Let’s Talk about Botox: A Guide

Ever considered giving Botox a go? If so, you probably have a few questions about its effectiveness and if, more importantly, it’s right for you. Thanks to this guide, you’ll have all your questions answered in mere minutes. Read on…

What’s Inside this Guide:

  1. Is Botox an Aesthetic or Anti-Ageing Treatment?
  2. How Much Does Botox Cost?
  3. What is Botox?
  4. What Do Studies Suggest?
  5. What Are the Side Effects of Botox?
  6. The Effects of Botox on Sensory Nerves and the Brain
  7. The Effects of Botox on the Central Nervous System
  8. Botox and its Food and Drug Administration (FDA) position
  9. The Effect of Botox on Muscles and Fibres
  10. The Effects of Botox on Muscles and Bone Density
  11. The Importance of Muscular Facial Activity
  12. What is the Role of the Muscles?
  13. Botox: Muscle Loss and Systemic Weakness
  14. Botox and Limitation of Lymphatic Circulation
  15. Botox & Drug Interactions
  16. Is Botox Worth It?

Is Botox an Aesthetic or Anti-Ageing Treatment?

When it comes to beauty and ways of aesthetic enhancement, Botox is the most favourable treatment that brings quick results.

The wrinkle-relaxing injections, according to The American Society of Plastic Surgeons guide in 2015, have been on the rise, with over 6.7 million people undergoing the procedure.

Claims include that it combats and prevents wrinkles – and all this and more ensure that Botox is the ‘ultimate’ solution. A series of well-placed injections along the jawline, lips and eyes or between the brows and on the forehead work to soften lines, smooth out furrows and even promise to give a gentle lift.

How Much Does Botox Cost?

The procedure can be performed several times (via retouches) and involves very little down time. Its price tag varies between £200 and £600, depending on the doctor and the package and area(s) treated.

Despite its popularity in the last two decades or so, the treatment is still under scrutiny for being a symptomatic approach to facial aesthetics, yet some say it doesn’t actually solve the issue of facial ageing. So, is Botox an aesthetic or anti-ageing treatment?

What is Botox?

Botox – also known as botulinum toxin type A – is made from the bacteria (Clostridium botulinum) that cause botulism (a life-threatening type of food poisoning).

Botulinum toxin blocks nerve activity in the muscles, causing a temporary limitation in muscle mobility.

When a small amount of Botox is injected into a muscle, it blocks nerve signals that permit muscles to contract. The effect is that it temporarily weakens/paralyses the facial muscles, resulting in the appearance of reduced skin wrinkles for a few months.

What Do Studies Suggest?

Botox may not be an anti-aging treatment after all, according to research. The preconception of aesthetics in beauty with the antiageing perspective for a beautiful healthy and resilient to ageing skin has been translated into ‘no wrinkle – no expression’ face. The reality is that by affecting the symptoms of ageing – including wrinkles and sagginess – we do not address the very causes of ageing, i.e. what caused the symptoms in the first place.

Botulinum toxin is currently being used therapeutically for more than 50 diseases, symptoms and other conditions. More than 1000 articles exist that deal with some aspect of the timing of these effects.

Despite that, Botox offers significant results in wrinkle reduction and prevention to a degree, It’s questionable whether it performs as an antiageing treatment and saves the skin from the effects of ageing.

Based on the more than 20,000 citations relating to Botox literature – appearing from 1980 to June 2009 – approximately 4600 citations were returned that contained at least few symptoms or condition terms.

A similar search using 19 time-related words returned almost 5000 citations that had at least one of these terms.

What Are the Side Effects of Botox?

Potential and long-term side effects and body mechanism impairments have been investigated to suggest that Botox needs to be used (if necessary) sporadically and in very small dosages, Factors such as age, hormonal background, medical history, and bio-absorbability rate should be taken into account, too.

Some associated effects of Botox have been also investigated for its safety and its impact on different aspects of our health. Some of them are summarised below:

The Effects of Botox on Sensory Nerves and the Brain

Botox injections in the forehead rearrange the brain’s sensory map of the hands. It needs to be questioned whether repeated treatments over a period of months and years result in permanent changes into the brain.

The product-toxin paralyses muscles by blocking the release of acetylcholine, the principal neurotransmitter at the nerve–muscle junction. Because facial expressions trigger different parts of the brain, immobilising facial movements reduces the amount of impulses sent to the brain.

As a result, a nearby area that responds to input from the hands also becomes underactive. Researchers reported that small loss of movement in the face from Botox injections may affect touch sensation in the hands.

The plasticity of the brain has been evidently documented; meaning that it circuits and microscopic anatomy are changeable. They can physically change in response to a number of factors. For example, a pianist brain mapping hands is greater than a non-pianist brain mapping in the same region, because they have educated and evolved this particular brain region.

