Botulinum Toxin Treatment

What is it, and where does the name come from?

The name comes from the Latin word botulus (sausage). Botulinum toxin type A was obtained in 1946. In the 1960s and 1970s it was used in the treatment of squint (strabismus), and it was first applied for treatment in 1980. Approval for lines between the eyebrows and for excessive sweating of the armpits was given in 2002.

Licensed uses

It is useful to know that botulinum toxin is not only a cosmetic treatment. Its licensed (approved) uses are:

• Excessive sweating of the armpits (axillary hyperhidrosis) in adults
• Lines between the eyebrows (glabellar lines)
• Spasticity of the arm in adult patients after a stroke
• Dynamic equinus foot deformity due to spasticity in patients with cerebral palsy aged two and over
• Blepharospasm (spasm of the eyelid) in adults
• Hemifacial spasm (spasm of one half of the face) in adults

Cosmetic areas of use

The main areas considered for cosmetic purposes are: horizontal forehead lines, lines between the eyebrows (glabellar), crow's feet, lower eyelid lines, lines at the side of the nose ("bunny" lines), lines around the mouth, a downturned corner of the mouth, lateral brow lift, the jaw muscle (masseter), asymmetry of the face, neck lines and platysmal bands. Migraine and excessive sweating are also among the areas of use. The décolletage and cheek lines are rare areas of use.

Some of these areas are outside the list of licensed indications. Which area is suitable for you, whether your expectation is realistic and the possible results should be discussed in detail with your doctor before treatment.

Who should not have it?

The following situations are obstacles to botulinum toxin treatment:

• Pregnancy and breastfeeding
• The use of certain medicines: aminoglycoside antibiotics, penicillamine, quinine, calcium channel blockers, magnesium, ciclosporin
• A tendency to allergy
• Nerve–muscle diseases: ALS, myasthenia gravis, Eaton-Lambert syndrome
• Conditions in the treatment area such as infection or eczema
• Inflammatory skin disease and a bleeding disorder
• People who are not mentally stable and who have excessive expectations — treatment is not considered appropriate in conditions such as body image disorder (dysmorphic disorder), borderline personality, obsessive-compulsive disorder or narcissism

How does the process work?

1. Information is given about the treatment, the possible side effects and its effectiveness.
2. A written informed consent form is taken, and the information required under data protection law is given.
3. Photographs before and after treatment are taken sitting upright.
4. The muscles are assessed both relaxed and contracted.
5. The injection points and the dose are determined.
6. Ice is applied if necessary; the skin is cleaned with an alcohol-free product.
7. It is given with the appropriate technique; the procedure and the batch number of the product are recorded in the file.

If the eyelid droops (ptosis)

One of the possible side effects of treatment is temporary drooping of the eyelid. Eye drops with an alpha adrenergic action can be used in managing this; one drop is applied 3–4 times a day at intervals of 3–4 hours. Radiofrequency, ozone and PRP treatments are also listed among the management options. This is a decision for the doctor; do not use drops on your own.