mm to avoid the backflow of toxin.
Instructions to Follow After Procedure:
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An individual in whom the toxin is injected should not recline for 3 to 6 hours to prevent unwanted diffusion of the toxin.
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Not to massage or manipulate the treated area for 4 hours to avoid bruising.
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Not to exercise the treated muscles for the first 2 to 3 hours, like not to frown or raise the eyebrows or smile.
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Wipe off any toxin immediately if present on the skin.
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Maximum effects are seen after 7 to 10 days and last for approximately three months, and in some cases, much longer.
What Are the Side Effects of Botox?
Generally, people can tolerate Botox injections, and so the side effects are uncommon. But, depending on the reason for these injections and the person’s response to the treatment, it causes some side effects.
Common Side effects:
The common side effects are redness, swelling, bruising, and pain at the injection site.
Important Side Effects:
Some important side effects include,
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Eyelid drooping.
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Eyebrow drooping.
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Ectropion (the lower eyelid turns outwards).
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Weakness of hands.
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Deep injection in neck muscles can lead to difficulty in swallowing or bending of the neck.
Other Side Effects:
Other side effects are,
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Dry eyes.
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Numbness.
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Stomach upset.
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Headache.
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Corneal ulceration after treatment for blepharitis.
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Eyelid drooping.
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Weakness of hands.
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Double vision after therapy for strabismus.
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Unwanted weakness or paralysis in nearby muscles.
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Urinary problems after treatment for urinary incontinence.
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Worsening of neuromuscular disorders.
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Spatial disorientation after treatment for strabismus.
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Cardiovascular events, such as,
a. Arrhythmia.
b. Myocardial infarction.
Depending on the type of Botox treatment they undergo, the effects may extend beyond the injection site, sometimes leading to difficulty breathing. Also, people should not use Botox if they are,
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Sensitive or allergic to it.
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Develop an infection at the injection site.
