Updated 15 May 2014

A-Z of Botox

What is Botox? How does it work? How long will it last? Is Botox the solution to your problem? This is your complete A-Z guide to botox.

Botox or botulinim toxin that is used for both cosmetic and medical use, is a purified polypeptide that has the ability to relax the muscle that has been injected.

Botulinim toxin consists of seven polypeptides termed A to G. A number of companies are manufacturing botox today and the main difference between them is the type of polypeptide used. Allergens (the gold standard with the most number of studies) has the type A protein and makes use of the heavy chain in the polypeptide molecule, while Myoblok and Neuroblok make use of the type B polypeptide.

Dysport also consists of the type A polypeptide but it makes use of the light chain in the polypeptide molecule. A number of other companies are coming forward with varying polypeptides, and their efficacy and duration is yet to be established. A product from China is manufactured with claims of similar results to the other better known brands, but although the product is cheaper, it contains an animal-derived protein base that has caused allergic reactions and rashes.

How it works
Botox works buy blocking the nerve receptors (neuro-muscular junction) that innervate the muscle injected. More specifically it blocks the release of acetylcholine, thereby preventing the muscle contraction. This stops the ability of the muscle to receive signals to contract, and this allows the smoothing of the overlying skin which in turn causes wrinkles to smooth out and prevent the wrinkle from deepening.

How long will the effect last?
The duration of effect of botox depends on a number of factors.

Firstly, the type of botox used will determine the length of duration, for example:

  • Botox type A (Allergan) – the effect will last three to six months,
  • Dysport – the effect will last two to three months,
  • Myoblok/Neuroblok – the effect will last two to three months.

Secondly, the total dosage used will also determine the duration of the effect. The higher the units used in specific areas, the longer the duration. However, a word of caution, the higher the dosage, the greater the likelihood of side effects and complications.

Other factors, namely muscle mass/size, skin thickness, ethnicity, and gender can also effect the duration but this is directly related to the dosage used.

The sites on the body where botox will work best
Today a wide area of cosmetic uses can be achieved with the correct application and dosage of botox.

Most commonly, the upper face (frown, forehead, and eyes) have a high success rate.

However, great results may be achieved with the bunny lines (wrinkles on the nose), lifting the brow and eyebrows, chin (orange peel effect), lifting the corners of the mouth, lifting the tip of the nose, turkey neck or platysmal bands, lifting the breasts, changing/improving posture, eliminating a gummy smile, correcting skew smiles and asymmetries on the face.

Botox is currently the best non-surgical treatment for hyperhydrosis or excessive sweating under the armpits, hands and feet. This will give relief for six to eight months and an entire 100 units or one vial of botox type A should be used.

Who will benefit most?
Today doctors recommend that people start using botox from the age of around 27 to 30, depending on the degree of sun damage as botox is a great tool to not only prevent wrinkles in the future, but also to delay surgery for as long as possible.

Furthermore, varying dosages and techniques, allows the injector design an individualised treatment plan for each individual, avoiding a mask-like appearance. One can inject areas of the face to accommodate those who need a lot of facial movement (performers on stage, presenters etc.), or those who want maximum benefits and anywhere in between.

Basically any person who would like to improve, enhance and return to a more youthful-looking face can benefit from botox injections.

Who won’t benefit?
Patients who have an unrealistic expectation of the result that botox can achieve. This is the main reason why a consultation is vital so that both the patient and aesthetic practitioner understand each others' aesthetic goal and formulate a treatment plan/programme that will benefit the patient.

For any facial area treated with botox, a number of variables, including specific aesthetic goals, influence the starting and total doses, as well as the placement and number of injections. The distinction between wrinkle effacement and facial shaping is critical. Patient evaluation within the framework of facial enhancement will lead to a treatment plan that incorporates the creation of harmony and balance rather than wrinkle removal in isolation.

Where will you receive the botox and how soon will you look normal again?
All botox injections are performed in the rooms of a doctor under sterile conditions. Depending on the practitioner and the number of areas injected in one sitting, patients can expect the procedure to last between 15 and 30 minutes.

The aim of all aesthetic improvement, including botox injections, is that the person always looks normal and not “done up” or “frozen”. The effect of the botox is directly related to the number of units used per area (discussed above).

What are the possible side effects?

