Botox is a drug based on botulinum neurotoxin type A, which is produced by Allergan (USA). This word is also used to refer to all analogues of the drug. The botulinum toxin injection procedure gained popularity at the end of the last century and has since remained the most popular non-surgical anti-aging technique.
Botulinum toxin: what is it and how does it help in the fight against wrinkles?
The effect of Botox is achieved due to the neurotoxin botulism type A. It is one of the most dangerous poisons in the world, but in cosmetology such microscopic doses of the substance are used that it is not at all difficult for a professional to control its effect and get a positive result.
Naturally, botulinum toxin is not used in cosmetology in its pure form. It is first stabilized and purified from protein impurities in the laboratory.
The effect of Botox is as follows: with an injection, it enters the muscle, blocking the transmission of nerve impulses in it. As a result, the muscle relaxes, its contraction stops, and as a result, the skin adjacent to it becomes smooth.
Indications for the use of Botox
Botulinum toxin can smooth out wrinkles in almost any area of the face. However, Botox shows the greatest effect in its upper third. So, the drug allows you to get rid of:
- horizontal and vertical wrinkles on the forehead and between the eyebrows;
- wrinkles around the eyes (so-called “crow’s feet”);
- folds on the back of the nose;
- so-called “marionette wrinkles” - labiomental folds;
- cords on the neck.
Botox is also used by highly qualified specialists for:
- correction of the shape of the eyebrows, their height position;
- narrowing of the wings of the nose and raising its tip;
- raising the drooping corners of the lips;
- visual lengthening of the chin;
- correction of facial asymmetry caused by blepharospasms and other spastic effects.
Botulinum toxin is also often injected into the feet, palms and armpits to reduce sweating. This procedure is indicated for people with hyperhidrosis, but it is often used by healthy patients on the eve of summer.
What affects the effectiveness of botulinum toxin injections?
- amount of drug administered;
- correction area. The duration of the effect of correcting wrinkles on the forehead will be longer than in the eye area;
- depth of wrinkles. The deeper the wrinkles, the less noticeable the effect;
- metabolic rate. The higher the speed, the shorter the duration of Botox;
- age. The older the patient, the longer the effect, since muscle tone takes longer to restore;
- floor. In men, Botox has a shorter duration of action;
- immunity. For some patients, botulinum toxin has no effect or its effect is insignificant. The immune system recognizes botulinum toxin molecules as viruses and destroys them;
- implementation of recommendations. The result of botulinum therapy and its effectiveness depends on the implementation of the following recommendations: in the first 2-4 hours it is not recommended to tilt your head, but keep it only in a horizontal position, it is forbidden to visit baths and saunas, and you cannot play sports.
Our publication on Instagram “Correction of facial wrinkles”.
Procedure algorithm
It is very important that botulinum toxin injections are performed by a qualified cosmetologist or plastic surgeon. Handling this rather dangerous drug requires experience and special training. The correct volume of the drug and injection points are the key to a good effect from Botox. At this stage, you simply cannot make mistakes. Otherwise, the patient will have to pay with a damaged face for several months at best or serious health problems at worst.
The procedure itself is carried out in several stages:
1. Cleansing. It is necessary to very carefully clean the skin of cosmetics, dust particles, etc., which can get into injection wounds and cause serious problems.
2. Marking and anesthesia. The doctor marks the points on the face where the drug will be injected and treats them with a local anesthetic. Despite the fact that the needle on the syringe is very thin and the doses of the drug are minimal, injecting Botox is painful, especially in sensitive areas near the lips and eyes. However, using a good anesthetic will significantly reduce the pain of the procedure.
3. Preparation of instruments and preparation. You have to wait up to half an hour for the anesthetic to take effect. During this time, the doctor prepares the drug - opens the package, dilutes it with saline, prepares syringes (one or several, depending on the number of facial areas being treated).
4. Injections. Next, the doses of the drug determined in advance are actually introduced into the points marked in the second stage. The patient needs to help the doctor at this stage by frowning or otherwise straining his facial muscles.
5. Antiseptic treatment. After all the injections have been administered, the doctor treats the skin with chlorhexidine and applies a cold compress to it, which will help reduce the severity of swelling and bruises that are sure to appear.
