Signs of aging such as fine lines and wrinkles, and sagging skin are one of women’s greatest skin concerns. In Singapore and elsewhere in Asia and in the West, more and more people are turning to doctors for aesthetic solutions over and above skincare, to address those concerns. Injectables such as Botox is one of the most popular and accessible in-clinic procedures used to combat the signs of aging.
WHAT IS BOTOX?
Botox is the brand name of a neurotoxin produced by the bacterium Clostridium botulinum. This neurotoxin is known as botulinum toxin type A. There are currently three HSA-approved brands of botulinum toxin in Singapore: Botox by Allergan, Dysport by Ipsen and, Xeomin by Merz. The three approved labels are prescription drugs, for use only in a clinic and performed by a licensed and trained doctor.
The first and most well-known brand in the market is Botox. It got its first FDA approval for treating upper facial wrinkles in the 1990s and its aesthetic indications have expanded in the ensuing 20 over years.
HOW DOES BOTOX WORK?
Essentially, it is a protein produced by a unique strain of bacteria that blocks the release of chemical signals from the nerve to the muscle, thereby making the muscle unable to contract. This resultant relaxation is used to treat selected hyperactive or hypertrophic muscles on our face, and even other parts of the body.
By using Botox to relax specific muscles, we can make a person look:
WHAT CAN IT DO FOR YOU?
Beyond the aesthetic applications listed above, Botox can be used to treat many other different medical conditions including chronic migraines, eye squints, strabismus (crossed eyes), facial tics, bruxism, muscle spasticity in stroke patients. Research has also shown that Botox can affect sebaceous or oil glands.
Women with a square jaw might find their appearance too masculine and would much prefer a slimmer and more feminine jawline. Chewing on foods such as dried squid or teeth grinding can result in over developed muscles in the jaw area also known as masseter hypertrophy or ‘square jaw’.
Botox can be injected to block nerve impulse in the sweat glands to temporarily reduce sweat production in the treated area. Patients reported a substantial decrease in sweating within two days and even stopped perspiration following the treatment. Repeat treatment is usually recommended within five to seven months.
Frozen shoulder or adhesive capsulitis, is a disease of chronic inflammation and scarring of the ligaments of the shoulder joints. Patients experience significant pain and reduction in the movement of the shoulder. Depending on the cause of frozen shoulder, Botulinum toxin (BTX) may be used for pain management and it is also found to retard the process of fibrosis.
Bruxism is the medical term for subconscious teeth clenching and grinding, whether awake or asleep. It can lead to painful and severe dental problems such as loss of tooth enamel, increased tooth sensitivity, flattening, chipping or cracking of the teeth, sore jaw, earaches, and migraines. Bruxism can also lead to hypertrophy of the masseter muscle or severe square jaw. Treatments with Botox can help to soften the appearance of the jaw line and provide tremendous relief to these painful and unpleasant problems associated with Bruxism.
Post stroke patients often have increased muscle tone in their limbs. Worsening of this problem may cause contractures and loss of function. Botox relaxes the spastic muscle and also preserves the function and range of movement of the affected joints. Research shows that repeated treatments of botulinum toxin over one year after a stroke can improve muscle tone and reduce pain in the arms and hands, making it easier for patients to perform personal hygiene and simple tasks such as dressing oneself.
Botox is injected to specific muscles at the sides of the face and the neck to reduce muscle tension around the head. This treatment option may be offered by the neurologist when medical treatment fails.
Facial tic/involuntary spasm:
Botox can be used to relax certain facial muscles that contract involuntarily, making it socially embarrassing for these patients.
In general, the most often requested areas for Botox injections in aesthetic clinics would be for ‘frown lines’, forehead lines and ‘crows’ feet’ (lateral canthal lines). Other popular Botox treatments include jaw muscle reduction.
PROCEDURE AND TREATMENT
Botox comes in a powder vial and is reconstituted with saline prior to injection into the targeted muscle(s). Botox is administered through many tiny injections, using the finest needles. It feels like little ant-bites and most if not all patients tolerate the procedure.
The procedure takes only a few minutes to perform but may take up to three days to take effect - ‘frown lines’, forehead lines and ‘crows’ feet’. But in very rare circumstances, it may take as long as three to seven days or even as long as two weeks to take full effect - jaw muscle reduction.
A review is usually done 2 weeks after the first injection and adjustments are made if required. The muscle-relaxing effect of Botox lasts between four to six months. As Botox is not a one-time fix and the effects wear off with time, repeated treatments two to three times a year are recommended.
RISKS AND SIDE EFFECTS
Botulinum toxin injections are generally well tolerated with very few known side effects.
Common side effects like bruising, erythema (reddening of the skin) and slight pain and swelling at the injection site may be experienced but are transient. Headaches can also occur but this is rare and it usually goes away in 24 to 48 hours. Depending on where the Botox is injected, eyebrow or eyelid drooping, drooping of the corner of the mouth, or inability to use a straw may be experienced. Patients are usually advised to refrain from rubbing the treated area and avoid lying down for three to four hours after injection.
Rarer side effects include local edema, mild nausea, numbness, temporary weakness or paralysis of nearby muscles, weakness of the lower eyelid or lateral rectus (a muscle controlling eye movement), dysphagia (trouble swallowing), diplopia (double vision), dry mouth, rashes or hives and wheezing.
Our doctors are qualified and well trained to recommend and administer the treatment after a comprehensive medical assessment.
Patients taking aspirin or oral anticoagulants for their heart problems or stroke are allowed to do their Botox treatment without stopping their medication. Extra care is taken to do longer compressions and icing the areas to prevent bruising.
Follow the post-injection instructions carefully and report any persistent side effects (if any) as soon as possible.
WHO IS NOT SUITABLE FOR BOTOX?