Updated 24 April 2014

Botox basics

It’s become the short-hand term for non-surgical anti-ageing interventions. Just what is this toxin, Botox, that so many are turning to?


It’s become the short-hand term for non-surgical anti-ageing interventions. Just what is this toxin, Botox, that so many are turning to?

Botox (botulinim toxin), used for both cosmetic and medical interventions, is a purified and diluted form of the clostridium botulinum bacteria. Its beauty lies in its ability to relax the muscle that has been injected, resulting in the “Look doll! No more frown lines!” appearance.

If the word Botox makes you feel slightly nervous, that’s because it reminds you of botulism, derived from the same bacteria, which you probably associate with food poisoning and paralysis. Happily, scientists have found a way of using it to human advantage for safe, controlled weakening of the muscles.

The Food and Drug Administration (FDA) in the United States, with its stringent safeguards, reports it safe for treating some – not all – wrinkles. And beware of imitation products with an animal-derived protein base – they have been known to cause allergic reactions and rashes.

How it works
Botox blocks 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 muscle from being able to receive signals to contract, which means the overlying skin smoothes over and wrinkles cannot deepen.

How long will the effect last?
The hard facts are that while this treatment is cheaper than a surgical facelift, you have to have follow-ups every few months as the effect wears off.

Professor Don du Toit, a former surgeon at the University of Stellenbosch now involved in cosmetic research, says that while Botox is a muscle relaxant, it does have some problems. “The treatment is variable and some people don’t have a predictable response. It wears off after three to six months, and you should return for a follow-up procedure.”

The duration of the effect of Botox depends on a number of factors, including the type used (different polypeptides are involved), and the total dosage applied.

Doctors have to balance longevity of response against the fact that the higher the dosage, the greater the likelihood of side effects and complications.

Other factors include muscle mass and size, skin thickness, ethnicity and gender.

Where it works best
In the late 1980s, the FDA gave the thumbs-up to use Botox to stop ailments like blepharospasm (uncontrolled blinking) and strabismus (lazy eye). It hit the headlines when it was also given the nod for rejuvenation treatment of frown lines between the eyebrows – called glabellar lines – known in the industry as “the Botox triangle”.

It is also used for other areas of the face, as well as a non-surgical treatment for hyperhydrosis or excessive sweating in the armpits, hands and feet.

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. Some practitioners also advise it as a preventative measure to prevent wrinkles in the future, and to delay cosmetic surgery.

Varying dosages and techniques allow the injector to design an individualised treatment plan for each individual, avoiding a mask-like appearance (and those whispered: “I’m sure she’s had Botox!” comments).

Who should steer clear
“Anyone over the age of 60!” says Prof Du Toit.Also patients who are pregnant, breastfeeding, have an infection or have a neurological disease or affliction such as Bell ’s palsy. And remember this is not the elixir of youth. If your expectations are to return to your 18-year-old visage, then best you lower them.

Where should you go?
To someone who is trained in the usage, dosage and application. People talk flippantly about popping in for a lunchtime quickie, but do remember this is a toxin and your face you are dealing with.

As Botox does not work for all wrinkles, a consultation with a doctor with the necessary skills is recommended. In fact, it should only be applied by a doctor, in a sterile environment, who has been trained in the administration of the product.

The Medical and Dental Professions Board of South Africa has stated that the performance of cosmetic surgery by medical practitioners without appropriate training is not acceptable. However, as recommendations regarding minimum education and training still have to be outlined, the onus is on the practitioners concerned to ensure they have the necessary training in the performance of procedures of this nature.

The Health Professions Council of South Africa has also warned the public not to be deceived and misled by glossy advertising, but rather to get an appropriately qualified practitioner to perform a procedure. Details of practitioners’ qualifications and disciplinary records are available to the public by phoning the HPCSA call centre at (012) 338 9100.

Are there any side affects?
Temporary bruising is the most common side effect. Headaches, which resolve in 24-48 hours, can occur, but this is rare. Some patients also develop eyebrow or eyelid ptosis caused by the toxin migrating into the surrounding area and causing temporary paralysis. It’s disconcerting but does pass. Patients are advised not to rub the treated area for 12 hours after injection, or to lie down for three to four hours.

Another side effect is the emotional one: disappointment. Some patients have unrealistic expectations of the result that the product can achieve, which is why a prior consultation is vital. It is important for the patient and practitioner to understand each other’s goal and to formulate a treatment plan/programme that will benefit the patient.

Where will you receive the procedure?
All Botox injections should be 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 15 to 30 minutes. The effect of the Botox is directly related to the number of units used per area.

How much will it cost?
Costs vary depending on where you go and the area being treated. Expect to pay R600 to R1 800 per session. Botox is applied in units, and it depends on how many units are used (men generally need a few more units). Some practitioners charge per unit and others per area treated.

(Robyn von Geusau, Health24)


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