BOTULOTOXIN – everything you need to know

Botulinum toxin is one of the basic substances used in aesthetic medicine today. Many of you know it in connection with wrinkles, but its use is much broader. We can treat some types of migraine and spasticity, teeth grinding, excessive sweating, and it can even help with enlarged pores and oily skin. In this article you will find out what botulinum toxin can be used for in aesthetic medicine. You will also find answers to many of your questions.

What is botulinum toxin and how does it cause wrinkles?

Botox, Dysport, Bocouture, Vistabel and others are trade names for a substance called botulinum toxin. It is a toxin (poison) produced by the bacterium Clostridium botulinum that temporarily blocks the transmission of neuromuscular impulses. For example, imagine a wrinkle on your forehead between your eyebrows. It forms when you think, when you experience negative emotions or when the sun shines on your face. It is made up of several muscle “bellies” connected to nerve fibres that are controlled by your head, whether you are aware of it or not. When you frown, wrinkles form. These wrinkles are actually incisions in the skin between each muscle. All the structures – skin, subcutaneous tissue and muscles – are one interconnected system. With the occasional frown and permission, the skin initially returns to its original state and smoothes out. Gradually, however, with frequent excessive movements, it shrinks and loses its ability to return to its original state. This ability is further reduced as the collagen and elastin fibres that provide elasticity diminish with age. Wrinkles that used to be visible only when the facial muscles moved gradually become deeper and deeper, and we can see them even when we are at rest.

What can botulinum toxin do?

Softening or smoothing wrinkles on the forehead (“accordion”), between the eyebrows (“frown lines”), on the nose (“rabbit’s nose”), around the eyes and under the eyes (“crow’s feet”), wrinkles above the upper lip (“smoker’s lines”), sagging corners and marionette lines, bumps on the chin (“walnut”), neck wrinkles, it is also applied to the chewing muscles to make the face narrower, to the nasal wings (narrowing of the nose), to the area above the upper lip to prevent the lip from curling inwards when smiling (thus visually enlarging the upper lip), it also solves the so-called “wrinkles”. It also helps to correct the gummy smile (a smile where the gums are visible), it can lift the eyebrows to a certain extent (brow lifting).

We also use it in the armpits and on the skin of the palms to prevent excessive sweating. Botulinum toxin temporarily blocks the activity of the sweat glands. People who have botulinum toxin injections in the forehead area find that they sweat less, their skin is less oily and softer, and their pores are less visible.

foto: archív

Frequently asked questions about botulinum toxin injections

The botulinum toxin injection itself is always preceded by a consultation. During this consultation, I will find out whether it is suitable for you, whether you can undergo its application and, most importantly, whether it will meet your expectations. Sometimes we choose a completely different type of treatment. The most common questions are answered below.

When can I start?

As soon as you start to notice that your exaggerated facial expressions are bothering you and leaving their mark in the form of fine lines on your skin. These fine lines would become more pronounced and deepen over time. If you know they would definitely bother you over time, don’t wait for the “right age”. Deep wrinkles are much harder to deal with than fine early wrinkles.

Won’t I look frozen and artificial? Will people notice?

Today’s trend is called beautification – looking like a better version of yourself after treatment, naturally, without significant changes in facial proportions. The aim is to look refreshed and youthful, and to avoid anyone around you seeing that you have had surgery at all.

Will I be able to move my face?

Facial expression and the feeling that you are moving your muscles will not be lost, only softened so that wrinkles do not form. My experience as a doctor is that each patient needs different results. If you are concerned about this frozen effect and are having your first Botox treatment, I will use a lower but still effective dose to soften the expression for the most natural effect. After 14 days, when the effect is at its maximum, we will discuss whether you would like to add more.

Won’t my forehead “fall off”?

With the right application technique you shouldn’t have to worry about this. The important thing is to look at the face as a whole and feel the other muscles and structures. I always use a white pencil to draw on my face the orientation zones, the injection points and always the areas to avoid. Planning is the key to success.

Does botulinum toxin affect the surrounding muscles?

Yes, and an experienced doctor is always aware of this. If we stop using one muscle group, another will try to compensate. For example, if you stop frowning after Botox (and you were frowning a lot before), you may start using the muscles in your nose more and crinkle it up like a bunny (bunny lines). Bunny lines can also be the result of botulinum toxin treatment for crow’s feet (the wrinkles around the eyes).

How is it applied?

After removing make-up, I draw auxiliary lines and dots on the areas where I want to apply botulinum toxin. I draw the same plan on paper and think about the dose needed for each injection. I disinfect the skin.

Botulinum toxin comes in a bottle in powder form and is dissolved in saline solution. So-called insulin tubes are used because they have a practical scale and thin needles. The needles are barely visible after application. You can cover them with make-up after 8 hours.

