CEBU, Philippines - Throughout history, mankind has always looked for ways and means to improve his or her appearance by making the face look younger, more vibrant with less crease and wrinkle lines. People have always searched for the ideal facial creams or the ideal surgical procedure to preserve the youthful look. The fountain of youth may not be discovered during our lifetime but new medical advances surely bring us closer to this goal. One of these innovations is the use of botulinum toxin to efface or remove wrinkles lines. Muscular action causes or worsens some lines on the face. Good examples of these are the glabellar and the forehead lines. The glabellar lines are the vertical lines found between the eyebrows which appear when we frown. The horizontal forehead lines are the wrinkles we see when we raise our eyebrows. There are other several wrinkle lines that patients usually worry about like the laugh lines found at the lateral side of the eyes, they should be there only when we laugh. Until recently, treatment for these lines was difficult and usually involved extensive surgery. With the introduction of the clinical formulation of Botulinum toxin, it has become possible to paralyze temporarily selected muscles of facial expression.
What is Botox?
Botulinum toxin is a neurotoxin produced by Clostridium botulinum, an anaerobic bacteria found in improperly preserved food. A neurotoxin is a substance that is a poison to the nerve and muscle. In this case botox produces paralysis of the involved muscle by preventing it to contract. Initially there were two commercial formulations of botulinum toxin. Botox (Allergan Inc., Irvine California, distributed here by Zuellig Pharma) and Dysport (Speyhood Pharmaceuticals, Maidenhead, UK) which is the one available in Europe. Botox comes in a vial that has to be mixed with distilled water for activation. The big problem of botox is its very short shelf life. Once the drug is activated it has to be used within 4 hours for maximum effect. This is the reason why most doctors have a ‘botox day’. They perform the treatment only on certain days of the week so as to accumulate enough patients for a single vial so that no amount of the expensive drug is wasted. Today there are several good brands of botulinum toxin from other countries like China and we have tested them to be safe and as effective. A big advantage is they cost only a third of the cost of the pioneering brands. Cost reduction makes the repetitive procedure very affordable.
How is the treatment done?
The treatment is an office procedure, which may take from 10 to 15 minutes. This consists of asking the patient to sit down comfortably and make faces like frown or do a force smile. This identifies the wrinkles to efface and also identify the location of the muscle to inject. After applying cold with ice to numb the area, small amount of botox is injected into the involved muscle. Anywhere from 3 to 12 injections are done depending on what the patient needs. They are then advised to contract the muscle involve, to stay upright and to avoid rubbing or massaging the area so the toxin does not spread.
How soon can we observe the results?
Results begin to show after 24 hours but the effect may not be complete until after 2 weeks.
How long does the effect last?
The clinical effects of Botox usually wear off after 3 to 6 months. In general, doctors will inform the patients that the effect will persist for 4 months and will often persist up to 6 months. The observation of many is that the interval between injections increases as the patient had more injections. Most patients require only one injection in a year.
What are the complications?
Most of the complications are minor and since the effect of the toxin is temporary, all complications are also temporary.
There is usually slight swelling over the injected site but this disappears after a few minutes.
The injected area may form an ecchymosis or bruising but again this will resolve in a few days.
The other complication is ptosis or drooping of the eyebrow. This is a result of injecting the toxin into the wrong muscle, but again this is temporary and the ptosis will heal by itself.
How much does it cost?
The cost of the toxin, if there are 5 patients to a vial comes out at about P6,000 to P7,000 per patient. In addition to this, the doctor will charge P5,000 to P8,000 more for the injection so the package would range from P12,000 to P30,000 per treatment. If botulinum from China is used, the cost would only be P8,000 per vial.
Botox treatment is fast becoming a widely accepted treatment worldwide. In the US it ranks second only to chemical peels among cosmetic procedures requested by patients. The fact that it is nonsurgical, simple and effective should convince a lot of patients to try it someday.