  • Swelling at the site of injection that disappears very quickly.
  • Bruising at the site of injection, but this is rare and usually the bruise is tiny and heals within two to five days. This can be easily hidden with make-up.
  • Stinging at the sight of injection, but everyone is different and most patients feel very little.
  • Swelling of the upper eyelids that can last for up to two weeks has been noted in some patients. This is usually mild and transient, and is thought to be due to the mild trauma to the forehead muscle (frontalis) with the injections resulting in inflammation/oedema.

Possible complications

  • World-wide, the rate of complications are seen to be just under 1:100 for both eyebrow ptosis and eyelid ptosis. Ptosis is defined as a drop, which may be mild or very noticeable,
  • Eyebrow ptosis develops in about 98% of cases as a result of injecting the frontalis muscle with too many units or if one injects too low or too close to the orbital rim. The forehead muscle is the only muscle that lifts the upper half of the face. So if the injector completely immobilises the forehead muscle, the ptosis will develop. Unfortunately this effect will last between two to three months.
  • Eyelid ptosis is usually seen when the botox diffuses from certain injection sites and affects the eyelid muscle. However, since it is only a diffusion (lower dosage of botox), these effect usually only lasts two weeks, but cases have been reported where this ptosis may last up to two months. There are eye drops that provide some relief to the upper eyelid, therefore helping to raise the lid.

How available is it?
Plastic surgeons, dermatologists and some general practitioners are all taking a great interest in this exciting and ever-changing field. This not only includes botox but encompasses a wide range of possibilities from fillers to chemical peels, mesotherapy, light- and laser-based treatments as well as tackling cellulite, lifestyle changes and using various ‘natural’ and hormonal supplementation to achieve a desired effect and result. The best way to find an experienced aesthetic practitioner, is by word of mouth.

More and more medical practitioners are turning their abilities to non-surgical enhancement, either full time or as part of their practice.

Ask around, especially if one has friends who already have an aesthetic practitioner. Doctors in this field of practice believe that worldwide, medical doctors will progress to aesthetic practitioners who specialise in a specific area and/or treatment modality. Recently, at the F.A.C.E. congress in London, a number of specialists were introduced with specific experience in one product, and are considered world-renowned not only for the injection technique.

When a patient is considering using both surgical and non-surgical methods to enhance and improve one’s outward appearance they should book a consultation with the prospective doctor or doctors, as a relationship and rapport is vital for achieving the desired outcome. Feel comfortable with not only the surroundings but also with the practitioner him/herself.

How much will it cost?
Genop Healthcare, the company that distributes botox type A, recommends that practitioners charge per unit used at a price of R50 per unit. The range of units used depens on a number of factors that each practitioner needs to consider before injecting. However, as a rough guideline the following botox type A (Allergan) units can be used as displayed below.

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  Female Male
Frown20 - 40 units @ R50 each 30 - 50 units @ R50 each
Forehead8 - 20 units @ R50 each12 - 25 units @ R50 each
Crow's feet (eyes)20 - 40 units @ R50 each30 - 50 units @ R50 each
Lips6 - 8 units @ R50 each8 - 10 units @ R50 each
Bunny lines4 - 8 units @ R50 each4 - 8 units @ R50 each
Corner of mouth6 - 8 units @ R50 each8 - 10 units @ R50 each
Platysmal bands12 - 20 units @ R50 each12 - 20 units @ R50 each

Some practitioners charge per area injected. Prices vary from practitioner to practitioner. Cheaper is not always better.

Patients can expect to pay between R800 and R1 500 per area injected. One area may be the eyes (crow’s feet), while a second area may be the frown and forehead.

In the UK, treatment of each of the areas can cost between £175 to £300, while an all-encompassing botox session (whole face) would cost a patient £500.

The price charged to the patient should be directly proportional to the number of units used, which in turn will determine the duration of the effect.

What is the success rate out of 10?
The world-wide success rate of botox is 83%. The remaining 17% failure can be attributed to unrealistic expectations, incorrect dosage or injecting technique rating. It is thought that 3% of the failure is caused by problems with person’s antibodies or problems with botox. Taking these figures, the success rate is 8.3 out of 10.

Article compiled for by Lorraine Forbes (journalist), and reviewed by Dr Alek Nikolik, MBBCh ATLS MBA, an aesthetic practicioner based in Cape Town who also consults in Johannesburg, London and Cardiff.
Date of last review: January 2007.
Dr Nikolik's contact details:
31 Piers Rd
Chelsea Village
Cape Town
tel: +27 (21) 797 0960 and mobile + 27 (83) 2540158
fax: +27 (21) 797 0962


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