What Is Botulinum Toxin? 

Botulinum toxin type A, brand names including BOTOX®/ Vistabel®/ Dysport®/ Azzalure®/ Xeomin®/ Bocouture®, are used to treat expression lines in the face by temporarily relaxing the muscles responsible for them.

This allows the skin to relax from repeated movements such as frowning or squinting.

Botulinum toxin has been used since the early 1990s for medical conditions such as muscle spasms and has since become widely used in aesthetics plastic surgery.

Common treatment areas include:

• Frown lines between the eyebrows (Glabella)
• Forehead lines (Frontalis)
• Wrinkles on the outer corner of eyes (Crow’s feet)

Depending on the dosing, muscles can be relaxed gradually depending on patients’ needs/wishes.

The most often used indications for treatment with botulinum toxin lie in the upper third of the face, for correction of vertical frown lines between the eyebrows, horizontal furrows on the forehead and crow’s feet. Other uses are less common and are best performed by experienced board-certified plastic surgeon.

*ISAPS does not endorse any named company or product.

Mechanism of Action

Botulinum toxin type A works by temporarily blocking the signals that nerves send to muscles, reducing their ability to contract. This helps soften lines caused by repeated facial movements.

The effect is temporary. Muscle activity gradually returns as the nerve connections recover.

Formulations

Several formulations of botulinum toxin type A are used in clinical practice, including onabotulinumtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, daxibotulinumtoxinA-lanm and relabotulinumtoxinA.

These formulations have different brand names and are not directly interchangeable. The appropriate product and dose depend on the treatment, the patient's needs and the practitioner's clinical judgement.

Contraindications

Botulinum toxin may not be suitable for everyone. Important considerations include:

• Certain neuromuscular conditions, such as myasthenia gravis and Lambert-Eaton myasthenic syndrome, which affect communication between nerves and muscles.
• An active infection at the injection site.
• Pregnancy and breastfeeding, because treatment is generally avoided due to limited safety information.
• Certain medicines, including aminoglycoside antibiotics and other medicines that can affect nerve-to-muscle communication, which may increase the effects of treatment or the risk of complications.

Patients should discuss their medical history and all medicines they take with their practitioner before treatment.

Complication Management

Most complications associated with botulinum toxin type A are mild and temporary. These may include bruising, headache and localised swelling. Depending on the symptoms, management may involve observation, reassurance and time for the effects to settle.

Severe allergic reactions, including anaphylaxis, are rare but possible with injectable treatments. They require immediate emergency treatment by a trained healthcare professional.

Who is this for? 

Botulinum toxin may be suitable for patients who wish to soften facial expression lines and achieve a more relaxed appearance.

It also has medical uses in appropriately selected patients. For example, botulinum toxin may be used to help prevent certain types of migraine or to treat excessive sweating in the armpits (axillary hyperhidrosis).

Suitability depends on the patient's medical history, treatment goals and expectations. A consultation can help establish whether botulinum toxin is appropriate and explain the potential benefits and risks.

Preparation

Before treatment, patients undergo:

• A consultation to assess patient wishes about treatment areas and goals
• Review of medical history, medications and allergies (e.g. neuromuscular disorders)
• Advice on avoiding blood-thinning medications or supplements if appropriate (plastic surgeon will evaluate every patient individually and give detailed information)