Once strictly reserved for the elites, with its long – lasting effects as well as gradually cheaper and easier production, botox has grandly conquered the cosmetic world, as well as the hearts of thousands of satisfied patients. Throughout the years, its price has steadily fallen to the point that the procedure is easily accessible to people from all over the world. As already mentioned, yes, it is effective, yes, the results do last long but what actually is botox? What is the mechanism behind its work, is it the right choice for me? In this guide we will walk you through all the essentials and dispel any of your doubts and worries.

To start with, what is Botox actually?

There is one important thing to clarify – botox is not in fact called botox. The products used for the procedure in your country may have a completely different name – Botox® is just one of them, among the other registered trademarks. Always look for drugs containing botulinum toxin and you will never get lost. In the United States, the substance is marketed under the brand names Botox, Jeuveau, Xeomin and Myobloc. (1)

We are aware that the word “toxin” may have aroused your suspicions but let us convince you that there is nothing to be afraid about this term. In medicine, many substances produced by microorganisms are named toxins – like in this case, the botulinum toxin is produced by bacteria called Clostridium Botulinum. Yes, this substance can cause a disease botulism however only when absorbed in higher concentrations and via other routes than injections e.g. via the GI tract or the airways. For the cosmetic reasons it is totally safe – the concentrations used are too low to enter the bloodstream and do any harm plus it is used locally.

How does the botulinum toxin work?

Botulinum toxin falls under the category of so – called metalloproteinases – it is a group of enzymes that simply destroy specific proteins.(2) It allows the botulinum toxin to enter the nerve terminals communicating with the facial muscles and act further from there. Inside those nerve endings, it deactivates proteins called SNARE. SNARE, on the other hand, normally are responsible for acetylcholine release from the nerve terminals. In normal conditions acetylcholine is a transmitter that causes a muscle contraction, also in the face. Because of that, what the toxin finally achieves, is the blockage of acetylcholine release what equals no muscle contraction. It’s effective to smooth out the skin of the face as well as reduce wrinkles since they are formed due to repetetive and regular contractions of facial muscles. (3)

When does botox start working?

Most commonly you will start seeing the results about 4 days post treatment, however you will have to wait from 10 to 14 days for the effects to be fully seen. (4) Then you can enjoy them 100%.

How long do botox effects last?

There has been a study carried out which confirms that the botox effects duration time varies among women and men. According to them, in females the results should last from 3 to 5 months while in males it is from 4 to 6 months. (5) Nonetheless, most of the patients renew their treatment every 4 months to maintain the maximum results. Some like the feeling of the movement coming back to the muscle though so they wait a bit longer before doing the injection again. Either way, the majority of people relapse by 6 months.

What does a Botox procedure look like?

Botulinum toxin injections are relatively quick and painless. They are often performed by cosmetic dermatology physicians. People literally do it during their lunch breaks. All you will be asked to do is calmly lay down and make specific facial expressions so that the doctor can mark the injection points in the correct manner. Then, you will be asked to relax your face, one or two itches and voilà – you’re done!

There is much faster recovery time compared to common cosmetic surgery procedures.

The Botox Procedure

Treatment with Botox is a non-surgical, chair-side procedure that takes about 10 minutes’ time. A specialist injects some amount of the filler directly into your facial muscles. Anesthesia may or may not be needed. The amount of pain one feels varies with the individual patients. Generally, a pricking sensation similar to a bug bite will be felt with slight pressure as the filler is injected. No rest is needed and you may go to work immediately after.

Which areas can be covered?

Botox treatment can be used to

  • Eliminate the worry lines between eyebrows
  • Get rid of the frown lines on the forehead
  • Eradicate the wrinkles known as crow’s feet beside the eyes
  • Remove the smoker lines around the mouth
  • Lift up the eyebrows
  • Reduce the neck bands
  • Smoothen out the upper lip and chin.The amount of Botox you need

The units of Botox that you’ll need depend on your desired results and the area to be treated. For example, the forehead is a bigger area and needs more amounts, while the inter-eyebrow area is small and so will be the amount of Botox needed. Several other factors affect the units of Botox required which include

  • Age​          
  • Gender
  • Patient preference for the amount of firmness they want
  • Face size and shape
  • Muscle strength
  • Severity of wrinkles
  • Metabolism

The manufacturer provides a set of guidelines​ to direct the clinician for the right amount of Botox needed for each specific area. The clinician can then adjust the dose according to these guidelines in order to achieve the required results.

