Botox (international trade name - Botox) is a drug based on botulinum toxin, the serovar (serotype) of the pathogen is type A. According to its pharmacological properties, it is a muscle relaxant that selectively affects neuromuscular connections and inhibits extrafusal muscle fibers. The drug is used in medicine for the treatment of pathologies accompanied by muscle hypertonicity and associated changes in the skin and subcutaneous fat (spastic changes in the skeleton and nerves of the neck, clonic hemifacial spasm, paralytic heterotropia, etc.).
A pronounced decrease in the functional activity of the muscle spindle after intramuscular injection of botulinum toxin allows the use of Botox and its analogues in cosmetology to combat facial wrinkles, treat excessive sweating, and correct nasolabial sweetness. Some clinics offer patients a Botox lifting service, which allows them to increase skin elasticity, correct age-related manifestations of gravitational ptosis and make facial contours clearer and more expressive.
The essence of the procedure
In modern cosmetology, the term “Botox” is used to refer to any drug where the active ingredient is group A botulinum toxin.
The concept acquired a common meaning due to the great popularity of the original product, which has been produced since 1988 by the Irish-American concern Allergan Inc.
Botox was the only one for a long time; now many analogue products have been developed for botulinum therapy.
In its pure form, botulinum toxin is a powerful neurotropic poison, poisoning with which poses a mortal danger - disruption of the diaphragm and heart muscle.
The medical toxin uses a minimal dosage in combination with additional components, so there is no threat to life and health.
Areas of use
Botox Cosmetic has been developed for the face, neck and body, which is a complex of group A botulinum toxin and associated proteins.
Most often, the upper part, as well as the lower third of the face, is pierced. Let's consider the main zones, as well as the required amount of substance.
- horizontal wrinkles - 10-25 units;
- interbrow area - 15-20 units;
- bridge of the nose - 3-10 units;
- areas around the eyes - 10-20 units;
- radial wrinkles on the upper lip - 2-5 units;
- raising the corners of the mouth - 5-10 units.
Buyanov Sergey Yurievich (Expert Doctor):
The number of conventional pharmacological units is indicated only for the classic drug “Botox”. When injecting analogues, dosage fluctuations are possible.
Efficiency
Botox injections are carried out using injections. The injection occurs into the target muscles. The molecule can only attach to the surface of the nerve, finds and penetrates neurons, affecting a specific protein. By breaking the chain of signals, the substance immobilizes muscle fibers. The loss of the ability to contract leads to the gradual smoothing out of wrinkles that arise due to constant muscle work.
The procedure completely changes the face: it tightens the contour, lifts the forehead, corrects the location of the eyebrows and their shape, dynamic wrinkles and pronounced folds disappear.
Young skin (from 30 to 40 years old) is smoothed due to the elasticity of the skin, so no additional procedures are required.
In adulthood, Botox is not enough to remove wrinkles. An integrated approach is needed - first the toxin is injected, and then other rejuvenating techniques are carried out. Biorevitalization works well, but sometimes various peelings are enough.
The first result is visible after 3-5 days, the maximum effect is achieved after a couple of weeks and lasts up to six months.
Gummy smile
This cosmetic defect is characterized by excessive exposure of the gum line when smiling. A gummy smile is most often found in people with a small distance between the base of the nose and the Cupid's bow, as well as in those with a prominent nose and an underdeveloped chin. Often in these same people one can observe pronounced nasolabial folds. The effect of a gummy smile is the result of the work of the muscles that lift the upper lip and the complex of the upper lip and muscles of the wing of the nose.
In addition, patients with gummy smiles often have an inverted upper lip, making them poor candidates for lip augmentation with fillers. The ideal option for them is a combination of filler injections and botulinum therapy. To match ideal facial proportions, the upper lip should cover the upper third of the central incisors. It is to achieve this effect that botulinum therapy for a gummy smile is aimed.