The brain maps of the hand and face territories lie next to one another in the sensory cortex. Patients with facial paralysis, due to Bell’s palsy or stroke, have decreased and altered the sensory input (tactile) in the hand region of the sensory cortex.

The Effects of Botox on the Central Nervous System

It has been reported that: “While no significant side-effects of using Botox medically have been a major concern, finding out how this highly active toxin travels to the central nervous system is vital because this pathway is also used by other pathogens such as viruses.”

Dr Tong Wang, a Postdoctoral Research Fellow in Professor Meunier’s laboratory, discovered that most of the toxin is transported to a cellular waste reservoir, where it is meant to be broken down to non-harmful substances before reaching the central nervous system.

“For the first time, we’ve been able to visualize single molecules of Botulinum toxin traveling at high speed through our nerves,” Dr Wang stated. “We found that some of the active toxins manage to escape this route and poison neighbouring cells, so we need to investigate this further and find out how.”

Dr Peter Misra – a leading London neurologist – acknowledged that the long-term effects of botulism on the brain, nervous system and muscles are unknown.

He says it’s being used ahead of clear scientific evidence, on the basis of small-scale studies, and that its growing use means more patients are at potential risk, however widely acceptable. There have been no studies of the long-term health effects of routinely injecting low doses of Botox over many years, as safety studies only examined its use over two years.

Dr Stewart Jessamine, head of Medsafe, confirms that: “we don’t actually know if there are long-term side-effects. This is a relatively new medicine, and it is a potent poison. It’s not been used for prolonged periods.”

Botox and its Food and Drug Administration (FDA) position

The Food and Drug Administration (FDA) has approved these products only for the temporary improvement in the appearance of frown lines and crow’s feet.

Botox injections also are FDA-approved for treating several medical conditions, including chronic migraine, severe underarm sweating and blepharo-spasm (eyelid spasm).

Bloomberg has reported that: “Botox can migrate outside the injected muscles and cause side- effects including botulism and considerable autoimmune reactions. Botox – a purified neurotoxin – paralyzes nerves to relax wrinkles and treat neurological disorders. The Food and Drug Administration (FDA) ordered all botulinum toxin products to highlight the warnings about muscle weakness and implement programs to minimise risks.

The Effect of Botox on Muscles and Fibres

Some age-related changes on muscles and skin are to be expected due to the ageing process and genetic or environmental associated factors.

However, researchers now suggest that many factors linked with ageing are due to progressively reduced activity, and that maintaining physical activity can help to slow down premature ageing.

Muscle changes may correspond with a number of factors working in combination, including:

  • Muscle fibres reduction and shrinkage
  • Muscle tissue is replaced less effectively by the body and lost muscle tissue is replaced with a tough, fibrous tissue
  • Neurological changes of the nervous system cause muscles to have reduced tone and ability to contract.

The Effects of Botox on Muscles and Bone Density

Muscle forces are necessary for the development and maintenance of a mineralized bone structure and integrity.

Excellent bone structure is crucial to the aesthetics of the human face. It is arguably the most important component regarding the contour and overall volume and foundation of the face.

Skeletal structure depends on:

  • Skeletal position of the maxilla and mandible is in harmony with the soft tissue
  • Good maxillary angulation
  • Angular brow
  • Strong, irregularly shaped bone growth around the cheekbones and jaw
  • Wide cheekbones
  • Wide jaw/chin
  • Proportional right and left features of the face.

Some studies have shown that Botox treatment may trigger a dramatic loss of bone density in the jaw, with parts of the jaw losing up to 40% of bone volume after just one treatment, with unknown evidence of bone regaining full density.

One person leading research in the field is Dr Karen Raphael – professor of oral and maxillofacial pathology at New York University College of Dentistry – who became aware after clinical research that Botox showed very dramatic losses in bone density. This  is when Botox was used for facial conditions, even after just one single injection of the ingredient.

Researchers found that after only four weeks, the bone in the injected area was ‘severely decreased’. Three months later only half the lost bone had been restored.

Patients and practitioners need to be aware that jaw muscle activity is an important element of jaw bone health, and that removing muscle activity with paralytic agents like Botox has a long-term complications.

Botox has no known direct effect on bone cells, but inhibits synaptic transmission in skeletal muscle and thus leads to flaccid paralysis.

Accordingly, its injection in to a muscle leads to the muscle’s ongoing atrophy and induces bone loss (Reference: Warner SE, Sanford DA, Becker BA, Bain SD, Srinivasan S, Gross TS. Botox induced muscle paralysis rapidly de-grades bone. Bone 2006;38:257).

The Importance of Muscular Facial Activity

There are 43 muscles in the face – most of which are controlled by the seventh facial nerve. This nerve exits the cerebral cortex and emerges from the skull just in front of the ears. It then splits into five primary branches: temporal, zygomatic, buccal, mandibular and cervical.

