Botulinum toxin: instructions for use and mechanism of action

Botulinum toxin, a toxin obtained with the bacteria Clostridium botulinum , is popularly called botox. It is used not only in aesthetic medicine, but also, in particular, in neurology. It is a strong enough poison, however, injected in small amounts is completely safe.

What is botulinum toxin?

Botulinum toxin is a substance produced by anaerobic bacteria Clostridium botulinum .It is produced in soil, bottom sediments, as well as in improperly prepared and stored meat and vegetable cans. Eating such canned food can lead to botulism. Has an adverse effect on neuromuscular tissues and affects the muscles. This substance is sensitive to high temperatures( it breaks down above 60 ° C).

There are several types of this toxin, which are designated by letters from A to G. To improve its appearance, it is used in very small doses that do not cause side effects. Aesthetic medicine uses botulinum toxin type A.

This substance is poisoned much more rarely than in the past. This is due to the fact that the food was stored in better conditions. When there is a possibility of poisoning with this poison, you should perform a gastric lavage and take a laxative to remove as many toxins from the gastrointestinal tract. In case of poisoning, the patient is given antitoxin( antibotulinum serum).It is very important to maintain proper hydration of the body and diet during treatment.

There are also cases of poison entering the wound, for example, through the soil. In such cases, surgical cleansing of the wound and antibiotic therapy are necessary.

Mechanism of action of botulinum toxin

The mechanism of action of this substance was first used in the treatment of neurological and ophthalmic diseases. The toxin was used, in particular, to relieve excessive muscle tension in children, patients with cerebral palsy, or people who had a stroke. When they began to treat them with strabismus, it was noticed that it not only improves the condition of the eyes, but also smoothes wrinkles. Through trial and error, physicians developed dosages, as well as methods of injecting the drug. In the 1980s, the drug began to be used in aesthetic dermatology. It was a very popular complex.

Botulinum toxin type A causes suppression of the release of acetylcholine, a neurotransmitter responsible for the formation of impulses between nerves and muscles. It acts by blocking the connection between nerve endings and muscles, that is, blocking the so-called neuromuscular synapses. Botulinum toxin binds to the membrane of presynaptic receptors and blocks the release of acetylcholine. This leads to the fact that the muscles relax, and wrinkles for a while are smoothed. This process is used in medicine.

With such diseases as strabismus, neurological pathologies that occur with excessive muscle tension, hyperhidrosis, facial wrinkles, use botulinum toxin. The drug with this substance works locally, but since nerve fibers have the ability to create new compounds, the therapeutic effect decreases and disappears 4-6 months after the injection of the toxin. Therefore, the procedure must be repeated.

Drugs used in medicine are produced laboratory from isolated strains of bacteria, cleaned and placed in a vacuum package in strictly metered doses. They are used safely and effectively in many fields of medicine.

In aesthetic dermatology, for smoothing wrinkles, doses of the order of 20-60 units are used during one procedure. Their toxicity is out of the question, since the toxic dose for humans ranges from 2.5 to 3 thousand units.

Application in dermatology

Botulinum toxin type A hemagglutinin complex( Botulinum toxin type A - hemagglutinin complex) is known in aesthetic medicine under the names of medicines "Botox", "Disport", "Xeomin".

In order for a drug with this substance to begin its action, it must be injected into a specific muscle. Injections of botulinum toxin block neuromuscular conduction, prevent spasm of muscles and cause their relaxation. In the end, a good cosmetic effect is obtained, that is, after relaxation of the muscles, fine wrinkles cease to be noticeable. In addition, the existing wrinkles will not become deeper, which is a kind of prophylaxis, allowing to prolong youth. Also, people whose wrinkles are not yet visible can use botulinum toxin. Its timely application will help to keep the face skin for a long time young and smooth. This does not mean that teenagers have to undergo the procedure. The introduction of botulinum toxin is performed only after consultation with a specialist in aesthetic medicine. The doctor should explain to the patient how the procedure goes, to tell about the results and possible side effects. The final decision on the operation should be made consciously by the patient.