What is Babybotox?

It is the use of a lower dose of botulinum toxin. Babybotox is for people who don’t yet have significant wrinkles, but who can see them starting to form in certain areas. Alternatively, it is a good option for those who just want to soften more pronounced facial expressions, but still maintain them to some degree.

What is Mesobotox?

Mesobotox is a method where diluted botulinum toxin, either pure or in combination with a mesotherapy cocktail, is applied evenly in small doses to the skin over the entire face. The aim is to soften the skin, shrink the pores and reduce excessive sebum production.

Who should not use botulinum toxin?

Botulinum toxin should not be used in pregnant or breastfeeding women or people with certain neuromuscular diseases. Your doctor will need to know your medical condition before giving you an injection. We also do not use it if there is a skin infection in the area where we would inject it, or if you have an acute infectious disease.

I have a skin condition – is this right for me?

If you are being treated for eczema, rosacea, acne, seborrhoea and other dermatoses, botulinum toxin is not for you. However, the skin at the injection site must be calm and free of inflammation at the time of injection.

How long does it work?

The effects of botulinum toxin last for about 3 to 6 months (9 months in exceptional cases). During this time, the neuromuscular junctions are gradually restored. If you do sports or have stronger facial muscles, the effect is likely to be shorter.

Does regular use prolong the effect?

For some people, excessive facial expressions or movements may be unlearned as a habit. So the prolongation of the effect is not due to the application itself (the poison), but to our mind.

Let me give you an example from my own experience. Imagine you have a habit of pulling down the corners of your mouth and pushing your chin up when you speak. Botulinum toxin “forbids” this movement and it can easily happen that you simply unlearn it – your head forgets it. That’s why I tell my patients not to watch themselves, and above all not to mimic too much, so that the habit doesn’t get back into their heads.

Why does it have a bad reputation?

Botulinum toxin has a bad reputation mainly because of the frozen face effect and people who have overdone it. I am glad that I and other colleagues are improving its reputation and not producing cold, emotionless faces.

If I apply it to my armpits and stop sweating, won’t it harm my body?

It won’t. The body will even out the sweating on the rest of the body. Dry armpits last about 3-6 months, which is why many people use it before summer.

Why is it expensive?

The price of botulinum toxin is based on the price of the product and other costs, which are considerable.

What if it fails? Is it a wrong application?

Unfortunately, this can happen. This risk is minimised by careful planning on the part of the doctor and by the patient following the post-application instructions.

Does the application hurt?

A little. The insulins have thin needles; I always use a new needle for each area to make it as sharp as possible and to penetrate the skin better. An anaesthetic cream (Emla) is not usually used before the injection, but if you are worried about pain, ask for it. It is left on the skin for 20-30 minutes.

Does regular use have long-term effects?

There has been some recent research into whether regular use of botulinum toxin can cause muscle atrophy (muscle shrinkage) at the application sites. It is logical that muscles that we do not move shrink in volume. This is how the much sought-after facial slimming can be achieved when the masseter muscles are used. Prevention of this phenomenon on other parts of the face can be achieved with the aforementioned Baby-Botox.

If I have it done, do I have to go back for more sessions or will my wrinkles get worse?

When you decide to try botulinum toxin, you are not committing yourself to anything. Once the effect wears off, your wrinkles will not get worse, they will just return to their original state. However, the ageing process will continue.

Can I be allergic to it?

Allergies to botulinum toxin do exist, but fortunately they are rare.

Can botulinum toxin not work?

This phenomenon, called resistance, also exists if your body develops antibodies against the protein in the product. According to the American dermatologist J. Zeichner, this resistance can be overcome by higher doses, more frequent applications or by switching to a different brand. Personally, I would opt for the third option for patients.

Are there other alternatives?

The effect of botulinum toxin on mimic wrinkles is unique. However, if you’re not impressed with its use and want better looking, more hydrated skin, try biorevitalisation with hyaluronic acid. It’s one of my favourite methods that visibly improves and heals the skin after just one treatment.

Who can use it?

Botulinum toxin can only be used by a qualified doctor.

My view as a doctor

I always use botulinum toxin after a consultation, taking a holistic view of each patient and aiming for the most natural result possible. I am interested in your perspective, your needs, and I want to achieve the maximum, yet natural effect with the minimum number of treatments.

I use botulinum toxin at the Avecutis clinic in Prague.

Každý z nás je jedinečný, takisto aj naša pokožka. Ak sa trápite s akné, rôznymi dermatitídami, mastnou, suchou či citlivou pleťou, chcete efektívne vylepšiť či prekopať rutinu alebo sa vôbec neviete zorientovať vo svete kozmetiky a vybrať si vhodné produkty, balíček Skincare podľa simona_derm je to pravé pre vás.


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