Botox Therapy: How It Works

How Botox Works

Botulinum toxin causes food poisoning and was developed at one time for biologic warfare. Now it is medical treatment for wrinkles, excessive sweating of the palms and armpits, and for headaches. Botulinum toxin food poisoning caused blurred vision, nausea, and fatal paralysis. It was found in salty food like sausage. Botulis is the Greek word for sausage. Clostridium botulinum is the bacteria that makes the toxin. There is a type A, B, and E. Type A is most used for medical purposes. Dr. Herman Sommer developed the toxin in 1920. Medical use began in the 1950’s by Dr. Vernon brooks and Dr. Alan Scott. Dr. Jean Carruthers is credited with discovering the cosmetic use of the toxin in 1987. While treating muscle spasms around the eye she found that the wrinkles between the eyebrows improved. The FDA later approved the use of Botox A and it has been used in cosmetic procedures since 1997.

Most wrinkles form as folds in the skin when the underlying muscles contract. As skin ages it does not recover as well and the folds persist at rest. Botox is injected into these muscles to paralyze them to some extent and flatten out the lines. Botox works at the neuromuscular junction where the nerve contacts the muscle it stimulates to move. At this junction a chemical called acetylcholine is released from the nerve ending into the muscle to stimulate it. Botox prevents the release of acetylcholine so the muscles cannot be triggered to move. The muscle weakness starts in 2-4 days and is maximal at 7-10 days. The muscle recovers from the effects of Botox in 2-5 months and the wrinkles come back. However, with repeated treatments, the improvement can last longer, up to a year on occasion and with wrinkles that are not as deep. When the area rests more fibrous tissue can form at the bottom of the wrinkle to give a more permanent effect as well.

The neuromuscular junction where nerve ending meets muscle

Acetylcholine release at the neuromuscular junction, Botox stops this release

Botox comes in 100 unit vials and is usually diluted before injecting it. It is prepared by mixing it with pure saline. It can also be mixed with saline preserved with benzylchloride which may help decrease the pain of injection. The company recommends using the prepared dose with in 4 hours and handling Botox gently. However studies do not show a clear difference in effectiveness when it is shaken or injected up to 6 weeks after the dose is mixed. There are other preparations like Mybloc (Botox type B) which is weaker and requires about 50-150 times a Botox A dose to be effective. Reloxin is another brand of Botox A but needs 2.5-3 times the amount of conventional Botox. Puretox is another type A toxin being studied.

The way Botox is diluted can affect the treatment. With more dilution, a larger volume of drug is injected. The drug can spread out more and cover more areas with fewer injections. However, you risk it going into other unwanted areas and causing more side effects perhaps interfering with speaking or vision. Resistance because of antibody formation is very rare. Botox can be used in combination with other treatments like injectable fillers and lasers to make the improvements last longer. Botox can be given before a laser is used to remove the outer layer of the skin, a resurfacing procedure. So as the skin heals over, the area is kept still so the wrinkles do not reform. Botox is the most popular cosmetic treatment in America with over 3 million people treated in 2005.