The cosmetic form of botulinum toxin, often referred to by its product name Botox, is a popular non-surgical injection that temporarily reduces or eliminates frown lines, forehead creases, crows feet near the eyes and thick bands in the neck. The toxin blocks the nerve impulses, temporarily paralyzing the muscles that cause wrinkles while giving the skin a smoother, more refreshed appearance. Studies have also suggested that Botox is effective in relieving migraine headaches, excessive sweating and muscle spasms in the neck and eyes. Botulinum neurotoxin is produced by the gram-negative anaerobic bacterium Clostridium botulinum.
Eight serologically distinct botulinum neurotoxins exist, designated as A, B, C1, C2, D, E, F, and G. Seven are associated with paralysis. Types A, B, E and, rarely, F and G are associated with human botulism.
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The dose of botulinum toxin is expressed in mouse units. One unit is equal to the amount that will kill 50% of a group of 18- to 22-g Swiss Webster mice when injected intraperitoneally. The human lethal dose (LD) for BOTOX (botulinum type A purified neurotoxin complex) is estimated at approximately 3000 units. BOTOX injections of less than 100 units usually are used for cosmetic purposes and of less than 300-600 units for other purposes, thereby allowing a wide safety margin. Recognizing that doses are not interchangeable among different formulations of botulinum toxin (BOTOX, Dysport, Myobloc) is important; to achieve similar clinical effects, different doses are used.
BOTOX is a sterile lyophilized form of botulinum toxin type A. It is produced from a culture of the Hall strain of C botulinum and purified by a series of acid precipitations to a crystalline complex containing the toxin and other proteins. The FDA approved BOTOX in December 1989 as an orphan drug for the treatment of strabismus, hemifacial spasms, and blepharospasm. BOTOX is distributed in 100-unit vials.
The original batch of neurotoxin prepared by Shantz in November 1979 (designated batch 79-11) constituted the original BOTOX formulation and was used until December 1997. It was replaced by a new neurotoxin complex batch designated BCB 2024. The new bulk batch is 5-6 times more potent on a weight basis. In a 100-unit vial, only 4.8 ng of neurotoxin is needed compared to 25 ng of 79-11. The new BOTOX is comparable in clinical efficacy and safety to the old, and a unit dose of new BOTOX provides an equivalent response to the same unit dose of old BOTOX. Hopefully, the reduced protein load of the new BOTOX leads to reduced immunogenicity and a lower incidence of neutralizing antibody formation.
Dysport is another formulation of botulinum toxin type A available in Europe and a few other countries. It is prepared using column-based purification techniques and distributed in 500-unit vials that can be stored at room temperature. BOTOX and Dysport are both botulinum toxin type A preparations but are quite distinct from one another. BOTOX is approximately 4 times more potent on a per unit basis, and Dysport doses often are approximately 4 times the BOTOX doses used to generate a similar clinical effect. Differences in these toxins may relate to differences in the strain of bacterium, preparation, diffusion, and potency testing.
Myobloc is a botulinum toxin type B preparation currently in clinical trials. It is anticipated that it will be distributed as a solution. Little information is available concerning the cosmetic use of Dysport and Myobloc. The remainder of this article therefore focuses on BOTOX, and all unit doses refer to BOTOX unless otherwise specified.
Reconstitution and storage
Store BOTOX in a freezer at or below -5°C. The package insert recommends reconstitution of BOTOX using sterile saline without preservative; 0.9% sodium chloride is the preferred diluent. Some investigators suggest that reconstitution with sterile saline solution with preservative (0.9% benzyl alcohol) reduces microbial contamination and provides a weak local anesthetic effect. However, contamination is rarely a problem, and the anesthetic effect is modest.
BOTOX is denatured easily by bubbling or agitation; gently inject the diluent onto the inside wall of the vial. Discard the vial if a vacuum does not pull the diluent in. The final dilution of BOTOX is mostly a matter of personal preference; 100 units commonly are reconstituted in 1-10 mL of diluent. Theoretically, more concentrated solutions reduce reliability in delivering a specific unit dose, and more dilute solutions lead to greater diffusion of the toxin. The authors prefer to use 2 mL of diluent to prepare a solution of 5 U/0.1 mL (50 U in a 1-mL tuberculin syringe if that much is to be used). Use a 30-gauge 1-inch needle to perform the injections.
Once reconstituted, keep BOTOX refrigerated at 2-8°C. The package insert indicates that reconstituted BOTOX should be used within 4 hours. One study found no loss of activity at 6 hours but a 44% Best Botox in Edmonton loss after 12 hours and a 70% loss with refreezing at 1-2 weeks. Other authors report no substantial loss of potency in a 10 U/1 mL reconstituted solution kept refrigerated for 1 month. Most practitioners discard unused reconstituted BOTOX after 1-7 days.
If you have considered getting Botox, you might be worried about what it can do for you and if you are willing to take the disadvantages with the advantages. Is there something else that can work as well? Are they better than wrinkle cream serums?
You might be interested to know that while Botox can be quiet effective at relieving the skin of some wrinkles and giving it a tighter look, there are other products you can use that are not invasive and that provide the same benefit.
Let's look at Botox first.
Advantages of Botox
One of the main advantages of Botox is that it's a relatively fast procedure. In a 15-minute procedure, you can have tighter and firmer skin. That's through the use of needles that inject the botulism toxin into the skin. You can go into a cosmetic surgeon's office looking a bit wrinkled and saggy and leave an hour later with firmer and tighter skin.
Another main advantage of Botox is that it works. That is, many products that claim to make you look firmer and reduce wrinkles do nothing of the sort. You invest money and time into a product that produces no noticeable results for you. But Botox works on nearly everyone, from women who have few wrinkles to those who have many.
Disadvantages of Botox
There are many disadvantages to Botox, not the least of which is pain. Many women are uncomfortable with the idea of having needles in their skin, especially needles that are carrying a toxin in them. Although Botox isn't considered invasive like a face lift might be, there is an invasive quality to having needles injected in your face.
Some women report having a "frozen face" and not being able to move their facial muscles after having Botox. Some of this is expected, but some women have more of a problem than others.
Finally, there are two main disadvantages to Botox that cancel out the others. First, it must be repeated every few months because the benefits only last that long and it's not cheap. Because the procedure must be repeated every few months in order to maintain the benefits, Botox can be an expensive option over time.
Alternatives to Botox
These days, many women think that having Botox is the end all, be all of good skin. That once they look a bit wrinkled and saggy, Botox is the only way to go. The reality is there are many things you can do that mimic the benefits of Botox without having Botox.
First, eat a good diet that's rich in fruits and vegetables, fish and whole grains. These foods will provide antioxidants, high water content, essential fatty acids and fiber. These are all excellent for maintaining a healthy weight, preventing age-related skin conditions and a general feeling and look of being younger.
Second, find good quality skin care products - that is, an anti aging cream that works. There are many wrinkle creams available these days that provide an instant lift and wrinkle reduction and that also provide benefit for the future. Find one of these products and test it out. You might find that it provides benefits similar to Botox, but without the Botox.
Remember, sometimes you can take a generic approach to problems. You might choose to go down the Botox road, but you also might instead choose to take a different road - one that's paved with a good lifestyle and high quality skin care products.