Cosmetic facial injections to smooth out facial wrinkles have been around much longer than most people realize. In the early 1900s, doctors tried injections of substances such as carmine and paraffin to plump up lines and creases. Carmine ended up causing a condition that looked like permanent cystic acne, while paraffin migrated to other sections of the face, causing disfiguring lumps of wax to form under the skin. Ensuing decades brought “Tissulaire injections” of animal embryo serum or shots of silicone, which turned out to be either relatively ineffectual or terribly dangerous.
Botox has been used since 1973 to calm eye ticks and straighten out crossed eyes. In 1988, a Canadian dermatologist recorded a fascinating side effect of botulinum toxin injections around the eyes: Patients’ crow’s feet appeared remarkably reduced in depth and severity. Since then, the use of the paralyzing neurotoxin to treat wrinkles has exploded in popularity. Occasionally, a negative news story appears, claiming that long-term use of the toxin has serious, possibly debilitating health effects.
Botox is a form of sterile, purified botulinum toxin A along with accessory proteins (human albumen) and sodium chloride. Because it blocks the action of acetylcholine, a neurotransmitter that binds to excitatory receptor cells in the body and causes muscles to move, injections of the toxin paralyze facial muscles, reducing the appearance of existing wrinkles and preventing new ones from forming. The vertical glabellar forehead lines, sometimes called “elevens” because of their resemblance to that number, respond best to Botox; using it to paralyze other facial muscles sometimes results in a strange, mannequin-like appearance.
Most people who receive muscle-paralyzing facial injections develop no serious side effects. However, there are some complications from time to time, and these can be frightening if unexpected.
If the area that received the injections is massaged or touched within 12 hours after treatment, the toxin can migrate and cause drooping of the forehead or eyes. Problems may also occur if the patient lies down within 3-4 hours after an injection. Drooping occurs in approximately 3-5% of Botox recipients, and usually goes away as the toxin gradually wears off.
Bruising, muscle weakness, headache, blurred or double vision, and flu-like symptoms have been reported in some cases. Again, these problems generally disappear (along with the wrinkle-smoothing effects) as time passes. Serious side effects include difficulty with speaking, breathing and swallowing. In rare cases, patients have allegedly developed permanent symptoms; and some people have found even the more minor side effects so distressing that they’ve discontinued use.
When muscles are not used, they have a tendency to atrophy and be replaced by fat and fibrous tissue. Muscle degeneration may be observed after about four months of disuse; electric stimulation may be used to slow down or prevent this process when an individual has to be immobilized in a cast for long periods. A 2010 University of Calgary study on rabbits claimed that long-term use of Botox causes muscle atrophy even at sites far away from the injection areas. In 2008, the Calgary team had obtained much the same results while experimenting on cats.
Articles immediately trumpeted that wrinkle treatment with Botox may “turn muscles into fat;” however, even a cursory glance at the study results show that it used higher dosages of toxin than are used in cosmetic procedures. The dosage necessary to treat serious, painful muscle spasms, such as those exhibited by cervical dystonia sufferers, is about six times greater than that used to treat facial lines: less than 600 “mouse units” for spasm as opposed to less than 100 for wrinkles (death in humans is caused by around 3000 such units, equivalent to around 100 full vials of Botox). The Calgary study results are thus not quite as dramatic or shocking as their presentation in the media might indicate.
A 2008 Italian research study performed on lab rats showed migration of toxin to areas of the brain, including those involved in long-term memory and spatial orientation. Allergan, the company that makes Botox and Botox Cosmetic, pointed out that this study used a mixture of Botox and pure botulinum toxin rather than Botox alone. The difference in preparation may well have affected the study results. Moreover, animals and humans may have different reactions to Botox injections, as they do to many other chemicals.
At least 2.5 million U.S. citizens had cosmetic Botox injections last year; the vast majority were pleased with their new appearance and repeated the treatment once the effects wore off. Still, the fact that some patients develop serious side effects gives one pause: getting Botox for cosmetic purposes alone should never be done on a whim; research and careful thought are necessary before deciding that the benefits outweigh any possible risks.
Aside from avoiding lying down or touching the treated area for the proscribed time period, patients can minimize the risk of serious side effects by being completely honest and open with physicians. Any family or personal history of problems like ALS or myasthenia gravis should be revealed; breathing problems such as asthma or emphysema may also contraindicate Botox use. All drug use should be thoroughly discussed, including use of herbal medications, illegal drugs, or over-the-counter sleeping pills.
Always make sure your doctor has had plenty of experience injecting Botox; an inexperienced physician may inject the substance in a manner more likely to cause side effects. Use the same type of research you would use if considering a face lift or other more intrusive procedure. If a doctor seems wildly overenthusiastic about the product, or recommends it even when you didn’t ask for it; find another, more objective, physician.
Never, ever get “bargain Botox;” injections of the real thing cost approximately $300-$1000, depending how many units are used. Inexpensive Botox is probably black market botox, which is often not approved for human use. Such substances have been known to cause symptoms of botulism poisoning, including paralysis or permanent respiratory problems, or sepsis at the injection site. Never get Botox injections from anyone except a qualified physician.