Injections are made symmetrically on both sides of the nose with the patient's smile as intense as possible. The BTA drug is administered intramuscularly above the periosteum. The first point of BTA injection is the body of the muscle that lifts the upper lip and the wing of the nose at the border of the junction of the nose and cheeks. The second point is approximately 2 cm closer to the bony edge of the orbit, in the muscle that lifts the upper lip (Figure 11)
.
BTA should not be injected too close to the zygomatic eminence to prevent penetration of the toxin into the zygomatic major muscle. The initial recommended dose for each side of the face is 2 units. Botox® or 5 units. Dysport®. After 15 days, the result is assessed and, if necessary, additional injections are given.
Figure 11. BTA insertion points for correction of a gummy smile
Complications: The most common complications are asymmetry and drooping of the upper lip. Asymmetry is eliminated using 25% of the initial dose of BTA with assessment of the result after a week. A drooping mid-upper lip may be the result of too much toxin exposure and overactivity of the zygomaticus major muscle.
Commentary by a cosmetologist, dermatovenerologist, doctor of medical sciences, professor, head. Department of Dermatovenerology and Cosmetology of the State Budgetary Educational Institution of Higher Professional Education "GGMU of the Ministry of Health of Russia" Yutskovskaya Y.A.:
— The goal of correcting a gingival smile is to reduce the contraction of overactive muscles responsible for exposing the gums, and, accordingly, reduce the “breadth” of the smile. Weakening of the muscles leads to a harmonized and aesthetically attractive smile. The injection pattern and technique depends on the presence of deep nasolabial folds. To assess the condition, the patient should be asked to smile as widely as possible. Exposure of the gums without the formation of deep nasolabial folds: a fairly deep injection into the center of maximum activity in the caudal zone of the m.levator labii superioris. If the exposure of the gums is associated with a deepening of the nasolabial fold, the injection is made in the area of the labial part of the m.levator labii superioris alaque nasi into the bulge in the upper section of the nasolabial fold. In this place the muscle is located literally on the surface; the injection depth should not exceed 3 mm. Dose of the drug: 2 units. drug Dysport.
Indications for use
- Horizontal folds on the forehead.
- Wrinkles between the eyebrows and the glabella.
- Crow's feet around the eyes.
- Drooping corners of lips.
- Pronounced creases in the area of the nasolabial triangle.
- Dermatochalasis (skin above the eyelid).
- Hemifacial spasm.
- Blepharospasm.
- Asymmetry of facial features.
- Hypertrophy of the masticatory muscle, when the lower jaw is very massive.
- “Gummy smile” (the upper gum is exposed).
- Violation of lip symmetry caused by paresis.
With the help of Botox, you can correct the shape of the nose and oval of the face, correct errors in the position of the lips, expressed in the constant elevation of both parts.
It is recommended to inject the drug after surgery to avoid the formation of scars at the incision site. Also, the toxin is used to treat neuritis of the facial nerve and tics that cannot be eliminated by medications.
Botulinum therapy is powerless when the defects are not related to muscle activity, so it is impossible:
- narrow the nose;
- remove bags under the eyes"
- get rid of pigmentation;
- get the effect of fullness of the skin (hide dents, pits).
Advantages and disadvantages
| Advantages | Flaws |
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Buyanov Sergey Yurievich (Expert Doctor):
It is important to get botulinum toxin injections only from an experienced specialist, since an insufficient dose does not lead to the desired effect. In this regard, it is necessary to re-administer the drug, which leads to the formation of antibodies to the drug. As a result, the effectiveness of injections is reduced.
Dimple on the chin
A dimple on the chin is formed as a result of contraction of the mentalis muscle. The BTA drug is injected into one or two symmetrical points located approximately 1 cm from the line dividing the face in half directly above the protrusion of the chin. It is not allowed to insert BTA closer than 1 cm from the lower lip. Since the mentalis muscle is located deeper than the others, intramuscular injection is recommended to the periosteum, below the dimple. This will prevent the toxin from spreading into the orbicularis oris muscle. Some authors argue that, despite the deep location of the mentalis muscle, good results can be achieved with superficial injections (Figure 15)
. The recommended total dose is 2.5-8 units. Botox® or 2.5-20 units. Dysport®.
