Chapter 11: Botox

Question 1

How was the Botox “toxin” first discovered/ isolated for use?

Answer 1

• A German scientist, Dr. Justinus Kerner of Wittenberg, first explained the disease called botulism (1817 - 1822) caused by “sausage poison”
  -Already imagined that the toxin that’s caused such a serious disease, could be used to treat diseases like muscular spasms
  —Dr Emile Pierre van Ermengem (Belgium) in 1895 successfully isolated this bacterium, named it Baccillus Botulinus

Question 2

When was Botulinum toxin first used to treat disease?

Answer 2

-1980 by Dr. Alan Scott (Ophthalmologist) and Dr. Edward Schantz in treating strabismus.

Question 3

How did the Botulinum Toxin begin being used for cosmetic purposes after 1980?

Answer 3

• in 1987, ophthalmologist Jean Carruthers observed that frown lines disappears after the use of botulinum toxin for blepharospasm
• in 1996 they published the first paper on the use of botulinum toxin for cosmetic purposes
• in 2002, the FDA approved the use of BOTOX Cosmetic to temporarily improve the appearance of moderate to-severe frown lines between the eyebrows (flagella lines)
• In July 2004, the FDA approved BOTOX to treat severe underarm sweating, known as primary axillary hyperhidrosis, that cannot be managed by topical agents

Question 4

Which bacteria is botulinum toxin produced by?

Answer 4

Clostridium Botulinum, a gram positive anaerobic Bacteria

Question 5

What are symptoms of botulism?

Answer 5

• double vision, blurred vision
• drooping eyelids
• slurred speech
• difficulty swallowing
• dry mouth
• muscle weakness
• these are all symptoms of the muscle paralysis caused by the bacterial toxin.

Question 6

What will result if botulism symptoms not treated?

Answer 6

symptoms may progress to cause paralysis of the respiratory muscles, arms, legs, and trunk

Question 7

How long does it take to realize symptoms in food borne botulism?

Answer 7

-symptoms generally begin 18 to 36 hours after eating a contaminated food, but they can occur as early as 6 hours or as late as 10 days

Question 8

What is BOTOX made of?

Answer 8

• Botox is a drug made from a neurotoxin produced by the bacterium Clostridium Botulinum called botulinum toxin
• it is used medically to treat muscular conditions and cosmetically for removing wrinkles by temporarily paralyzingl muscles

Question 9

HOW does BOTOZ work?

Answer 9

• the toxin induces weakness of striated muscle by in hi biting transmission of alpha motor neurones at the neuromuscular junction
• this has led to its use in conditions with muscular over activity
• transmission is also inhibited at gamma neurones in muscle spindles, which alter reflex over activity
• the toxin also inhibits release of acetylcholine in all parasympathetic and cholinergic neurones (treatment of hyperhidrosis)

Question 10

Mechanism of action:

Answer 10

• Botox is absorbed by the nerve root that supplies the overactive muscle
• signal is blocked from nerve to muscle
• once inside cell, Botox release of a substance called acetylcholine, this is what stops the nerve from activating the muscle
• botulinum toxin acts at the neuromuscular junction

Question 11

How does Botox work?

Answer 11

• Botox is a muscle relaxant
• Botox PREVENTS wrinkle progression and can be used with all other types of anti-aging treatments
• the toxin requires 24-72 hours to take effect, reflecting the time necessary to disrupt the synapse process
• in rare circumstances, some individuals may require as many as five days for full effect to be observed
• peaking at around 10 days, effects lasting nearly 8-12 weeks

Question 12

Aesthetic Indications for Botox:

Answer 12

Botox is indicated for all wrinkles produced due to persistent muscular contractions. These include:

• horizontal forehead lines
• glabellar lines and verticals frown lines
• crows feet
• bunny lines
• marionette lines
• dimpled chin
• platysmal bands

*dynamic wrinkles respond better than fixed wrinkles

Question 13

NON Aesthetic indications for Botox:

Answer 13

• localized axillary or palmar hyperhidrosis that is non responsive to topical or systemic treatment
• Botox is a local treatment, it is not filtered by liver or kidneys so it is totally safe even for those who have liver or kidney disease

Question 14

What happens as Botox wears off?

Answer 14

• needs to be repeated every several months, because nerves “regrow” and the muscles resume activity
• results tend to last longer with subsequent treatments (as a result of muscle weakening)
• it will take up to 7-10 days to see the results after the first treatment
• the new nerve muscle junction begins to work and the wrinkles return, it is now time for re-treatment

Question 15

How long do the effects last?

Answer 15

• first treatments wear off faster Avg- 3 months
• Subsequent treatments last longer- Avg- 4-6months
• results vary, some people experience results for longer or shorter periods
• longevity can be improved by increasing the dose of Botox in subsequent sessions

Question 16

Side Effects:

Answer 16

Most individuals do not experience side effects. If there are side effects, the most common are related to the fact that an injection has been given and include:

1. slight tenderness at injection site
2. pin point bleeding- very brief
3. Transient swelling- very brief, like an insect bite
4. Temporary bruising
5. Unlikely chance of local infection

Question 17

Home care after injection:

Answer 17

• aftercare is very simple, your client can have a normal lifestyle
• applying makeup, taking your routine medications, working, exercise etc are all fine
• 7-10 days to see full results

Question 18

Contraindications for Botox:

Answer 18

1. patients effected with a pre-existing neuron disease, myasthenia gravis, Easton- lambert syndrome, neuropathies, psychological un-stability
2. history of reaction to toxin or Albumin
3. Pregnancy and lactating females
4. Infection at the injection site