How long do its effects last?

The results of Botox treatment on your face will become evident gradually with time. The first sign will show after about 3 to 5 days with the maximum results showing at about 7 to 14 days post-treatment.

You will have a rejuvenated and younger-looking skin that will last for approximately three to six months after treatment. After three months, the results will start to fade away and expression lines will again start to show up because the fillers are biodegradable materials that the body naturally gets rid of. It’s then, time to head to the beauty clinic again for another session to revive your look once again.

Are there any side effects?

Even though it contains the same toxin that causes a life-threatening condition called Botulism that occurs due to food poisoning, Botox is considered safe as it is used in small amounts. A 2005 study has shown that the risk of adverse effects caused by the toxin is more likely with therapeutic use rather than the cosmetic use, corresponding to the higher therapeutic doses.

Botox injections are generally safe, possible side effects if any are minimal and include

  • Pain
  • Puffiness at the site of injection
  • Chills
  • Headache
  • Fever

Minor side effects around the eyes include

  • uneven eyebrows
  • drooping eyelids
  • excessive tearing or dry eyes

Minor side effects around the mouth include asymmetrical smile and drooling. However, in rare cases, if you experience allergic reactions or symptoms like difficulty swallowing, breathing, poor vision or loss of bladder control, immediately seek medical care.

Side effects of the Botox injections

Any medical intervention entails some specific side effects nevertheless it doesn’t mean that they will happen.(6) In this particular case we can divide the side effects into those that happen often and those that are very rare.

The common side effects of botox injections:

  • little swelling or bumps at the injection site which subside within around 40 minutes after the procedure
  • bruising especially if you take the drugs listed later in this guide; they dissapear within a week
  • headaches; regular ibuprofen or paracetamon are totally accepted here.

The rare side effects of botox injections:

  • ptosis (the dropping and heaviness of the eyelid(s)); if it happens it resolves within 4 – 6 weeks (7)
  • allergic reaction
  • infection.

Can I take my medication before the treatment?

There are no drugs that are strictly forbidden before botox injections or put you in direct danger. If you cannot get off your medication for a few days, it is alright, you will just be at a higher risk of getting some bruising which, as earlier mentioned, will subside by itself within a week. Nonetheless, if bruising is your concern, it is advised not to take the listed drugs for 3 days before the injection:

  • Anticoagulants like warfarin (8)
  • Ibuprofen / Aspirin
  • Vitamins
  • Omega – 3 fatty acids
  • Retin – A and other forms of tretinoin.

The first four positions slow down the clotting of the blood so you will more likely get bruising. Tretinoin, on the other hand, deprives the skin from its strong protective lipid barrier thus the skin is more susceptible after applying it. Increased skin susceptibility equals increased risk of a skin infection what none of us would like to get.

Can I wear makeup during the procedure?

For the same reason aka skin infection prevention, you should not be wearing your make – up or any other cosmetics during the procedure nor apply it for at least 2 hours post the injection. 2 hours is the shortest time for the skin to replenish its protective barrier so if you can wait with make – up even longer, it would be only for your best.

Can I drink alcohol before/after the procedure?

Luckily for you, there are no contraindications for having a drink before or after a botox injection! However, you should be careful if you go to a party afterwards – you could sweat the toxin out off your body if you dance too hard. Avoid all forms of intensive excercise for 24 hours post treatment.

Can I workout after the procedure?

Please read the paragraph above.

Can I get an injection while pregnant/breastfeeding?

It is advised not to get a botulinum toxin injection while being pregnant or breastfeeding. There are no clear findings about what happens if a person does so, however it is always better to avoid potentially detrimental foreign substances while caring for a baby.

Is botox used only for cosmetic reasons?

It’s an interesting fact, isn’t it? The injections are widely used in miscellaneous branches of medicine since acetylcholine is reponsible for many other processes in our body. For instance, its excessive realease is correlated with excessive sweating – here the botulinum toxin is used as the treatment. Moreover, since botox stops specific muscle contractions, it is also used in patients with overactive bladders, tremors, muscle spasms or strabismus.

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