Although following the above advice certainly will not eliminate all chance of complications, such precautions may serve to help minimize problems by transforming an uninformed gamble into a more calculated risk. Always remember that getting any facial injection is not at all like purchasing a new shade of lipstick or eye shadow, even if fashion magazines and “Fountain of Youth” hype-filled advertisements often seem to equate their gravity.
Botox has been used since 1973 to calm eye ticks and straighten out crossed eyes. In 1988, a Canadian dermatologist recorded a fascinating side effect of botulinum toxin injections around the eyes: Patients’ crow’s feet appeared remarkably reduced in depth and severity. Since then, the use of the paralyzing neurotoxin to treat wrinkles has exploded in popularity. Occasionally, a negative news story appears, claiming that long-term use of the toxin has serious, possibly debilitating health effects.
What is Botox?
Botox is a form of sterile, purified botulinum toxin A along with accessory proteins (human albumen) and sodium chloride. Because it blocks the action of acetylcholine, a neurotransmitter that binds to excitatory receptor cells in the body and causes muscles to move, injections of the toxin paralyze facial muscles, reducing the appearance of existing wrinkles and preventing new ones from forming. The vertical glabellar forehead lines, sometimes called “elevens” because of their resemblance to that number, respond best to Botox; using it to paralyze other facial muscles sometimes results in a strange, mannequin-like appearance.
Side Effects of Botox Injections
Most people who receive muscle-paralyzing facial injections develop no serious side effects. However, there are some complications from time to time, and these can be frightening if unexpected.
If the area that received the injections is massaged or touched within 12 hours after treatment, the toxin can migrate and cause drooping of the forehead or eyes. Problems may also occur if the patient lies down within 3-4 hours after an injection. Drooping occurs in approximately 3-5% of Botox recipients, and usually goes away as the toxin gradually wears off.
Bruising, muscle weakness, headache, blurred or double vision, and flu-like symptoms have been reported in some cases. Again, these problems generally disappear (along with the wrinkle-smoothing effects) as time passes. Serious side effects include difficulty with speaking, breathing and swallowing. In rare cases, patients have allegedly developed permanent symptoms; and some people have found even the more minor side effects so distressing that they’ve discontinued use.
Possible Long-term Side Effects of Botox
When muscles are not used, they have a tendency to atrophy and be replaced by fat and fibrous tissue. Muscle degeneration may be observed after about four months of disuse; electric stimulation may be used to slow down or prevent this process when an individual has to be immobilized in a cast for long periods. A 2010 University of Calgary study on rabbits claimed that long-term use of Botox causes muscle atrophy even at sites far away from the injection areas. In 2008, the Calgary team had obtained much the same results while experimenting on cats.
Articles immediately trumpeted that wrinkle treatment with Botox may “turn muscles into fat;” however, even a cursory glance at the study results show that it used higher dosages of toxin than are used in cosmetic procedures. The dosage necessary to treat serious, painful muscle spasms, such as those exhibited by cervical dystonia sufferers, is about six times greater than that used to treat facial lines: less than 600 “mouse units” for spasm as opposed to less than 100 for wrinkles (death in humans is caused by around 3000 such units, equivalent to around 100 full vials of Botox). The Calgary study results are thus not quite as dramatic or shocking as their presentation in the media might indicate.
A 2008 Italian research study performed on lab rats showed migration of toxin to areas of the brain, including those involved in long-term memory and spatial orientation. Allergan, the company that makes Botox and Botox Cosmetic, pointed out that this study used a mixture of Botox and pure botulinum toxin rather than Botox alone. The difference in preparation may well have affected the study results. Moreover, animals and humans may have different reactions to Botox injections, as they do to many other chemicals.
At least 2.5 million U.S. citizens had cosmetic Botox injections last year; the vast majority were pleased with their new appearance and repeated the treatment once the effects wore off. Still, the fact that some patients develop serious side effects gives one pause: getting Botox for cosmetic purposes alone should never be done on a whim; research and careful thought are necessary before deciding that the benefits outweigh any possible risks.
Minimizing Bad Reactions to Botox
Aside from avoiding lying down or touching the treated area for the proscribed time period, patients can minimize the risk of serious side effects by being completely honest and open with physicians. Any family or personal history of problems like ALS or myasthenia gravis should be revealed; breathing problems such as asthma or emphysema may also contraindicate Botox use. All drug use should be thoroughly discussed, including use of herbal medications, illegal drugs, or over-the-counter sleeping pills.
Always make sure your doctor has had plenty of experience injecting Botox; an inexperienced physician may inject the substance in a manner more likely to cause side effects. Use the same type of research you would use if considering a face lift or other more intrusive procedure. If a doctor seems wildly overenthusiastic about the product, or recommends it even when you didn’t ask for it; find another, more objective, physician.
Never, ever get “bargain Botox;” injections of the real thing cost approximately $300-$1000, depending how many units are used. Inexpensive Botox is probably black market botox, which is often not approved for human use. Such substances have been known to cause symptoms of botulism poisoning, including paralysis or permanent respiratory problems, or sepsis at the injection site. Never get Botox injections from anyone except a qualified physician.
Although following the above advice certainly will not eliminate all chance of complications, such precautions may serve to help minimize problems by transforming an uninformed gamble into a more calculated risk. Always remember that getting any facial injection is not at all like purchasing a new shade of lipstick or eye shadow, even if fashion magazines and “Fountain of Youth” hype-filled advertisements often seem to equate their gravity.
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