Figure 15. BTA insertion points for correction of dimpled chin
Complications: As long as the restrictions on BTA insertion near the lower lip are observed, this procedure does not entail any complications other than bruising and hematomas.
What drugs are used
Botox
Manufacturer: Allergan (USA). Release form: glass bottle 100 units. Validity period: 6 months.
Ingredients: botulinum toxin type A, human serum albumin, sodium chloride.
A first generation drug that is considered a “golden classic”. It has the largest molecules (900 kDa), so the possibility of spreading into neighboring tissues is lower than that of its analogues.
Dysport
Manufacturer: Ipsen (France). Release form: glass bottle 300/500 units. Validity period: 5 months.
Ingredients: botulinum toxin type A, serum albumin, lactose.
It has been produced since 2002 and ranks second in popularity after the original drug. The molecular size is from 500-800 kDa. It has less impact, so you need 2.5 times more substance than Botox.
Xeomin
Manufacturer: Merz Aesthetics (Germany). Release form: bottle 50/100 units. Validity period: 4-5 months.
Ingredients: botulinum toxin without impurities of proteins of bacterial origin, albumin, sucrose.
It has a small molecular weight of 150 kDa, so it can be injected into small muscles. It is most often used in the upper part of the face to eliminate transverse and longitudinal folds on the forehead.
Rayfanex
Manufacturer: KC Pharmaceuticals Factory/MedicalReseachInstitute (Japan). Release form: glass bottle 50/100 units. Validity period: 7-8 months.
Ingredients: botulinum toxin type A, albumin protein, dextran, mannitol.
Japanese Botox has an improved formula and a low risk of negative consequences. Due to the minimal spread of the drug in the injection area, there is no chance of temporary muscle sagging.
Botulax
Manufacturer: Hugel Inc (South Korea). Release form: glass bottle 50/100 units. Validity period: 4-6 months.
Ingredients: neurotoxin type A, proteins, sodium salt of hydrochloric acid.
Korean relaxant with peripheral effects, stabilized by auxiliary components. In Russia, the product was registered in 2020. The official distributor is Martinex.
Myasthenia gravis
Myasthenia gravis (muscle weakness) at certain stages may be a clear contraindication to botulinum therapy due to the risk of developing severe muscle paralysis. With myasthenia gravis, neuromuscular conduction is initially impaired, which is why the muscles themselves are weakened. If this condition is also strengthened by Botox, then complete paralysis is possible with serious complications - ptosis, drooping cheeks, the “waxy face” effect and other unpleasant consequences.
At the same time, upon completion of treatment for myasthenia gravis or in stable remission, the cosmetologist may decide to inject Botox in small quantities into the most problematic areas. In any case, he must know that the patient has myasthenia gravis.
Rules
Rejuvenation will be safe and effective if you prepare in advance. A week before the procedure, you should give up alcohol, stick to a simple diet and stop taking medications. Before administration, the doctor must conduct a diagnosis and make sure there are no contraindications.
The most difficult stage is marking. To do this, the specifics of the patient's facial expressions are studied. Having identified the points and calculated the dosage, the specialist dilutes the drug with a 0.9% sodium chloride solution and begins injections.
Sequence of procedure:
- Cleansing and disinfection of skin.
- Treatment of the face with an anesthetic.
- Injection of toxin. The injections are made to a depth of 2-3 millimeters, the muscle is first compressed with the fingers. After removing the needle, the area is slightly rubbed.
- Wiping the face with a damp swab.
The manipulation lasts up to half an hour and can be accompanied by 20-25 injections, which account for 200 units of the drug. However, most often a session consists of 10 injections, when up to 80 units are administered.
After the procedure, the specialist records the name of the toxin, the schedule of administration, its quantity and gives recommendations regarding further care.
Course duration
Botox works while the innervation of the nerve endings is restored. The process starts when it enters the cell, but the substance is suppressed after 3-4 months. The effect fades away gradually over several more months.
