How exactly does Botulinum toxin work?
Botox® is simply a registered brand name for a substance called Botulinum Neurotoxin type A, but the substance is also known and produced under a number of different brand names.
The active substance, Botulinum neurotoxins, are produced naturally by clostridial bacteria. For use in medicine and cosmetics, it is purified and isolated in a complex series of steps that is highly regulated by government agencies in the UK.
Tiny quantities are diluted and injected directly into the target muscle, where it acts locally but is not absorbed systemically, i.e. it doesn’t enter into the bloodstream or spread throughout the body.
The substance binds to the nerve endings within the muscle and (in very simple terms) prevents the muscle from contracting. By preventing the muscles from contracting, Botox® prevents skin creases from forming above the contracting facial muscles. Eventually the nerve endings recover and normal muscular function is restored.
However, this does not mean that there are no long-lasting benefits to receiving Botox®:
Muscles Adapt to Botox
Muscles tend to adapt to the positions they are chronically held. So if a muscle is weakened by Botox® over a long period of time, both that muscle group and the muscles having the opposite effect adapt, thus yielding a longer lasting and sometimes even permanent effect with enough treatments.
If Botox® is a Toxin, how can it be used for cosmetic injections?
The secret lies in very precise application and very small doses:
The toxic dose of Botulinum Toxin is estimated to be 0.09 to 0.15 mcg by injection directly into the bloodstream. In cosmetic use, an entire 100 unit vial of Botox® contains only 0.00073 mcg of Botulinum Toxin. So the chances of accidental poisoning from cosmetic injections is negligible, as long as reputed and regulated brands of Botox® are used.
Botox® can have long-term benefits for your Skin
Creases and wrinkles that only show during facial movements and muscle contraction are known as dynamic lines. In contrast, wrinkles and creases that remain visible at rest are known as static lines.
Botox® prevents dynamic wrinkles from forming by preventing contraction of the underlying muscle. Dynamic lines only become static lines over time as the continuous contraction prevents the skin from regenerating and hydrating smoothly.
Through use of Botox® in areas where dynamic lines have already become more permanent static lines, by allowing the skin enough crease-free time, the skin is able to better rejuvenate and heal the already formed static creases, thus the skin becomes smoother with time.
Will I still be able to move my face after getting Botox®?
Yes. The goal of anti-wrinkle injections such as Botox® is to smooth unwanted lines and minimising unwanted effects of facial muscles, while highlighting facial features. This is achievable without preventing facial expressions or eradicating movement in the face.
The application of Botox® is both a science and an art: There are 43 muscles in the face, and correct use of anti-wrinkle injections comes from a deep understanding of all these muscles and how they interact to produce facial movements.
In cosmetics, the most common applications of Botox® are in the face for the prevention of lines and wrinkles of the forehead, frown lines, crow’s feet, and lines around the nose and mouth. But most are unaware of just how many cosmetic applications of Botox® there are:
Botox® can also be used to relax the upper lip to correct “gummy smiles” and smooth a “dimpled chin”. Botox® is a very safe and effective way to treat a large number of these cosmetic skin concerns.
Botox® is used widely for a large number of conditions
Medically, it is an effective way to treat Bruxism (teeth grinding), and headaches. Disorders characterised by overactive muscle movement benefit from Botox® treatments, such as muscle spasticity of the head, neck, limbs, vocal cords, urinary tract, and bladder. Even eye disorders such as misalignment and strabismus are very successfully treated using Botox®.
How Botox® is used for Lines and Wrinkles in the Upper Face and Forehead
Botox® for the treatment of lines in the forehead (frontalis), central brow (glabella) and around the eyes (Crow’s feet) are amongst the most popular Botox® treatments across the UK. The procedure is quick and virtually painless, as the injections are performed very superficially.
Frown Lines: Glabella
These lines are caused by the contractions of brow muscles that pull and lower the eyebrows.
Persistent contraction of these facial muscles creates wrinkling between the central brows, and can cause an unintentional expressions of frustration, tiredness, or disappointment.
Over time, static lines can form between the brows even at rest.
Botox® is injected into brow muscles called the Procerus and the left and right Corrugator supercilii.
In women, a total dose of 20 - 30 units of Botox® is generally injected across 5 injection points along the frown line. Men have stronger facial muscles and generally require 40 - 80 units of Botox® across 7 injection points along the frown line.
Forehead Lines: Frontalis
Horizontal forehead lines are caused by the contraction of a large muscle called the frontalis.
These are sometimes also called “worry lines”, and are more noticeable in individuals who habitually contract their forehead.
Depending on the severity of the skin wrinkles, 4 or more sites are injected across the forehead, requiring between 10 - 30 units of Botox®. Injections are placed very superficially, just under the skin.
