Saving poison: botulinum therapy against wrinkles, strabismus and sweating

Many believe that botulinum neuroprotein type A, a muscle relaxant (colloquially Botox, after the name of the most famous of the drugs in this group), is used only to eliminate wrinkles. However, the range of its application in medicine is so wide that one listing of the pathologies in which it is used will take up a whole page.

This amazing drug is in demand in gynecology, ophthalmology, neurology, dentistry, orthopedics and gastroenterology. For example, only in neurology, as Marina Vasilenko, a neurologist at JSC Meditsina, said, botulinum toxin therapy is used very widely. This muscle relaxant is used to treat:

• various pains (migraine, muscle spasms, myofascial syndromes);
• blepharospasm (eyelid spasm);
• hemifacial spasm (spasm of facial muscles);
• paralytic strabismus;
• spastic torticollis.
• Botox is also used to reduce local muscle spasm in adults and children over two years old (including cerebral palsy and stroke);
• hyperhidrosis (excessive sweating);
• bruxism (spasm of chewing muscles, due to which people erase tooth enamel).

And in aesthetic medicine, the range of application of Botox is very wide. According to Aleksey Paramonov, dermatologist, surgeon, trainer-expert in injection techniques, thanks to Botox, you can not only remove crow’s feet and wrinkles on the forehead, near the nose and around the mouth, but also raise the lowered corners of the lips or overhanging eyebrows, eliminate facial asymmetry , as well as to correct a gingival smile, in which part of the gum is exposed.

Also, Botox will help to correct the contours and oval of the face, and even improve the shape of the shins. It also works in the décolleté area (it helps to remove the rings of Venus on the neck and wrinkles on the upper chest). But why then so many claims to such a wonderful universal drug?

In fact:

In fact: As of 2022, 7 types of preparations of this neuroprotein have already been registered in Russia: Botox, Dysport, Xeomin, Lantox, Relatox, Botulax, Myotox. They are all analogues. However, the likelihood of running into a fake is high. To protect yourself from the grief of specialists, who are now a whole army, the expert advises to always check the doctor’s diplomas of education. An official distributor will never sell an original drug to a pseudocosmetologist.

In fact: “There can be no blindness from Botox (do not confuse it with fillers), says doctor Paramonov. – And there are no cases of serious complications in the form of anaphylactic shock and similar conditions in the world, although the drug has already been used for more than 30 years. Every year, the number of injections goes into the millions. Even if the drug was stored or transported incorrectly (only Xeomin can be stored not in the refrigerator), in the worst case, it simply will not work, but there will be no harm from it.

However, complications can still arise. All of them, as a rule, are the result of a doctor’s mistake (too high a dosage of the drug, improper administration technique, not bringing the rules of behavior to the patient’s attention). For example, after the procedure, you can’t go to the sauna, sunbathe, etc. for some time.

Among the complications may be: edema, bruising, lacrimation, allergies, drooping (ptosis) of the upper eyelid and eyebrows, asymmetry of the mouth, and others. Fortunately, these side effects are very rare, and besides, they are completely reversible (disappear on their own within one month).

In fact: “Botox is injected not to paralyze the muscles, but to remove excess tension from them, which leads to creases and wrinkles,” says Alexey Paramonov. – Yes, there are cases when even the average dosage of the drug acts excessively strongly. Therefore, in my practice, I use the most minimal dosage for the first injection of Botox in order to minimize the likelihood of complications. ”

As the expert specified, the average doses for the area around the eyes are 12-16 units, for the forehead – 6-12 units, for the area between the eyebrows – about 20 units. In men, these doses may be higher. Separately, it is impossible to prick the forehead without the interbrow, otherwise the look will become formidable.

“The main principle of dose selection is that it is always better not to stab than to stab,” the expert believes. “Wrinkle correction should be carried out delicately, pointwise.”

Myth number 5. You can not resort to a Botox injection before the age of 35. Otherwise, it will quickly stop working.

In fact: “The age when you need to start is not an entirely accurate indicator,” Alexey Paramonov clarifies. – There are patients who have very lively facial expressions since childhood and mimic wrinkles are laid as early as 20 years old. And others do not even have a hint of wrinkles even at 40 years old. In general, it is better to start doing botulinum therapy when wrinkles have just begun to form. But even then it’s not too late, it’s just that you may need to carry out several procedures or supplement them with filling with a filler.

Myth number 6. Botox can be injected no more than once a year. And it’s good to take breaks.

In fact: Botox lasts from two to nine months (usually three to four). In people with too mobile facial expressions, such as actors, the effect is even shorter. But, in any case, you can perform a second injection no earlier than three months later. This is necessary so that resistance to Botox does not develop, and it does not stop working. But such injections can be used for a very long time without any harmful consequences.

It is very important to seek a Botox injection from a doctor and carry out the procedure only in a medical institution, also because with a rather impressive list of diseases and conditions, the use of boxing is prohibited.

Contraindications include diseases associated with impaired neuromuscular transmission, pregnancy, acute illnesses and exacerbations of all chronic diseases, a tendency to form keloid and hypertrophic scars, and much more.

In particular, the ban on Botox can also be imposed by taking certain drugs that enhance or weaken the effect of the toxin (antibiotics of the aminoglycoside group, macrolides, tetracyclines, polymyxins, and a number of other drugs).

“And also, if you decide to correct wrinkles around the eyes (crow’s feet) and you have a high degree of myopia (nearsightedness), you need to take into account that then it will be inconvenient for you to squint to focus your vision,” the doctor adds. “For your own peace of mind, it’s best to consult an ophthalmologist first.”

“Primary insensitivity to botulinum neuroprotein is quite rare, in about two percent of cases,” Paramonov says. “Botox does not take such patients at all, moreover, subject to the correct dosage and administration scheme. In this case, botulinum therapy should be abandoned and wrinkles should be treated by other methods (filler filling, mesotherapy and biorevitalization, thread lifting, peeling, hardware and laser procedures).”

Resistance to Botox can also occur if the technique is used incorrectly: with a significant single excess of the dosage or frequent injections of the drug in small doses. In this case, antibodies are produced to the hemagglutinin complex of botulinum toxin, which neutralize the effect of the drug, and it stops working. To prevent resistance, it is necessary to observe an adequate dosage and frequency of use of the drug.

One to five percent of patients develop antibodies after repeated injections. The formation of antibodies is facilitated by the introduction of large doses of the drug.

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