The ageing process is associated with the combined effects of gravity, progressive bone reduction, decreased tissue elasticity, and redistribution of subcutaneous volume, with changes in muscle mass and strength of muscle decline after the age of 30 and accelerated after 40. The decrease in physical activity with the aging process is the key factor in development of strength and muscle mass loss.

As a normal course of aging, you begin to lose the muscle fibres that are responsible for quick muscle responses. The speed of transmission of impulses from the brain to the muscles also slows down, so it takes longer to get the signals transmitted fully.

In addition, the muscles also can’t repair themselves as quickly as they used to, due to a decrease in enzyme activities and protein turnover. There are more muscles in the face than any other part of our body. There is likely to be satisfactory activity and they’ll start shrinking by an average 1% per year.

For the human new-born face to have a normal morphologic appearance, contractions of these muscles must occur to stimulate forward growth of bone, cartilage growth, and facial muscle volume. Lack of craniofacial muscle contractions may lead to morphological abnormalities.

New understanding of the role of muscle relationship controlling the osteoblasts, osteocytes, and osteoclasts in particular, pinpoints the pathways that could be targeted to delay these age-dependent changes.

Osteo-blasto-genesis is regulated by various pathways. The osteoblasts are surrounded by mineral and extend long processes (dendrites), which allow signalling and nutrition to pass from cell to cell through channels in the bone called canaliculi. These mineral-surrounded cells are known as osteocytes, and they make up approximately 90% of the cells in the bones. 

What is the Role of the Muscles?

The role of muscle in affecting bone size, bone geometry and osteoblastogenesis is significant.

Cellular and molecular mechanisms underlying age-related changes in the muscle-bone relationship addresses the cellular and molecular mechanisms linking bone and muscle that are altered with age and which negatively impact cross communication between the two tissues.

Aging is associated with the development of sarcopenia (muscle loss) in skeletal muscle and osteoporosis in bone structure (bone loss). A therapeutic approach for improving bone health would require targeting both muscle and bone maintenance and enhancement.

Some French investigators confirm that injecting Botox into jaw muscles leads to significant bone loss in adult rats. The authors were primarily interested in the mandible and whether it would lose bone when these muscles were injected with Botox, causing temporary muscle paralysis.

Botox: Muscle Loss and Systemic Weakness

A study published in the Journal of Biomechanics, found that limbs which had been injected with the substance experienced muscle wastage of up to 50%.

But interestingly, they also discovered that muscle loss also occurred in limbs that hadn’t been treated – suggesting the effects of the drug could be spread to other parts of the body.

The product works by stopping muscles from tightening, making wrinkles less prominent. It also may be more likely that risk for systemic effects is related to total injection dose and injection frequency.

Distant spread may also be mediated by botulinum toxin entry directly into the vascular system through the capillary field or venous system.

Botox and Limitation of Lymphatic Circulation

The lymph nodes of the head and neck can be divided into two groups; a superficial ring of lymph nodes, and a vertical group of deep lymph nodes.

The superficial vessels drain lymph from the scalp, face and neck into the superficial ring of lymph nodes at the junction of the neck and head.

When Botox is injected, the muscular structure around the eyes shrinks to pump out the fluids from inside the eye bags and gradually receive it back. Therefore, if the eye muscles are weakened, the muscles are not able successfully to push out the fluid and receive it back quickly.

It may take some time to drain and refill the fluids. Puffiness from Botox in the under eyes is very common, with potential presence of itchiness. In rare cases, it may also swell the upper eyelids, causing by a non-allergic eye oedema.

Botox & Drug Interactions

Other medicines can increase certain side-effects of Botox, especially: cold or allergy medicine, muscle relaxers, sleeping pills, bronchodilators, bladder or urinary medicines, and irritable bowel medicines.

Botox is an effective treatment for softening facial lines and medically proven to treat several health concerns.

The pursuit of beauty is embraced in our culture with the majority of women and men investing considerable time and money enhancing their physical appearance.

The concept of beauty is associated with confidence, social acceptance, and power and has blended with wellbeing and health.

Is Botox Worth It?

The question of addressing ageing by reducing its symptoms may not be sufficient to delay or disguise the ageing process and in the case of Botox, it may actually accelerate it.

Does skin with no wrinkles make a face more youthful? Is a limited facial expression attractive? Is treating wrinkles addressing the ageing process of the skin itself? All these questions need to be answered in respect to what we conceive as beautiful and substantially effective for alleviating the signs of ageing.

The fact that healthy skin is beautiful skin needs to become a primary focus on this pursuit for prolonged youth, bringing into account the skin’s and body’s own regenerative potential and abilities.