Indications for use

This drug is often used on patients with facial wrinkles on the forehead and in the eye area. They can arise even in very young people and are associated with familiar mimicry. In case the wrinkles are very deep, sometimes an additional procedure is required - filling them with hyaluronic acid( eg Dethail, Juvederm).Can be combined with other methods of facelift.

The drug is used in removal:

• wrinkles between the eyebrows( forehead area);
• around the eyes( crow's feet);
• others: lower eyelid, area around the mouth, on the chin, neck.

In dermatology it is also used to treat hyperhidrosis of the palms, feet and underarms. Injections are recommended in the treatment of diseases associated with muscle cramps and nerve tics, in the treatment of spasticity in children with cerebral palsy, in ophthalmology for the treatment of strabismus. The introduction of Botox into the appropriate areas of the forehead and neck cures a headache.

Procedure of

Botulinum toxin is injected into the muscle using a disposable syringe with a special needle. A small amount of the drug is exactly injected into several places on the face. The procedure does not last long. Depending on the number of injection points, it takes about 15-20 minutes. The pain associated with the introduction is minimal. Many patients compare it to an ant or mosquito bite. The procedure does not require local anesthesia. For patient comfort, local anesthesia with a cream( eg EMLA) is sometimes used about 1 hour before the procedure.

After operation

Wrinkles are completely or partially eliminated, facial expression becomes softer, it looks natural, the overall facial expression is preserved. The dose used for cosmetic purposes is many times lower than the therapeutic dose, and is completely safe. It is chosen individually depending on your needs.

The toxin begins to act after 2-3 days from the moment of injection. A full therapeutic effect will be visible only after 7-10 days. The effect after the procedure is maintained for an average of 6 months. It depends on the individual characteristics of the body.

After a while, the facial expression gradually becomes the same. After the full expiration of the injection, treatment should be repeated. The person already after one procedure - that is, approximately a half-year period of the action of injections - looks younger, more rested.

Therapy with the use of botulinum toxin for aesthetic purposes is relatively simple, conducted on an outpatient basis, does not require any special diagnostic tests. Immediately after its completion, the patient can return to his daily activities.

Contraindications

Absolute:

• disorders of neuromuscular conduction;
• hypersensitivity to the components of the drug( human albumin);
• skin inflammation;
• pregnancy, lactation period.
• use of other drugs: aminoglycosides( streptomycin, gentamicin), aminoquinolines( chloroquine, hydroxychloroquine), D-penicillamine, "Cyclosporin", "Tubocurarine", lincomycin, tetracycline, polymyxins.

Relative:

• coagulation disorders;
• use of anticoagulants( eg, aspirin).

Treatment is not practiced in children under 12 years( with the exception of some neurological and ophthalmologic indications).

Absence of indications for the operation is also a contraindication, which should be remembered. Not everyone needs to use cosmetic procedures with this drug to reduce wrinkles, and the task of the competent doctor is to explain this fact to the patient.

Side effects of

During and after the procedure, there may appear:

• pain at the time of injection;
• small bruises at the injection site, if the needle enters the vessel;
• excessive lowering of the level of the eyebrow or too much of its ascent;
• small swelling with the appearance of a slight tingling at the injection site;
• excessive sagging of the muscles( with lowering of the eyelids, corners of the mouth);
• headache after applying an anesthetic.

Note: these reactions tend to disappear after a few days. There is no risk of any scars or damage, and the injection site remains invisible. The risk of side effects depends on the muscle in which the drug is injected, so the procedure should be discussed in detail with the doctor before it is performed.

Behavior after operation

After injections of botulinum toxin:

• , it is impossible to train mimic muscles within an hour;
• avoid massage at injection sites for 4 hours;
• after the procedure, do not tilt your head down( for example, when putting on shoes or while you sleep).

Repeat procedure

Injections can be repeated every 6-8 months, but no more than once every 3 months. This is one of those procedures to which patients return with joy, because it gives a very fast and long-term result, noticeable to everyone. Simultaneously, this procedure is non-invasive and easy to perform.