Botox Applications, Botulinum Toxin Type - A Applications

Botox Applications, Botulinum Toxin Type - A Applications

BoNT-A is successfully used by plastic surgeons not only in the treatment of skin wrinkles, but also in the treatment of spasm in muscle diseases, in the treatment of migraine, and in the problem of excessive sweating in the armpits, palms, and soles of the feet.

Botulinum toxin type A (BoNT-A) creates a temporary loss of activity in the muscles that provide facial facial expressions and temporarily prevents these muscles that attach to the skin in that area from forming indentations, that is, wrinkles, on the skin. The effect period of BoNT-A is temporary and the effectiveness is observed for an average of 2-8 months, in some brands 4-8 months. The return of muscle activity may vary between applied areas. Botulinum toxin is one of the most potent poisons in the world, but only very diluted amounts are used. This poison is secreted by a bacterium called Clostridium botulinum. The first cases of poisoning in history were caused by homemade offal foods in the 1800s. Homemade sausages (Latin; botulus = sausage) were the main source of this. There are various BoNT-A derivatives available on the market. The most preferred ones are Botox /Vistabel, Dysport, Azzalure, Medexall, Lantox, Neuronox, EsteTox, Botoxin A, Prosigne, Refinex, Live Well BT. BoNT-A is successfully used by plastic surgeons not only in the treatment of skin wrinkles, but also in the treatment of spasm in muscle diseases, in the treatment of migraine, and in the problem of excessive sweating in the armpits, palms, and soles of the feet.

Various problems may be encountered in BoNT-A treatments. In patients where facial wrinkles are treated, drooping eyelids or eyebrows, asymmetry in facial lines, insufficient improvement in wrinkles, tear trough deformity in the upper inner part of the cheek due to muscle thinning due to decreased muscle activity, weakness in the corner of the mouth, and lower eyelids in overdone cases. Sagging of the lid may occur, and very rarely, allergic reactions ranging from simple to shock may occur.

Frequently asked Questions

How should I behave in my daily life after botulinum toxin application?

After BoNT-A applications, you can continue your daily life as before. Concealers such as foundation can be used for rarely visible bruises. The benefits of arnica montana extract applications for rapid resolution of bruises are controversial. Although there are publications (1) showing that botulinum toxin reduces the deterioration in blood supply to the skin due to smoking, scientific articles on the interaction of BoNT_A with smoking are limited in general practice.

Our female patients can easily apply make-up and use perfumery products. There is no defined problem regarding the applications to be made during the menstrual period. There is no harm in male patients shaving their beard on the morning of the application and using after-shave lotion or cologne.

Can I have botulinum toxin applied if there is a suspicion of pregnancy?

As stated by the manufacturers as a warning in the package insert, there are no sufficient clinical studies regarding the safety of BoNT-A during pregnancy. Although it does not show a significant increase in anomalies in experimental animal studies and in company-sponsored retrospective clinical studies (2), the frequency of applications during pregnancy causing abnormalities in babies was found to be similar to pregnant women without BoNT-A application (2.7%), most of the publications are on cases with the lowest level of scientific evidence. notifications are in the form of (3). To put it briefly, the drug is not recommended for use during pregnancy.

Can filling and botulinum toxin type-A or laser, skin scraping (dermabrasion) be performed at the same time?

Although it is possible to perform these applications together, it is not recommended to perform these applications together with filler injection in order to minimize possible problems. I recommend that my patients wait at least a week for it to pass. Especially for patients who are considering botulinum toxin (BoNT-A) application along with the filler, it would be logical to apply BoNT-A first and after a week, its effect has settled and the filler injection is planned according to the final state of the wrinkles on the skin. The damaging effect of lasers on the skin and subcutaneous tissue raises questions regarding the effectiveness and reliability of filler injection. Therefore, it will be safer to perform laser, chemical peel and mechanical scraping type applications days before filler injection.

After BoNT-A application, there was a metallic taste in my mouth. What should I do in this situation?

The production of BoNT-A may vary between companies. Although allergic reactions caused by preservatives used in production lines have been reported, metallic taste is very rarely observed. This table, like every rare side effect, must be reported to the manufacturer along with the barcode number of the administered drug. Therefore, report such side effects to your doctor.

Can I be injected from a bottle used by someone else?

If the physician thinks that the dose will be appropriate for two or more people applying at the same time, the drug can be administered to different syringes after dividing the drug. However, make sure that the medicine package has been newly opened. It is not recommended to use a previously used medicine with an unknown opening date on another patient. Especially during applications made by incompetent people, there is a possibility of contracting serious diseases such as infectious hepatitis and AIDS, as the tip used for injection to the patient is dipped back into the bottle. should also be taken into consideration. Therefore, do not have an injection without making sure that the BoNT-A to be administered to you and the syringes into which it will be drawn have been unpackaged in your presence. Since drug effects may vary when administered to a patient, the diluted drug can be stored and reapplied in case of additional doses. However, this is again an application that is not recommended by the manufacturers. Storage should be done at a constant temperature (this temperature may vary depending on the production technique of the manufacturer) and only in the packaging of the medicine. In patients who will be re-administered with an additional dose, do not have an injection without making sure that the openly packaged medicine to be used is labeled with your name.

Before the application, my face was swollen with redness and warmth. The doctor said it was an abscess. Can I still have BoNT-A injection?

Botulinum toxin should not be applied in the presence of an infection that causes general condition disorders in the body, especially infections in the areas where the application will be made. This applies to any infection (tooth root, lung, paranasal sinus, urinary tract, eye, etc.).

In addition, patients with herpes around the mouth (Herpes simplex) should not receive botulinum toxin injection until the physician confirms that their herpes has healed. The possibility of herpes spreading may increase (4).

resources

1. Karayel H, Kaya B, Caydere M, Terzioğlu A, Aslan G. Prevention of unfavourable effects of cigarette smoke on flap viability using botulinum toxin in random pattern flaps: An experimental study. Plast Surg (Oakv). 2015 Fall;23(3):177-82.
2. Brin MF, Kirby RS, Slavotinek A, Miller-Messana MA, Parker L, Yushmanova I, Yang H. Pregnancy outcomes following exposure to onabotulinumtoxinA. Pharmacoepidemiol Drug Saf. 2016 Feb;25(2):179-87.
3. Newman WJ, Davis TL, Padaliya BB, Covington CD, Gill CE, Abramovitch AI, Charles PD. Botulinum toxin type A therapy during pregnancy. Mov Disord. 2004 Nov;19(11):1384-5.
4. Gadient PM, Smith JH, Ryan SJ. Herpes zoster ophthalmicus following onabotulinumtoxinA administration for chronic migraine: a case report and literature review. Cephalalgia. 2015 Apr;35(5):443-8.