Botulinum Toxin (Botox)

Botulinum toxin is produced by the Gram positive rod Clostridium Botulinum, a bacterium commonly found in soil. Clostridium botulinum was first isolated by Prof Van Ermengem in 1895. Over 50 years later in 1946 Dr Edward Schantz, Maryland succeeded in purifying botulinum toxin type A, which is the type most commonly used in clinical and cosmetic practice. The first practitioner to use botulinum toxin for medical reasons was Dr Alan Scott, an eye surgeon in San Francisco, who used the purified neurotoxin to straighten misaligned eyes (squints).

Since then the clinical applications of Botox has expanded considerably and include:

• Blepharospasm
• Hemifacial spasm
• Squints
• Spasmodic torticollis
• Muscle spasms eg cerebral palsy
• Excessive sweating

Botox has been used since the early 1990's for cosmetic reasons, especially in the USA. The use was initially "off licence" until the American regulatory authorities (FDA) approved Botox Cosmetic in 2002. A licence was granted for the limited cosmetic use of Botox in the UK in 2006 and Vistabel was launched.

Vistabel (botulinum toxin type A) manufactured by Allergan

How does Botox work?

Unwanted facial lines and wrinkles are often from "over active" muscles involved with facial expression. Botox is a purified protein which works by temporarily reducing or preventing nerve cell signals from reaching these muscles. It is diluted to a very controlled solution and carefully injected into targeted muscles using a fine needle. The muscle activity reduces over a period of 2-5 days and the beneficial effect usually lasts 3-6 months before wearing off. Most people have the treatment repeated at around 4 months before the facial lines return completely.

Botox is carefully injected into target muscles using a fine needle

The areas most frequently treated are in the upper 1/3rd of the face: forehead wrinkles, frown lines, "bunny lines" on the side of the nose and "crows feet" (or laughter lines). Less commonly, but sometimes with good effect, Botox can be used in the lower face especially around the lips.