The truth about toxins
20 years since the advent of Botex, the world's most popular wrinkle-busting drug is still misunderstood. Specialist Dr Samantha Gammell dispels the myths
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Myth: Botulinum toxin (Botox) injectionsare highly toxicNearly every worthwhile drug in medicine is a dilute solution of a toxin. If you were rushed to hospital with a heart attack, some of the drugs used to save your life would be digoxin, atropine, lignocaine and adrenalin – all chemicals extracted from plants, microbes or animals that are used in a controlled fashion. Some drugs, such as digoxin (extracted from the foxglove plant) can actually stop your heart beating, but used in a dilute form can allow it to beat normally. Other drugs, such as atropine (extracted from deadly nightshade), can block nerves and slow the heart. In a similar way botox is a mild dilution of botulinum toxin which can cause a form of food poisoning. The safety of botulinum toxin however is ensured by its selective administration of very small dilute amounts into certain muscles, which leaves it largely incapable of action outside that given area. New-born babies and children with cerebral palsy are given much higher doses of this toxin everyday without problems. Most physicians would agree that aspirin and antibiotics are potentially more harmfully than botulinum toxin, however, like any prescription medication it should only be used by trained physicians in proper clinics.
Myth: Botulinum toxin injections distort or freeze facial expressionThe resultant expression on a patient’s face after treatment is really dependent on the skill of the person carrying out the treatment and has little to do with botulinum toxin. The degree of residual upper facial movement depends on the amount of botulinum toxin used and the injection location. Accordingly, facial expressions can be distorted only in the case of overdose or misdirected injection of the drug. By analogy, if your house flooded after installing a new washing machine, surely you would blame the plumber and not the water company.
Myth: Botulinum toxin injections should only be given to people over 35 Although mid-to-late 20-somethings seeking treatment remain a minority, the numbers are on the increase. Younger patients generally come to the clinic knowledgeable about the treatment and with prevention in mind. Some studies suggest that botox use at a younger age may be more effective in delaying ageing than it is in treating established deeper wrinkles. With younger patients however, the ethical approach inherent in doctor’s training and experience is key to treatment decisions.
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Myth: There are risky side effects from botulinum toxinThis is a total misconception as side effects are uncommon, generally mild and always transient. The needle used can cause bruising, discomfort, slight redness and possibly a headache. The most bothersome, although fortunately rare, side effect is a lowering of the upper brow or eyelid which can occur when frown muscles are injected. Most lowered brows resolve spontaneously in four weeks and conversely if the brows are too elevated this is easily corrected. It is more difficult to treat eyelid droop, although many patients are responsive to special eye drops called Apraclonidine. Fortunately, in the worst case scenario all side effects will disappear when the action of the toxin wears off in three to five months.
Myth: Botulinum toxin injections can create new wrinklesThis misconception was started back in 2002 by a doctor who suggested that people unconsciously recruit nearby muscles if certain muscles have been weakened by botulinum toxin. Many doctors disagreed and the original doctor later retracted his statement.
Myth: Patients shouldn’t lie down for four hours after botulinum toxin treatmentThe underlying logic of this misconception comes from the fact that lowering of the eyelid, a rare complication of botulinum toxin treatment, comes from the migration of the product through the orbital septum. If this were true then patients should really stand on their heads to prevent this type of diffusion. I don’t give patients this instruction, but I do tell them to avoid manipulation of the area.
Myth: Nurses can administer botulinum toxin without consulting a doctorBotulinum toxin is a prescription only medication (POM). Only doctors, dentists and a small body of nurses known as Nurse Independent Prescribers can prescribe and administer botulinum toxin. In November 2009, the Nursing & Midwifery Council (NMC) set clear guidelines to protect the public stating that, ‘A nurse can only administer injectable cosmetic medicinal products after the prescriber (ie the doctor, dentist or NIP) has assessed the patient and those who continue to ignore this advice will be accountable for their actions and risk losing their license to practice’.
Myth: Patients should not fly after botulinum toxin treatmentAnother misconception yet still advised by some doctors. This perceived logic comes from the fact that different cabin pressures could cause migration of the toxin. Cabin pressures however are generally the same as air pressures on the ground. It is the air pressure outside the cabin that is different. Only if a patient is flying long haul should they be advised to wait one day.
Myth: Botulinum toxin is only used for cosmetic purposesWhile botulinum toxin has been popularised by its use for wrinkles, this wonder drug is now being used to treat a wide range of medical conditions including hyperhidrosis (excessive sweating), migraines, incontinence, spasms, cerebral palsy and prostate disease as well as chronic back and neck pain.
In focusHighly acclaimed within her field, Dr Gammell is on the board of the British Association of Cosmetic Doctors (BACD) and an honorary University lecturer and examiner in Cosmetic Medicine. In addition Dr Gammell has been involved in developing the first Masters Degree in Cosmetic Medicine aimed at regulating doctors within the industry.