An injectable neuromodulator that weakens skeletal muscles. It is derived from neurotoxins produced by Clostridium botulinum.
Facts: Botox Trends
- C. Botulinum discovered in 1897
- Several serotypes, only serotypes A and B have clinical use
- The first cosmetic use was reported in 1992 (1)
- Comsetic use approved by the FDA in 2002.
- Thorough medical and surgical history.
- Understand patients concerns and manage expectations
- Identify areas of concern and correlate with facial anatomy
- Look for other signs of ageing: skin laxity, textual changes.
No routine pre-operative investigations.
- Cosmetic: Rhytides (Glabller Lines, Periorbital, Frontalis, Platysma bands)
- Denervation (e.g torticolis, blepharospasm and hemifacial spasm)
- Anhydrosis (e.g hyperhydrisosis, Frey’s Syndrome)
- Injection site infection
- Known hypersensitivity
- Cows-milk protein allergy
- Caution in pregnant/lactating women, myasethenia gravia, Eaton-Lambert Syndrome.
- Common: Pain, swelling, bruising and redness.
- Unwanted muscle weakening
- Palmar Hyperhydrosis
- Extra-ocular muscle involvement: diplopia and ptosis
- Systematic Review and Metanalysis (n= 1425): no serious adverise effects (2)
- FDA: 13 adverse affects over a 15 year period
- Incidence of side effects decreased with repeated injections (3, 4)
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Mechanism of Action
- Exotoxin binds to pre-synpatic cholinergic receptors
- Becomes internalised into lysosomes by endocytosis
- Catalyses the breakdown of proteins involved in acetycholine production
- Results in presynaptic inhibition of acetylcholine release.
- Initial Effect: 1-3 days.
- Peak Effect: 1-4 weeks.
- Decreased Effect: >3 months (may be longer if muscle atrophy)
- Formation of neutralizing antibodies may gradually reduce efficacy.
- Rare: 11 exhibited seroconversion in a meta-analysis of 2240 patients (5)