The procedure does not require particularly complex rehabilitation. You only need:
- in the first hours - do not take a horizontal position, strain the facial muscles to evenly distribute the drug in the tissues;
- in the first days - do not rub the injection sites, do not use cosmetics and care products, do not expose the skin to ultraviolet radiation;
- in the first weeks - do not go to the gym, sauna or swimming pool, do not drink alcohol or other products that retain water.
The most common reasons are
If after injections of Botox or its analogs there is no effect or is weakly expressed, then we are most likely talking about complete or partial denaturation of botulinum toxin molecules. This occurs due to violations of storage conditions before diluting the bottle with botulinum toxin, errors in diluting the drug, violation of the conditions of its storage and use after dilution. There are also particularly enterprising cosmetologists who simply charge 15-20% less units than what was paid by the client.
1) Violation of storage conditions (before dilution) –
Most botulinum toxin preparations are very sensitive to storage temperature. You can store undiluted botulinum toxins from any manufacturer (with the exception of Xeomin) either frozen in the freezer or in the refrigerator at a temperature of 2-8 degrees Celsius. And this storage regime cannot be violated from the moment the drug is packaged by the manufacturer until the drug is diluted with saline solution directly in a cosmetology clinic or beauty salon.
But imagine that somewhere during the transportation/storage stage the power supply is turned off, and the drug was first defrosted and then frozen again, or it simply lay overnight in a non-working refrigerator even without re-freezing. All this immediately leads to a decrease in the effectiveness (strength and duration of action) of the drug. The only botulinum toxin that can be stored at room temperature until diluted is the German drug Xeomin, which provides a guarantee against violations of storage conditions at least until the drug is diluted.
2) Errors when diluting the drug –
Botulinum toxin molecules are a very delicate substance that needs to be very carefully diluted with a solvent (saline). For example, if saline solution is introduced into the bottle too quickly, then during the dilution process many air bubbles and foam may form - which should not happen under any circumstances. Also, you should not shake the bottle, trying to dissolve the botulinum toxin crystals in the saline solution. Incorrect dilution and vigorous shaking of the solution lead to denaturation of botulinum toxin, i.e. to complete or partial loss of effectiveness.
3) Violation of storage conditions (after dilution) –
This is the most common violation. Any botulinum toxin after dilution should be used only within 24 hours, which is stated in black and white in the instructions for use for Botox, Xeomin, Dysport, etc. That is why, in clinics that value their patients, botulinum toxin injections are carried out on special “Botox days”. For example, a patient came to you, and in front of him you diluted a bottle of Botox 100 units. You will only give this patient 25-35 units, but the rest should only be used within 24 hours.
The next patient may come only in 2-3 days or a week, and it turns out that the remainder of the diluted drug will need to be thrown away. That is why the clinic collects several patients, and when they have the required number, they call them and invite them to a certain day. It usually happens quite differently in beauty salons, where most often they work not with dermatologists or cosmetologists with higher medical education, but with ordinary nurses with advanced training in “nursing in cosmetology.”
In beauty salons, in order not to lose clients, they are not prescribed on special days, but injections are given immediately. How does this happen. The cosmetologist dilutes a bottle of Botox with 100 units, and this fresh solution is given only to the first patient (for example, 30 units), and the remaining 70 units of the drug solution are consumed as follows. The first option is to put the bottle of diluted botulinum toxin back into the refrigerator, where it can stand for 2-3-4 weeks until the cosmetologist uses it completely. Naturally, the strength and duration of action of botulinum toxin will be lower the longer the bottle of the diluted drug sits in the refrigerator. Let us remind you that it can stand for 24 hours, after which it must be thrown away.
The second option is to take the remaining 70 units into several syringes (say 30 units + 20 units + 20 units), and these syringes are placed in the freezer. And when the patient arrives, the syringe is removed from the freezer. Considering the small volume of the solution, only 5-10 minutes are enough to defrost it. But the whole point is that diluted solutions cannot be re-frozen, because... ice crystals mechanically destroy botulinum toxin molecules. In clinical studies with Gartlan MG and Hoffman HT, it was shown that after repeated freezing and thawing, at least 69.8% of botulinum toxin molecules lose their activity.