Crow’s Feet: Lateral Canthus Lines
Wrinkles along the outer angles of the eyes are often called crow’s feet, or lateral canthus lines. These are formed by the contraction of the orbicularis oculi muscle.
Some may find that they only want to treat certain lines around the eyes, and not all, as these may be perceived as smile lines. This is easily accommodated by treating only certain sections of the orbicularis oculi muscle. It is also easy to use good technique to prevent the feared “frozen look” caused by over-injecting in the area.
Doses of between 10 - 25 units of Botox® are injected for women, and between 20 - 40 units for men. This allows the periorbital muscles to relax, smoothing out any creases in the area.
Bunny Lines: Transverse Nasalis
Bunny lines describe the diagonal lines that appear on the sides of the nose and across the nasal bridge that appear during certain facial expressions such as laughing and smiling.
These can be undesirable as the lines often unintentionally project the appearance of distain or dislike. Sometimes these lines can appear as a result of receiving frown line Botox® alone in the presence of other strong facial muscles, in which case they are often called the “Botox® Sign”.
These lines are easily treated by injecting very small doses of between 2 and 5 units of Botox® on either side of the nose bridge (for a total of 4 - 10 units), into the transverse nasalis muscle.
Chemical Brow Lift using Botox
With passing time and hours spent outdoors, the skin on our face loses its natural elasticity and begins to sag. This is most noticeable when the eyebrows droop, creating a hood over the eye. This can give the appearance of a ‘heavy’ or tired look.
Luckily, this can be easily treated with only a small dose of Botox® on each side.
One or more injections of 2 - 4 units of Botox® each are placed in the lateral Obicularis oculi muscles on each side, allowing for relaxation of the downward pulling eye muscles, creating a lifting effect of the eyebrows.
How Botox® is used for Lines and Wrinkles in the Mid Face: Nose and Cheeks
A quick, easy, and affordable way to reverse noticable signs of ageing in the face.
Advanced Botox® for Downturned Nose tips and Nasal Flare
It’s natural for some individuals to have characteristically broader nasal bridge and wide nostrils that flare easily due to strong nasal muscles.
Those who are able to intentionally dilare their nostrils often make good candidates for this nose-slimming treatment. In some individuals the tip of the nose may be downturned, or rotate downwards during facial movements such as talking or lip puckering. This is due to the strong downward pull of the nasal septum muscles.
A combination of the downturned nose tip (called nasal tip ptosis) and widening nostrils often gives the unintentional appearance of a snarl or disgust.
Treatments to correct these concerns are considered advanced uses of Botox® and few practitioners are competent and trained in the technique. Medic Squad is proud to be one of the few aesthetic providers to offer these treatments in Brighton, London, and surrounding areas.
The treatment for nasal flare is performed by injecting small doses of Botox® (between 4 - 10 units) into the nostril muscles on each side called the Alar nasalis. Dynamic downturned noses can be lifted by injecting small amounts of Botox® (4- 8 units) into the Depressor septi nasi muscle responsible for pulling down the nose tip.
How Botox® is used for Lines and Wrinkles in the Lower Face: Mouth and Chin
Lower face lines and wrinkles are often neglected, and suggest tiredness and ageing. These concerns are all easily corrected in little time.
Botox® for the Treatment of Perioral Lip Lines
The mouth is the centre of focus for the lower face, and so plays an important part in our overall facial appearance and expression of emotions and personal sentiment.
A full smooth full lip with a distinct lip border has long been a hallmark of youth and beauty. With increasing age and sun exposure, the lips grow thin, deflated, and wrinkled. Lines can appear not only around the lip borders, but also appear as creases within the lips. Lip lines are exaggerated over time by habitual puckering of lips, using straws, whistling, or smoking. A common frustration with lip lines is that they form grooves for lipstick or lipgloss to travel along, blurring lip outlines and making makeup more difficult to apply.
Lines that are accentuated during certain lip or facial movements are good candidates for treatment with Botox.
By injecting Botox® very precisely into the muscles around the lips, a relaxation of the lip border not only smooths lines but also allows the lip to appear fuller.
How Botox® is used for the Treatment of Downturned Mouth Corners
Mouth corners can be persistently downturned in some individuals, projecting unintended negative emotions.
When pronounced, downturned mouth corners can create folds called labiomandibular creases sometimes inelegantly called “drool grooves”. When these folds become persistent in older age, they’re then often known as “Marionette lines”.
The corners of the mouth can easily be given a little "lift" by treating the muscles that pull the mouth downward with 6-12 units of Botulinum toxin onto each side of the chin.