The Other Misconceptions of Botox
Despite the increasing uses of Botox, many people are still frustrated by the misconceptions surrounding it. Some of the misconceptions have come about through tawdry science, others through anecdotal evidence and others through ignorance.
This misconception started back in 2002 when Dr David Becker, an assistant professor of dermatology at Weill Cornell Medical College in New York, suggested people unconsciously recreate facial expressions in the area where the facial muscles have been paralysed. His work was published in Cosmetic Dermatology (2002; 12: 35-36). The doctor noted increased wrinkle prominence and the development of fine lines following botulinum toxin therapy for vertical frown lines. His feeling that paralysis of a set of muscles in one area might lead to recruitment of other nearby muscles to compensate was not shared by Allergan (the maker of Botox) who immediately repudiated the results. Other doctors around the world including Dr Robert Sinclair, from the Australasian College of Dermatologists, stated that he had also seen the effects of muscle recruitment after Botox was used in the forehead and frown area. Many other doctors disagreed and in the end Dr. Becker retracted his findings somewhat afraid he was being misquoted. My own impression after treating tens of thousands of patients is that it probably happens to a lot of patients to a very minor extent, but because you can usually easily treat the new muscular activity there is little to worry about.
Misconception No 7: Botox injections should be administered only to persons above 40
It is difficult to know where this misconception came from or in reality if it really still exists amongst young people in most developed parts of the world. The feeling possibly exists amongst an older generation who are less exposed to media and peer pressure. These people often feel it is a big event to approach a doctor who get Botox and wish to keep it a secret known only to themselves. In reality, the average age of starting Botox in the US has now dropped to 19 years and Australia is considering legislation not to allow patients below 18years to have it freely available. So, why is there such a generational difference in attitudes to Botox? It is really simple…young people now realise that it is a lot easier to tackle a problem at its early stage and if they start early they will not develop wrinkles at all. If you start early then you probably get a better response and require less to continue into your later life.
Misconception No 8: Patients are not allowed to lie down for four hours after receiving a Botox injection
This is probably a misconception although many doctors still give patients this instruction. The perceived logic comes from the fact that lowering of the eyelid (ptosis) is thought to be caused by migration of toxin through the orbital septum. Patients are thereby instructed to remain in an upright position for 3-4 hours following injection. However, if this was the only reason then patients should really stand on their heads to prevent this type of diffusion. In general I don't tend to give patients this instruction but do tell them to avoid manual manipulation of the area. Active contraction of the muscles under treatment may increase the uptake of toxin and decrease its diffusion.
Misconception No 9: Patients are not allowed to fly after receiving a Botox injection
This is also probably a misconception although many doctors still give patients this instruction. The perceived logic comes from the fact that different cabin pressures could contribute to causing migration of toxin through the orbital septum. Patients are thereby instructed not to fly following injection. However, cabin pressures are generally the same as the air pressure on the ground. It is the air pressure outside the cabin that is different. In general I treat many patients from overseas and usually don't tend to give patients this instruction but do tell them to avoid manual manipulation of the area. Active contraction of the muscles under treatment may increase the uptake of toxin and decrease its diffusion. If they are flying long haul, I tell them to wait one day.
Misconception No 10: Botox injections are a painful experience
On the contrary, an injection of Botox is usually quite painless. The needle that is used to administer Botox is tiny, in fact it is the same size used by diabetics every day to give insulin. Those who were given Botox injections compare their sensations to those experienced during an insect bite. Some patients do prefer applying an anaesthetic cream to the face about fifteen minutes before the procedure and this totally eliminates any possibility of pain. There is no pain after injection as Botox works as a kind of anaesthetic itself.
Misconception No 11: Botox will be less effective if it is used to often
There is evidence that about 5% of patients injected continually with BOTOX® can develop neutralizing antibodies that can cause the injections to stop working. The chances of this happening depend on large doses being injected, repeat or booster injections given within four weeks of treatment. There is a new form of German Botox coming onto the market in early 2007, which has a lower potential for neutralizing antibody production because of its decreased protein load. Hopefully this will minimise the problem of non-response.
Misconception No 12: Botox injections are dangerous if given during pregnancy
This is another misconception. From evidence from millions of people all around the world, women who inadvertently were injected during pregnancy thus far have had uneventful deliveries, and to date no fetal abnormalities have been attributed to botulinum toxin. Nonetheless, it is a category C medication, and delay of injections is recommended until pregnancy is complete and breastfeeding has ended
Misconception No 13: There is no effective treatment if a brow or an eyelid drops after Botox injections and patients have to wait until it wears off.
This is a misconception to an extent, although any person who has had to sit out four months with a lowered eyelid may think differently. Lowering of the upper brow or eyelid (ptosis) can occur after injection in the frown muscles. This may occur as late as 2 weeks after injection and is more common in older patients receiving Botox for the first time. Patients are usually instructed to avoid rubbing the area. Some doctors feel that actively contracting the muscles under treatment may increase the uptake of toxin and decrease its diffusion. Most lowered brows tend to settle after about 4 weeks. Elevated brows can easily be corrected. It is more difficult to treat eyelid drop, although many patients are responsive to a special adrenergic agonist eyedrop called apraclonidine. This medicine causes specific Müller muscles to contract but it should not be used in patients with documented sensitivity. Phenylephrine (Neo-Synephrine)
Misconception No 14: Different types of Botox last for different periods in patients
In the United Kingdom and Ireland, the pharmaceutical comes in two differing forms. One is known as Botox ® and the other Dysport ®.
There is anecdotal suspicion amongst many doctors and patients that the UK variety Dysport ® lasts six months while the US based formulation Botox ® lasts four months. In reality, various clinical studies have shown no difference between the two groups. However, my own experience would tend to favour the patients anecdotal beliefs.