There are opinions about addiction to Botox. These are not myths, since with constant injections in small doses, insensitivity appears due to the production of antibodies to the toxin.
Some cosmetologists use a minimal amount of the drug during the first injection, and then add it later.
It is important that the interval between injections is at least six months, even with small volumes. The next procedure is prescribed only after the muscle has been restored.
Combined techniques
BTA preparations are used both separately and in conjunction with other agents, during one or more sequential procedures aimed at treating different layers of the skin and its imperfections. Over the past few years, the principles of facial rejuvenation have undergone significant changes and have moved from a two-dimensional approach to correcting hypodynamic wrinkles to a three-dimensional approach, which also includes the aspect of tissue volume lost with age. This has led to some changes in the clinical use of BTA drugs. Now doctors are trying to correct not one, but several areas at once in order to achieve the most natural result. In addition, BTA preparations are increasingly used in conjunction with other products, including dermal fillers. The combined use of BTA and fillers corresponds to the concept of a three-dimensional approach to rejuvenation and provides more aesthetically attractive and long-lasting results. When administered together with a filler, BTA slows down metabolic processes in the surrounding tissues and thereby prolongs the period of action of the filler.
BTA also enhances the effect of laser rejuvenation, since collagen production in immobilized tissues occurs faster. For example, excellent aesthetic results can be achieved using laser lip rejuvenation with preliminary (1-2 weeks before) administration of BTA. Regular (with an interval of 4-6 weeks) BTA injections after anti-aging procedures prolong their effect.
In addition, BTA preparations are successfully used in conjunction with chemical peels, especially in patients with signs of photoaging.
BTA injections can also be combined with various plastic surgeries, for example, eyebrow lifting, blepharoplasty of the lower and upper eyelids and rhytidectomy.
Aftercare
Botulinum therapy is not accompanied by long-term rehabilitation. After injections, you do not need to change your lifestyle, just follow some rules.
To ensure uniform distribution of the substance during the first hours, you cannot:
- tilt;
- take a horizontal position;
- massage and touch your face with your hands;
- wash with hot water.
Further, the following restrictions must be observed:
- avoid exposure to the sun;
- avoid sudden changes in temperature;
- do not massage;
- do not injure the skin with aggressive means and procedures;
- do not drink alcohol;
- do not exercise;
- do not take medications (containing prostaglandin, low molecular weight dextran, and calcium channel blockers);
- sleep on a high pillow.
How long does Botox last and how to prolong its effect?
Manufacturers guarantee that the results will be maintained for 6-8 months if the patient is in absolute health and has a moderate metabolism. The effect of the active component can be extended under two conditions - the professionalism of the doctor and compliance with all recommendations after injection therapy:
- exclusion of alcohol - under the influence of ethyl alcohol, blood flow to the face increases, the effect of Botox is reduced;
- ban on visiting bathhouses, saunas, steam rooms, hot tubs;
- protection of the face from direct sunlight;
- limiting physical activity.
Some medications, cosmetic procedures (masks, hardware techniques, physiotherapy), and smoking can reduce the effect of botulinum toxin.
Note! Patients are not recommended to sleep on their face, or to rub their face too intensely while applying care products, washing their face, or removing makeup. In the first week, it is not advisable to use decorative cosmetics.
Precautionary measures
Side effects:
- hematomas, compactions, itching;
- headache;
- flu-like syndrome;
- ptosis;
- facial expression disorder;
- facial asymmetry;
- spasms of the eyelids;
- loss of sensation at injection sites;
- rash, pimples with purulent contents;
- swallowing disorder;
- difficulty blinking;
- blepharoptosis.
If negative consequences occur or the result is unsatisfactory, compensatory injections are performed.
If the result is not satisfactory, then the toxin can be removed. For this purpose, medication and physiotherapeutic treatment are used. In particular, microcurrent therapy. Myostimulation activates blood circulation and restores the functionality of facial expressions. A direct antidote is the substance dimethylethanolamine, which tones the muscles.
