Botox: How a Tiny Bacteria Made a Huge Impact on the Medical and Cosmetic Industry
It’s Toxin Tuesday in the office again. The waiting room is not full of the normal Dermatology patients that are seen by our providers. The day will hold a steady stream of women and men looking to fight the signs of aging, and they will do it by having a toxin injected into the muscles in their face. Each person has secured their appointment time with a deposit, but patients rarely miss the appointment. As each patient is escorted back to a room, they will have their faces cleaned, sign a consent form, and have pictures taken of the area that the toxin will be injected.
“Make a scowling face” one of the Medical Assistants tells a patient as she is taking pictures of different facial expressions. “Now raise your eyebrows.” “Give me a smile.” A few minutes later, Dr. Stewart or our Physician Assistant, Katelyn, comes in and discusses the expectations of the appointment, the areas that the patient wants treated, and how many units of toxin that will be used. The possible side effects and risks of the injections are reviewed as well as the different options of toxin. Most patients are familiar with the brand Botox, but there are additional toxin brands on the market, such as Xeomin and Dysport. A few patients have their favorite, attributing one particular brand to giving longer lasting effects or feeling like one starts taking effect faster than the other two. Overall though, they all have similar results.
What is Toxin?
First noted by Justinus Kerner, a German Medical officer in 1820, tiny rod-shaped bacteria called Clostridium botulinum were found to produce a powerful neurotoxin capable of paralyzing muscles. As the toxin comes into contact with the muscles, it begins to interfere with neurotransmission, or the signals that the body gives to the muscle to create movement. The result is something called “flaccid paralysis” which means that the muscle won’t be able to move as easily, or at all. The effects of the toxin eventually go away, but can last up to 4 months. It is a powerful toxin that if ingested in even small quantities, can kill a fully grown adult in a matter of a couple of weeks. This was apparent in the late 1800’s and early 1900’s as Botulism was found in canned food due to lack of pasteurization at the time. So what do scientists want to do with such a powerfully toxic substance? Find uses for it! The military began experimenting with Botulinum Toxin as a biological weapon during WWII. Other doctors and scientists started wondering if the paralyzing effect could be useful to treat patients with overactive or spasming muscles. After multiple studies and experiments, they realized they can target individual muscles with the toxin. Suddenly, a whole realm of possibilities opened up. Toxin could be used for multiple medical issues involving overactive or spasming muscles, such as clenched jaws, locked muscles in the hands, correcting muscular imbalances in the eye, and even bladder problems and sweating. Studies are still underway to see where else toxin can be used. More recently, it was approved for use in treating migraine headaches.
Eventually, toxin made it to the cosmetic market. In 1989, Dr. Richard Clark, a Plastic Surgeon in California, injected the first patient with toxin for cosmetic use. Since then, toxin has become a multi-billion dollar a year industry. Toxin could be used to soften or prevent wrinkles without surgery or downtime. Men and women were finally able to get rid of the little lines that formed in the middle of their brow that can make them look angry when they aren’t. “People always tell me that I look too angry or serious”, patients will often say. Toxin helps soften what is commonly referred to as “resting angry face”, which can happen when someone tends to unintentionally make a scowling or angry face when they are at rest or thinking. The most common cosmetic areas treated are the forehead, the glabella (between the brows), and crow’s feet (smile lines around the eyes).
“You’ll feel a slight pinch. Ready?” Dr. Stewart says as she is preparing to place the first injection. A slight bit of discomfort is felt as the needle goes in. A 30 gauge needle is one of the smallest and thinnest needles you can get, so while there is a little bit of a sting, it is tolerable for most patients. She carefully makes precise injections into each of the pre-marked areas and administers a few units of toxin into each muscle. Every injection site becomes slightly raised, like a small bug bite or blemish; a temporary effect that for some will fade by the time they get home. As patients leave the office, the 2 week waiting game begins. The effects of toxin aren’t instant.
Safety and Side Effects
A common concern that patientsl have before trying toxin is the safety of injecting this potentially lethal toxin into their body. Can you die from having toxin injections? The answer is no….and yes. It can be very safe if it is administered by a trained medical professional. The biggest concern is not the amount of toxin that is used, but the location that the toxin is placed. But, since many patients are concerned with how much toxin a body can handle without the possibility of killing you, let’s discuss numbers.
The median lethal dose, or the ability to kill half of the people that receive the dose, is 1.3-2.1 nanograms per kilogram of body weight. So for someone who weighs approximately 100kg (220lbs), it would require around 130 nanograms, or 178 full bottles of Botox to reach the Median Lethal Dose. Most cosmetic injections use less than half of a bottle per treatment, meaning that your chances of dying from a toxin overdose are minisculy low. Although allergic reaction can always happen, it is a rare occurrence for someone to have an adverse reaction to toxin injections. The most common side effects are swelling at the site of injection, headache, and possible bruising. For a full list of side effects, you can visit www.botoxcosmetic.com.
As stated earlier, the biggest concern with toxin is not the amount used, but the location that the toxin is placed. It is imperative that you go to a properly trained medical practitioner who has studied the structures and muscles of the face and surrounding area. If toxin is injected into the wrong muscle, or travels to a surrounding muscle, it can cause multiple problems. In cosmetic injections, the most common side effect is eyelid droop, which caused one or both upper lids to temporarily droop. In other areas, injecting into the wrong muscle can interfere with vital bodily functions, such as trouble swallowing or speaking if injected incorrectly into the throat. Breathing problems have been seen in injections around the diaphragm, as it can cause the diaphragm to weaken. You are also more at risk of these side effects if you have certain medical conditions, such as amyotrophic lateral sclerosis or Lou Gehrig’s disease, myasthenia gravis, or Lambert-Eaton syndrome.
To Inject or Not to Inject?
Overall, toxin is a safe and effective choice for softening or getting rid of lines around the eyes, forehead, and in between the brows. There is some minor discomfort when receiving the injections and you may get a headache for a few days after treatment. Expect to see results starting at around 2 weeks. The results can last anywhere from 2 to 4 months, depending on the amount of toxin injected and individual tolerance. Make sure to go to a provider who has experience with injecting toxin to decrease your risk of having the toxin placed in the wrong area. And, of course, always talk to a professional if you have any questions or concerns!
Leave a reply →
Most Commented