Ever since gaining U.S. Food and Drug Administration approval ten years ago on April 15, 2002, to smoothen frown lines between the eyebrows, the number of Botox injections used for all types of cosmetic purposes has soared to dizzying heights, ranking by far as the world’s most common cosmetic procedure year after year. About 5.7 million people In USA had this treatment last year — 518 percent more than the 1.1 million who had the injections in 2002, according to the American Society of Plastic Surgeons.
In 1946 Edward J. Schantz and colleagues succeeded in purifying Botulinum Toxin Type A in crystalline form, for the first time providing scientists with the raw material necessary to study the molecule in greater detail.In the 1960s, ophthalmologist Dr. Alan B. Scott started injecting botulinum toxin type A into monkeys, presuming its muscle-relaxing effects will help in the treatment of crossed eyes (or strabismus). In 1978, Dr Scott received FDA approval to inject tiny amounts of botulinum toxin into human volunteers and soon he published that it “appears to be a safe and useful therapy for strabismus.”
But by far the most defining discovery came accidentally when Canadian ophthalmologist Dr. Jean Carruthers noticed that her blepharospasm patients were also getting rid of their frown lines. In 1992, she and her dermatologist husband published a study in the Journal of Dermatologic Surgery and Oncology stating that treatment with C. botulinum-A exotoxin for the treatment of brow wrinkles. Finally on April 15, 2002, Allergan received FDA approval to market its formulation for its first cosmetic use for improvement of the moderate to severe ‘frown lines’ between the eyebrows (Glabellar lines).
Clostridium botulinum produces eight serologically distinct botulinum toxins called A, B, Cα, Cβ, D, E, F, and G. Of the eight serotypes, type A is the most potent and most commonly commercially available formulation, although serotypes B and F are almost as strong. Onabotulinumtoxin A or BOTOX® relaxes the tiny facial muscles that cause expression lines, leaving the overlying skin smooth and unwrinkled. Expression lines result from the contraction of facial muscles. If the facial muscles responsible for the wrinkles relax, the skin gradually reshapes itself making the wrinkles less noticeable. Thus the lines gradually smooth out from disuse, and new creases are prevented from forming. The effects start showing due to muscle relaxation that usually begins 2–3 days after local injection, which may ultimately progress to total relaxation by 8–10 days depending on the dose injected.
BOTOX® Cosmetic is used widely for the elimination of ‘Frown Lines’ between the eyebrows, ‘Worry Lines’ or horizontal forehead wrinkles and ‘Crows feet or Smile Lines’ around the eyes. It is also being used to lift the eyebrow (Chemical Brow lift) and open up the eye for a more youthful appearance (Awake Look). Good results are also seen in ‘Gummy Smile’ (excessive show of upper gums during smiling), perioral lines ("smoker’s lips"), and reducing neckbands and chin dimpling or creasing. Another area where BOTOX® Cosmetic has given excellent results is in Excessive sweating (Hyperhidrosis)
During treatment, very low doses of BOTOX® Cosmetic are administered by tiny injections directly into the muscles that cause those stubborn lines. The treatment is usually done in about 10 minutes, and no recovery time is needed. Within days, patient may see an improvement in the wrinkles. Lines continue to improve for up to a month, and results can last for 4 -5 months or more. If one discontinues treatment, the wrinkle lines gradually will look like they did before treatment.
BOTOX® Cosmetic treatment is very safe and effective and a trained Plastic surgeon or Dermatologist can help in assessment for BOTOX® Cosmetic treatment needed. BOTOX® Cosmetic is a drug with a large margin of safety making its cosmetic use a relatively safe endeavor. Care should be taken to use the necessary dosing ranges and Injectors should possess excellent knowledge of facial anatomy.
Injection at wrong place by an untrained/ unqualified person can produce undesired effects. In the amounts used for wrinkle therapy, the most common side effects are temporary and localized to the area of injection. These include soreness or mild bruising, mild headache, and very rarely, developing a heavy eyelid lasting 1-4 weeks which generally responds to treatment with eye drops.
There are some contraindications to use of this medication for cosmetic purposes in patients. BOTOX® Cosmetic should not be used in a patient who is pregnant or lactating. Additionally, any patient with a neuromuscular disorder, such as myasthenia gravis or amyotrophic lateral sclerosis, should not receive BOTOX® Cosmetic . BOTOX® Cosmetic should not be used in the presence of infection at the proposed injection site.
Popularity of BOTOX® has led to mushrooming of clinics and medical spas facilities offering these shots at discounted prices and unfortunately more and more untrained or poorly trained practitioners are venturing in this field. This will need proper government regulations and legal framework to streamline and regulate medical cosmetology market and guidelines for setting up and management of these facilities need to be provided.
For the full year, total BOTOX® sales, generated by both its medical and aesthetic uses, increased by 12.4 percent and the annual sale figure of BOTOX®
Not only has BOTOX ® survived the hard years of the recession, BOTOX® Cosmetic has actually thrived during economic downturn in recent years. The sluggish economy made the demand for more expensive surgical procedures like breast augmentations and facelifts plummeting, more people turned to the less-costly magic found in a vial of BOTOX® Cosmetic. A surprising fact is that at present about 50% of the revenue from BOTOX® is cosmetic, but the rest comes from therapeutic treatments such as juvenile cerebral palsy, adult spasticity, chronic migraine and overactive bladder in people with spinal cord injuries or patients suffering from MS.
Over the past 20 years, BOTOX® has been recognized by regulatory authorities worldwide as an effective treatment for 21 different medical uses in approximately 80 countries. With approximately 2,100 publications on BOTOX® (Onabotulinumtoxin A) and BOTOX® Cosmetic (Onabotulinumtoxin A) in scientific and medical journals, BOTOX® is one of the most widely researched medicines in the world.
Before 2002, the only approved product, in the field of Medical Aesthetics, for the treatment of wrinkles was Collagen injection, which had very limited results. BOTOX®
About Author: Dr K M Kapoor MCh, DNB, is a Senior Cosmetic Surgeon at AntiClock -Age Reversal Clinic & Medispa, Chandigarh. He is also a trainer for BOTOX®
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AntiClock- Age reversal clinic and Medispa at Chandigarh, is India's first Medi spa with focus on antiaging services. Headed by Dr K M Kapoor, It provides facilities like Botox, fillers, Mesotherapy, peels, Laser & RF skin treatments & Cosmetic Surgery .