Contraindications:
- pregnancy, lactation;
- acute form of ARVI;
- exacerbation of chronic diseases;
- oncology;
- epilepsy;
- hernias on the upper and lower eyelids;
- gravitational ptosis;
- myasthenic syndromes;
- neuromuscular disorders;
- autoimmune diseases;
- epilepsy;
- damaged skin on the face.
Oncology
This contraindication to the use of Botox is also relative, and the doctor makes the decision to perform injections after examining the patient and studying his medical history. In this case, much depends on the stage of the cancer, the location of the tumor and the therapy performed.
So, during chemotherapy, severe disease and taking powerful medications, Botox cannot be injected. At the same time, for a disease at an early stage, for the treatment of which surgery is being prepared, or conservative treatment is being carried out (for example, for skin cancer not on the face), botulinum therapy may be acceptable.
Here it is important to soberly assess the need for cosmetic procedures themselves in case of developed oncology. If we are talking, for example, about a pathology at an early stage that is easily treatable or surgically removed, then botulinum therapy may be acceptable. In case of severe diseases, for which the outcome of treatment is unknown, and the pathology itself significantly affects the patient’s condition, the additional burden on the body during botulinum therapy may be completely inappropriate.
Alternative to Botox
Patients who are immune to the action of botulinum toxin type A can use the American drug Myoblok, which is based on type B toxin.
The product is produced in California by Solstice Neurosciences and differs from its analogues in its potency and safety. One unit is 100 times weaker than a unit of Botox. The effect lasts from 3 to 4 months.
To replace injections, Thai liquid Botox is used. YaYa's Alternative Botox Serum spray contains predominantly natural ingredients .
The product fights external signs of aging and does not affect facial expressions. After use, muscle relaxation and smoothing of small facial wrinkles are noted.
Children under 2 years old
Here we are talking not about cosmetic, but about the therapeutic use of botulinum toxins: they are often used in the complex treatment of cerebral palsy, strabismus, cervical dystonia and other neurological diseases in children.
Botulinum toxin for the treatment of strabismus in children under 2 years of age is prohibited for use.
Previously, the age limit for such procedures was set at 12 years. It was believed that injecting a child with a neurotoxin at an earlier age was dangerous. However, after numerous studies, the permitted age was lowered to 2 years. However, the decision to use the drug in a child is made only by a doctor, assessing the condition and possible risks.
On a note
It is clear that in cosmetology Botox is not used in children at all - this is not necessary, since even in adolescents, wrinkles do not yet develop due to very elastic skin and the absence of prolonged reflex contractions of the facial muscles. The need for injections to eliminate wrinkles usually arises no earlier than the age of 25, when there are no longer age restrictions on these procedures. Simply put, when Botox is really needed to eliminate wrinkles, you can already inject it.
A relative contraindication to botulinum toxin injections is also age over 60 years : the result of injections in older people is less predictable and there is a risk of developing facial asymmetry. Moreover, for such patients, the possibility of using botulinum toxin is assessed by a doctor individually based on the severity of wrinkles, the characteristics of the facial muscles and other parameters.
Cost of the procedure
The cost of botulinum therapy depends on the type of drug and the area being treated. You can buy drugs in specialized online stores and pharmacies.
Attention! Prices in salons are per unit of administered substance.
