What is BOTOX

BOTOX

Author: Durga Umesh

An injectable wrinkle relaxant is called Botox Cosmetic. It temporarily paralyzes muscle by using botulinum toxin type A, more precisely Onabotulinumtoxin A. This lessens the visibility of wrinkles on the face. Botox treatments are not very intrusive. It’s regarded as a secure, reliable treatment for wrinkles and fine lines around the eyes. In between the eyes on the forehead, it can also be applied. In 1989, the FDA first approved Botox to treat blepharospasm and other disorders involving the muscles of the eyes. The FDA authorized the cosmetic use of Botox in 2002 to treat moderate to severe frown lines between the eyebrows. In 2013, the FDA authorized it for the treatment wrinkles around the corners of the eyes. A 2016 clinical report claims that Botox is a simple, safe, and effective treatment for reduction of forehead wrinkles.

Preparation:

BoNT-A, onabotulinumtoxinA (BOTOX®; Allergan; Irvine, Calif.), abobotulinumtoxinA (Dysport®; Ipsen; Paris, France), incobotulinumtoxinA (Xeomin®; Merz Pharmaceuticals, Frankfurt, Germany), prabotulinumtoxinA (Jeuveau®; Evolus Inc., Santa Barbara, Calif.), CS-BOT (Chiba Serum Institute; Chiba, Japan), and Chinese BTX-A (Prosigne ®; Lanzhou Biological Products Institute, China) have varying potencies.
C. botulinum cultures are fermented in a lab to produce BoNT-A. The protein known as crude botulinum toxin has a molecular weight of roughly 190,000 Daltons. The toxin is diluted with human serum albumin, bottled in vials, lyophilized (freeze-dried), and sealed once it has been purified.
Just before use, each freeze-dried vial containing 100 units (U) of BoNT-A is reconstituted with 1–5 mL of preservative-free normal saline. It is advised by the manufacturer to utilize the poison four hours after reconstitution. Mouse units (MU) are used to quantify the efficacy of BoNT-A. The amount of toxin that kills 50% of a group of 20 g Swiss-Webster mice after three days of intraperitoneal injection (LD50) is equal to one MU of BoNT-A.

As per a report, roughly 20 U of BOTOX® are present in 1 nanogram of toxin, so that 1 U of BOTOX® is equivalent to approximately 0.05 nanogram of the toxin.

Another article comparing the three distinct preparations of BoNT-A states that one nanogram of Dysport has about 40 MU, one nanogram of BOTOX® has about 4 MU, and one nanogram of CS-BOT has about 15.2 MU.

More pharmacologically relevant unit of biologic activity is believed to be the median paralysis unit (MPU). A 2.44-fold variation in potency was seen between Dysport and BOTOX® formulations when the potency ratio based on MPU values was compared.
The estimated LD50 of BoNT-A for an adult male weighing 70 kg is 2500-3000 U (35-40 U/kg).
For monkeys, a minimum fatal dose of BoNT-B is 2400 U/kg.
In clinical settings, one unit of BoNT-A (BOTOX®) is about equal to three units of Dysport®.
The first long-acting botulinum toxin synthesized with peptides is called DaxibotulinumtoxinA (Daxxify®); its median duration of action is six months.
Research on the usage of Prosigne® and Xeomin® units dosed similarly (1:1) to BOTOX®.

According to an animal study, BOTOX® has the lowest specific neurotoxic activity, while Dysport® and Xeomin® have the highest specific neurotoxin activity. Measurements of the pharmacologically significant activities of the toxin are being used in standardization efforts.
Porcine gelatin (5 mg), dextran (25 mg), and sucrose (25 mg) are found in Prosigne® vials, whereas sodium chloride (0.9 mg) and human albumin (0.5 mg) are found in BOTOX® vials. The protein load in these vials is 4-5 ng/100 units of BoNT-A. It is estimated that BOTOX® has 1.5 times the potency of Prosigne®.
In the US, RimaBotulinumB (MyoBloc®) is the brand name under which BoNT-B is sold. This preparation comes in three vial sizes (2,500, 5,000, and 10,000 U) and is stable for up to 21 months when stored in a refrigerator. It is a ready-to-use solution that doesn’t need to be reconstitutioned.

Which body parts are eligible for Botox Cosmetic treatment?

The following places are where the injectable can be utilized cosmetically:
The glabellar region, which lies between the eyebrows, to treat moderate-to-severe frown lines around the eyes, also referred to as “crow’s feet lines.”
Additionally, the FDA approved Botox to treat a number of medical conditions, such as:
excessively active bladder, persistent migraines, lower limb stiffness, and profuse perspiration underarms.

How does cosmetic Botox function?

The way Botox Cosmetic functions is by momentarily preventing muscle contractions and nerve signals. This makes the lines between and around the eyes look less wrinkled. Additionally, by reducing the contraction of face muscles, it can slow the creation of new wrinkles.
The process involves little invasiveness. Neither general anaesthetic nor incisions are necessary. You can numb the treatment area with ice or a topical anaesthetic if pain or discomfort is a concern.
During the procedure, your provider will inject three to five shots of type A botulinum toxin using a tiny needle. The desired area between the eyebrows will be injected. For crow’s feet to disappear, three injections on the side of each eye are typically required.
The whole process takes about ten minutes.

Side effects:

• Swelling in the eyelid area
• Tiredness
• Headache
• Neck pain
• Double vision
• Dry eyes
• Allergic reactions, such as rash, itching, or asthma symptoms

After Cosmetic Botox, what to expect

Avert rubbing, massaging, or exerting any force on the area that has been treated. Botox Cosmetic may spread to other parts of the body as a result of these processes. Your outcomes may suffer as a result of this. Do not bend over or lie down for three to four hours after receiving an injection between the brows. If this is done, the Botox can slide under the orbital rim. This could result in drooping eyelids.
After the procedure, minimal to no recovery time is anticipated. In most circumstances, you should be able to get back to your regular activities right away. It’s critical to comprehend potential advancements and set reasonable expectations. After treatment, noticeable benefits should be seen one to two days later. Usually, Botox Cosmetic’s full effects last up to four months. By calming the muscles, it can also aid in preventing the recurrence of fine lines.
In order to keep your results, you might get more Botox injections.

Conclusion:

The FDA has approved Botox Cosmetic to reduce fine lines on the forehead and around the eyes. It is non-invasive and quite safe.

Make sure the practitioner you select has the necessary licenses to administer Botox Cosmetic. Inform your provider of any allergies or underlying medical issues, and get in touch with them straight away if you have any negative effects after treatment. The decrease of wrinkles can be maintained with further injections, and results should continue for around four months.

Reference:

1. Wisco L. Botox: The Cosmetic Use of Botulinum Toxin.2024;11(1):12-7.
2. Mendez-Eastman SK. BOTOX: a review. Plastic and Aesthetic Nursing. 2023;23(2):64-9.