Botulinum Toxin Type A
What is Botulinum Toxin Injection (Botox)?
Botulinum toxin (Botox) is a purified protein derived from Clostridium botulinum. Botox is a neurotoxin produced by the bacterium Clostridium botulinum. As a treatment, Botox is used for both cosmetic and medical purposes. It is approved by the FDA for certain cosmetic and medical indications. It is widely used in both cosmetic and medical treatments to relax specific muscles and reduce the appearance of dynamic wrinkles - those caused by facial movements such as frowning, squinting or raising the eyebrows. Botox is also used for conditions such as chronic migraines, muscle spasms, and excessive sweating.
How does BoNT/A work?
Botulinum toxin works by temporarily blocking nerve signals to the muscles; the toxin, a potent neurotoxin produced by bacteria, interferes with the communication between nerves and muscles. When injected, it prevents the release of acetylcholine (the neurotransmitter responsible for muscle contractions), leading to muscle relaxation. The solution is injected into specific muscles in a fine needle to achieve targeted effects.
How does BoNT/A reduce the appearance of wrinkles?
By injecting BoNT/A into specific facial muscles responsible for dynamic wrinkles, the targeted muscles relax, leading to a noticeable improvement to a particular area or type of wrinkle. This allows wrinkles to smooth out and helps to prevent the formation of static lines over time. Results may vary depending on the strength of the treated muscles or the individual's skin type.
Common BoNT/A Brands in Singapore
- Botox®
- Manufacturer: Allergan (AbbVie)
- Origin: from the USA
- Most widely used and well-studied brand worldwide
- Dysport®
- Manufacturer: Ipsen
- Origin: from the UK/France
- Slightly faster onset and the ability to spread more, making it good for larger muscle groups/treatment areas
- Xeomin®
- Manufacturer: Merz Pharma
- Origin: from the Germany
- “Naked” formulation with no immunogenic proteins, potentially reducing the risk of resistance
Common indications of BoNT/A:
Botox and other botulinum toxin treatments are used for both cosmetic and medical purposes, making them versatile options for patients seeking aesthetic enhancement or relief from certain health issues.
- Dynamic wrinkle reduction:Botulinum toxin softens expression lines caused by repeated facial movements for cosmetic purposes, such as:
- Forehead lines – horizontal lines from raising eyebrows
- Glabella lines – vertical “frown” lines between the eyebrows
- Crow’s feet – lines around the outer corners of the eyes when smiling or squinting
- Bunny lines – wrinkles on the sides of the nose when smiling
- Facial slimming & jaw contouring:Injection into the masseter muscles (chewing muscles):
- To slim a square jawline for a more V-shaped face
- Help with bruxism (teeth grinding) and jaw tension
- Improve facial asymmetry from overactive jaw muscles
- Brow liftPrecise botulinum toxin placement can help to lift the eyebrows, opening the eye area for a more refreshed and younger appearance without surgery
- Chin dimpling improvement (mentalis muscle relaxation)Used to smooth a dimpled chin, creating a more youthful and relaxed lower face
- Neck rejuvenation (Nefertiti lift)Botulinum toxin can be injected into the platysma bands to reduce neck banding, and soften and improve the jawline contour
- Excessive sweating (hyperhidrosis)Botulinum toxin is also used off-label to treat excessive sweating, especially in areas like underarms, palms, soles of feet and scalp
Botulinum toxin is also prescribed for medical conditions including chronic migraines, muscle spasticity, cervical dystonia, overactive bladder, and certain eye disorders such as strabismus and blepharospasm.
Duration of effect of BoNT/A:
Effects of botulinum toxin A typically start to appear within 3-5 days, while full effect is usually seen in 10-14 days. Results last approximately 3-4 months.
Duration of effect may vary based on the site of treatment, dosage of botulinum toxin, muscle activity and metabolism, and may differ due to factors such as individual metabolism or muscle activity.