4) Deception with dilution of the drug -
Let us explain using the example of the drug Botox. If a bottle of Botox® 100 units is diluted with 2.0 ml of saline solution, in this case there will be 5 units in 0.1 ml of solution. If 2.5 ml of saline solution is used for dilution, 0.1 ml will contain 4 units of botulinum toxin. But imagine that the cosmetologist specifically used 1.0 ml more saline solution for dilution than needed, so that in each 0.1 ml injected into you there would be several units of Botox less. The units of the drug saved from such manipulation will be supplied for money to another patient.
5) Illegal Botox injections in beauty salons –
We have already said above that botulinum toxin injections cannot be administered by nursing staff, although in beauty salons, “cosmetologists” are predominantly nurses who have undergone advanced training in “nursing in cosmetology.” Moreover, such a certificate also does not give them the right to inject botulinum toxin, and for this they need to undergo special training. But the fact is that according to the law, only doctors can teach botulinum therapy, i.e. specialists with higher medical education.
You can easily check the last statement by trying to enroll in a course on botulinum therapy, for example, at the Department of Additional Professional Education at Moscow State Medical University named after. Sechenov or MIEM. But in small private offices, in an effort to make money from training, they even teach nurses illegally, giving them commercial certificates that do not give them any right to carry out additional professional activities. Having completed such 1-2 day courses, without properly knowing either the anatomy of the facial muscles or the exit of nerve trunks and blood vessels, they begin to inject Botox.
A common mistake of such specialists is that they do not know the location of the muscles well and do not always make injections at the right points. In addition, they are simply afraid to inject and often inject too superficially - sometimes not even into the muscles, but into the deep layers of the dermis. Of course, such specialists can say that the solution has diffusion (i.e., the property of spreading in tissues), and it will reach where it is needed. This is partly true, but the muscles are surrounded by fascia, through which solutions diffuse poorly. This is if the solution is injected deep into the muscle - it will have good diffusion along the muscle, but not otherwise.
Important: but poor knowledge of the facial muscles and injection techniques can lead not only to the lack of a good effect. The most serious complications with botulinum therapy relate to excessive relaxation of certain muscles, especially when you inject between the eyebrows or in the eye area. Frequent complications are diplopia (double vision), lagophthalmos, swelling of the eyelids, hernial protrusion of infraorbital fat pads. Other common complications are ptosis (drooping) of the upper eyelid, ptosis of the eyebrows.
When does Botox start to work and how long does it last?
Already a couple of hours after the procedure, the first result is noticeable. After a few days, the effect is clearly visible visually. It will take about 2 weeks to form the final result.
If it is sufficient and satisfies both the cosmetologist and the patient, then no further manipulations are performed. Otherwise, for example, if minor asymmetry occurs, a correction session is performed with a small dose of botulinum toxin.
4-6 months is how long Botox can last. Gradually during this period, muscle and nerve fibers are restored. Six months after the injections, the procedure can be completely repeated.
It is noteworthy that several courses of Botox injections can increase the patient’s tolerance to botulinum toxin. This means that subsequent procedures will require a larger amount of the drug, and it will act in 1.5-2 times less time.
As a rule, tolerance increases if Botox is injected more often than once every 4 months. It is possible to restore the body's sensitivity. To do this, you should take a break from injections for at least 1 year.
Comparison of the effectiveness of different botulinum toxins –
You can often hear from patients that, for example, Dysport or Refinex act stronger and longer, and for example Botox, Botulax, Xeomin - more gently. But other patients say the opposite. I would also like to comment on this. There are comparative clinical studies that show that 1 unit of Botox is completely identical to 1 unit of Xeomin or, for example, 1 unit of Korean Botulax. At the same time, 1 unit of Botox corresponds in strength to 2.5-3 units of Dysport.
It is also difficult to compare the effectiveness of different botulinum toxins delivered by different cosmetologists because all specialists apply slightly different amounts of units to each zone and use different dilutions of the drug. Those. There are too many factors influencing the final result. Below we will describe what may lead to differences in the perception of the effectiveness of botulinum toxins from different manufacturers.
- Number of units in the bottle - for example, if the bottle says 100 units, then in reality there will never be exactly that many units. This is due to the technological impossibility of packaging a strictly defined number of botulinum toxin molecules into bottles, and, by the way, the manufacturer never keeps silent about this. The range is usually 5 units more or less. Those. a bottle of the same drug may contain less or more botulinum toxin, which affects its final concentration in solution and effect. And then how lucky you are.
- The number of units at each point - for example, you were given 12 units of Botox at the outer corners of your eyes (on each side), i.e.
3 needle insertion points were made on each side, and 4 units were removed in each. You felt the effect after the injections for 5-6 months. The next time you went to another cosmetologist, who put 11 units on each side, but at the same time made not 3, but four injection points on each side. For example, the doctor decided to make 2 additional injection points at the outer edge of each eyebrow to raise them a little, and put 1 unit at each of them. As a result, the concentration of botulinum toxin is distributed over a larger area, and accordingly this will reduce the severity and duration of the effect.
- The degree of dilution – a lot depends on the degree of dilution.
Different cosmetologists prefer different dilutions: for example, some dilute 100 units of botulinum toxin in 1.0 ml of saline, some use 2.0 ml, and others use 2.5 ml. As a result, it turns out that the number of units you need (for example, 30 units) will be diluted with a different volume of solvent in each case. In other words, in each of these cases the syringes will contain a different volume of liquid, but each of them will contain 30 units of botulinum toxin. Why is it important? The fact is that the larger the volume of the solution, the stronger its diffusion in the tissues. For example, in the first case, at each needle insertion point, 2 units of botulinum toxin are released, which are contained in 0.05 ml of the drug. In the second case, 2 units of botulinum toxin are also released at each injection point, but in 0.1 ml of the drug. So, in the second case, the diffusion (spread) of the drug in the soft tissues will be greater, and accordingly these 2 units will be distributed over a larger area and the concentration of botulinum toxin in the muscles will be lower.
- The most important and common reasons are that the strength and duration of action of botulinum toxins will be affected by violations committed by the cosmetologist. For example, one specialist supplied you with a freshly diluted high-quality drug, and another gave you a long-diluted drug that had been stored in the refrigerator for several days or weeks, or even a re-frozen and thawed drug. Other reasons are incorrect injection technique, insufficient number of units, and incompetence of a specialist.
Compatibility of Botox with other procedures
As practice shows, the effect of botulinum toxin injections increases significantly if you combine it with preparations with hyaluronic acid. So, first, facial wrinkles are corrected with Botox, after which other facial irregularities are eliminated with fillers. By the way, both procedures can be performed in one session. However, this requires a very highly qualified cosmetologist.
One month before injections and for the same period after them, you should avoid any aggressive procedures such as peelings and plastic surgery.
Hardware techniques that restore connections between muscle fibers and nerve endings, such as magnetotherapy, microcurrents, galvanotherapy, ultrasound therapy or electrical stimulation, can significantly reduce the effect of botulinum therapy.
Conclusions -
Thus, the first thing you should do is understand which specialist you came to see and whether he has the right to perform botulinum toxin injections.
Secondly, you should be wary if the cosmetologist immediately suggested that you do botulinum toxin injections on this first visit, and not on the “Botox day”. This means that the drug has either already been diluted in advance, or the remainder of the drug will go to other gullible suckers. If the doctor took out a syringe that had already been drawn up in advance, and you did not see him drawing it from the bottle, this means that you have a re-frozen and thawed drug in front of you. Some patients, when you start telling them this, begin to very zealously defend such a specialist. It’s like nothing that the drug was diluted in advance, because Botox “got up” after that. But besides the fact that he “got up” or “didn’t get up”, there are other criteria, for example, the duration of action of the drug (24stoma.ru). In addition, this can have an impact on the development of resistance to botulinum toxins - lead to the production of so-called blocking antibodies by the immune system (and then gradually the botulinum toxins will no longer affect you at all). And lastly, this is the deliberate provision of obviously low-quality services.
As for comparing the effectiveness of different botulinum toxin preparations, as we showed above, there are many simultaneously influencing factors that patients are not even aware of. And these are not only different names of drugs and the number of units, but also the degree of dilution of the drug, the “freshness” of the solution, the correct injection technique, and, banally, the honesty of the cosmetologist.