Moscow
| Name of the clinic/salon | Address | Price | Telephone |
| Center for cosmetology and hair removal "Doctor Laser" | Michurinsky Ave., 25, bldg. 2 | 320 | +7 |
| Beauty salon "Else style" | st. Generala Glagolev, 26, p.4 | 450 | +7 |
| Beauty salon "Mont Plaisir" | st. Sergeya Makeeva, 1 | 430 | +7 |
Krasnoyarsk
| Name of the clinic/salon | Address | Price | Telephone |
| Clinic "Face & Body" | st. Alekseeva, 8 | 350 | +7 |
| Laser cosmetology center "O.K." | st. Alekseeva, 111 | 400 | +7 |
| Medical and cosmetology | st. Vzletnaya, 26g | 360 | +7 |
Novosibirsk
Botox
| Name of the clinic/salon | Address | Price | Telephone |
| Beauty salon "Marlene" | st. Pisareva, 53 | 300 | +7 |
| Medical | st. Dusi Kovalchuk, 270/3 | 350 | +7 |
| Clinic of medical cosmetology "Art-Medica" | st. Zheleznodorozhnaya, 22 | 300 | +7 |
Orenburg
Dysport
| Name of the clinic/salon | Address | Price | Telephone |
| Clinic "Maximed" | st. Avtoremontnaya, 1, building 4 | 130 | +7 |
| Medical | st. Eastern, 42/2 | 120 | +7 |
| Cosmetology “Universe of Harmony and Beauty” | st. Ostrovsky, 45 | 120 | +7 |
Belgorod
Xeomin
| Name of the clinic/salon | Address | Price | Telephone |
| Cosmetology clinic "East-West" | st. Pushkina, 67 | 460 | +7 |
| Family Medicine Center "Life-Giving Spring" | st. Vokzalnaya, 26a, building 1 | 350 | +7 |
| Unite Clinic | 330 | +7 |
Irkutsk
Dysport
| Name of the clinic/salon | Address | Price | Telephone |
| "Center for Innovative Medicine" | st. Timiryazeva, 16 | 140 | +7 |
| Center for Medical Cosmetology "Ashi" | st. Deputatskaya, 25 | 110 | +7 |
| Center for Aesthetic Medicine "Satel" | st. December Events, 100 | 160 | +7 |
Bryansk
Botox
| Name of the clinic/salon | Address | Price | Telephone |
| Center for Aesthetic Cosmetology "Larus" | Boulevard 50 Let Oktyabrya, 3 | 280 | +7 |
| Cosmetology "Ethel" | st. Romashina, 32 | 280 | +7 |
| Medical | st. Krakhmaleva, 47 | 320 | +7 |
Samara
Botox
| Name of the clinic/salon | Address | Price | Telephone |
| "Postnikov Clinic" | st. 6th clearing, 165 | 300 | +7 |
| Medical Clinic "Daliz" | st. Alexey Tolstoy, 78 | 330 | +7 |
| Clinic "Doctor Bormental" | st. Sadovaya, 335 | 250 | +7 |
Ufa
Dysport
| Name of the clinic/salon | Address | Price | Telephone |
| Surgery Clinic "Uhelp" | st. Academician Uraksina, 3 | 150 | +7 |
| Medical | st. Salavata, 13 | 100 | +7 |
| Clinic "Be Healthy" | Oktyabrya Ave., 6/1 | 100 | +7 |
Ekaterinburg
Xeomin
| Name of the clinic/salon | Address | Price | Telephone |
| Medical | st. Tveritina, 16 | 320 | +7 |
| Clinic "Magnolia" | st. Bolshakova, 61 | 300 | +7 |
| "Family Clinic" | st. Klyuchevskaya, 15 | 300 | +7 |
Volgograd
Dysport
| Name of the clinic/salon | Address | Price | Telephone |
| Medical | st. Pugachevskaya, 7b | 110 | +7 |
| Clinic "Olympus" | st. Rokossovsky, 62 | 110 | +7 |
| Clinic "Movement" | st. Rionskaya, 2 | 150 | +7 |
Tambov
Botox
| Name of the clinic/salon | Address | Price | Telephone |
| Center for diagnostics and treatment "Tambovmedservice" | st. Kronstadtskaya, 14b | 350 | +7 |
| Clinic "Doctor Profi" | st. Sovetskaya, 181 | 250 | +7 |
| Beauty Clinic | st. Svobodnaya, 12a | 300 | +7 |
Arkhangelsk
Botox
| Name of the clinic/salon | Address | Price | Telephone |
| Clinic "Persona" | st. Vyucheyskogo, 25 | 260 | +7 |
| Medical Clinic "Academy of Health" | Dzerzhinsky Ave., 7, bldg. 4 | 340 | +7 |
| Clinic "Aesculapius" | st. Loginova, 21, bldg. 1 | 400 | +7 |