Treatment frequency:
For optimal wrinkle prevention, treatments are recommended every 3-4 months.
With consistent care, some patients may be able to extend the interval to 4-6 months.
Regular sessions can help prevent and delay the development of static lines.
Risks, side effects, and possible complications:
Botulinum toxin is considered safe when performed by trained professionals. However, like with all medical procedures, it carries some risks. There are potential health complications associated with botox, so it is important to be aware of possible side effects and seek medical supervision if needed.
a) Common temporary side effects
- Mild redness or swelling at injection sites
- Bruising
- Headache
- Facial asymmetry (can often be corrected with additional treatment)
Safety warning: After your treatment, do not rub or massage the treated area, and do not lie down for at least four hours. Do not drive or operate heavy machinery if you experience vision changes, dizziness, or muscle weakness.
b) Rare complications
- Eyelid or eyebrow drooping
- Dry eyes or excessive tearing
- Flu-like symptoms
- Muscle weakness beyond the targeted area
Contraindications:
If you have any of the following conditions, inform your healthcare provider before receiving treatment, as recommended by the provider or regulatory authority:
- Pregnant or breastfeeding
- History of neuromuscular disorder (eg. myasthenia gravis, amyotrophic lateral sclerosis)
- Active infection or inflammation at the injection site
- Allergic to Botulinum toxin ingredients
Interactions with Other Drugs
Botulinum toxin injection, commonly known as Botox, is used to treat a variety of cosmetic and medical conditions, such as fine lines and wrinkles, chronic migraine, and muscle spasms. However, the use of botulinum toxin can interact with other medications, which may affect the safety and effectiveness of your treatment.
If you are considering Botox for the treatment of forehead lines, lines between the eyebrows, or other areas, it is essential to inform your healthcare provider about all medications and supplements you are currently taking. This includes prescription drugs, over-the-counter medications, vitamins, and herbal products. Certain medications, such as blood thinners, can increase the risk of bruising or bleeding at the injection site. Other drugs, like muscle relaxants, sleeping aids, or allergy medications, may enhance the effects of botulinum toxin, potentially leading to increased muscle weakness or other side effects.
It is also important to let your healthcare provider know if you have any medical conditions, such as neuromuscular disorders, or if you have previously received other botulinum toxin injections for medical or cosmetic purposes. Using multiple botulinum toxin products at the same time, or within a short period, can increase the risk of side effects and may require careful monitoring or dosage adjustments.
For adults using Botox Cosmetic to reduce the appearance of fine lines and wrinkles, following your provider’s instructions is crucial for a safe and effective outcome. After the procedure, you may be advised to avoid certain medications, such as specific antibiotics or antihistamines, as they can interact with the effects of botox. Additionally, you should avoid rubbing or massaging the injection site and remain upright for several hours after your treatment to minimize the risk of complications.
If you have any concerns about potential interactions between botulinum toxin and your current medications, or if you experience any unusual side effects after your injections, contact your healthcare provider promptly. By sharing your full medical history and medication list, you help ensure that your botox injections are as safe and effective as possible, reducing the risk of serious side effects and achieving the best possible results for the appearance of your skin.
Pre-procedure:
- Detailed consultation with doctor to determine injection plan
- Face is cleaned and topical numbing cream applied for 20 mins
Post-procedure:
- Apply topical healing cream on the treated area, followed by moisturizer and SPF50 sunscreen
- Post-procedure advice:
- Avoid alcohol for 24hrs
- Avoid strenuous activities for 24hrs
- Avoid hot sauna/ extreme heat exposure for 24hrs
- Avoid massage/ rubbing the injection site for 24hrs
- Avoid makeup on the same day and only light makeup the following day
- Stay upright for at least 4hrs post-injection
- Can apply cold compress over the injection site to reduce swelling, if present
- Inform the clinic immediately if there is any unusual post-injection side effect such as intense pain/ swelling or extensive bruising at the injection site.
Comparison between different Botulinum toxin A brands:
