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The Ultimate Guide to Botox

Every question you’ve ever wanted to ask about botox*, answered by Dr Tim Beazleigh and our team of experts.

* Botox is a trade name of the botulinum toxin which it has become commonplace to use as a generic term for anti-wrinkle injections. In using the term “botox” generically this article does not intend to make an association with any specific manufacturer of the botulinum toxin.

About the botulinum toxin

What is botox?

The botulinum toxin (botox) is a neurotoxin which is produced by the bacterium Clostridium botulinum.

Who discovered botox?

The effects of botulism (poisoning caused by the botulinum toxin) were first fully described in 1820 by Justinus Kerner, a German doctor. Botulism most commonly occurs when you eat food containing the botulinum toxin or if the bacteria infect a wound.

Later that century, in 1895, Émile van Ermengem, a professor of bacteriology, successfully grew the Clostridium botulinum bacterium and identified it as the source of the toxin.

How was botox discovered?

The focus of attention which, lead to the discovery of botox, was botulism; poisoning which is mainly caused by consuming infected food. When Émile van Ermengem identified the bacterium, it was following a funeral where over thirty guests had succumbed to botulism after eating salted ham.

He extracted the bacterium from the ham and discovered that it caused botulism-like paralysis in laboratory animals.

What was botox originally used for?

It was originally used to treat two eye muscle disorders:

  • Strabismus, where the eyes do not align correctly when looking at an object. This can present with symptoms such as ‘crossed eyes’ or ‘lazy eyes’.
  • Blepharospasm, which causes the eyelid to contract or twitch abnormally.

The first human patients underwent treatment in 1977 and the treatment obtained FDA (the US Food and Drug Administration) approval in 1989.

Is botox a poison?

Yes. Botox is the botulinum toxin. A toxin is a poison which is produced by a living organism, in this case the Clostridium botulinum bacterium.

However, we use many poisons, such as botox, in our everyday lives. So long as they are given in the right way and in the right doses (and the medical/cosmetic doses of botox are minute), they shouldn’t cause harm.

Is botox safe?

Yes, when administered by an appropriately trained healthcare professional in a safe environment.

Is botox permanent?

No, the effects of your botox treatment will last between three and six months, at which point the botox will have naturally dispersed and the body will have removed it, as it would with any similar substance. Regular users of botox generally find that the effects last longer than new users.

Is botox reversible?

No, once you’ve had the treatment you will need to wait for the body to naturally remove the botox, at which point the effects of the botox will gradually cease.

Is botox vegetarian?

Botox is produced by bacteria, not animals. However, in botox treatments the pure botulinum toxin is mixed with other ingredients which can include the albumin protein, which may be derived from human or animal blood. The albumin helps to stabilise the botox and encourages it to bind more smoothly to the muscles.

Therefore, depending on your viewpoint, it may or may not be considered vegetarian.

Is botox vegan?

As described above, botox injections will include albumin proteins from animals or humans.

Is botox kosher?

Yes, strictly speaking botox is kosher because it is not consumed.

It should be noted that botox is mixed with other ingredients to improve the effectiveness of the treatment, which can include albumin protein, which may be derived from human or animal blood.

What colour is botox?

Botox is colourless.

Does botox smell?

No.

Are there different types of botox?

Yes, there are eight different “serotypes” (labelled A to H), which means that there are eight distinct variations of botox.

While structurally and functionally similar, they are all slightly different.

Serotypes A and B are the most common and the ones used for cosmetic and medical purposes.

What’s the difference between Botox and Dysport?

These are brand names for botox.

While all brands of botox are made from the same serotypes of botox (A and B) the varying formulations result in a unique combination of

  • how effective the botox is,
  • how long it lasts,
  • how safe it is and
  • how your body reacts to it.

There are three main types of botox used in the UK, with different brand names depending on the type and quantity of the toxin in each vial:

  • Type 1
    • Botox (100 unit vials)
    • Vistabel (50 unit vials)
  • Type 2
    • Dysport (500 unit vials)
    • Azzalure (125 unit vials)
  • Type 3
    • Xeomin (100 unit vials)
    • Bocature (50 unit vials)

Botox and wrinkles

How does botox stop wrinkles?

Botox temporarily relaxes muscles, which is believed to happen because it blocks the nerve signals which would otherwise cause the muscles to contract.

By reducing the activity of the muscles which would normally cause wrinkles, for example when you frown, botox stops the wrinkles forming.

Which wrinkles can botox treat?

Botox is effective on wrinkles which are caused by muscle activity. So, it tends to be used for the horizontal lines on your forehead, the vertical lines between your eyebrows (commonly called “11s”) and the horizontal lines at the outer corners of your eyes (known as “crow’s feet”).

More about botox anti-wrinkle treatments.

Will my forehead be ‘frozen’ if I have botox?

It’s completely up to you!

A botox treatment can fully eradicate movement in your forehead so no wrinkles will appear.

Alternatively, a subtler effect can be achieved which retains some movement in your forehead while minimising the wrinkles.

Speak to your practitioner about the outcome you’re looking for and they will be able to advise you.

Can I still smile after botox?

Yes, although if you have botox to reduce the appearance of crow’s feet (at the outer corners of the eyes) then this can reduce the movement around your eyes when you smile.

As with all botox treatments it’s up to you to decide to what extent you’d like the muscle activity to be reduced, so you can balance your desire to remove wrinkles with the facial movement you’d like to retain.

Can botox prevent you getting wrinkles?

Yes, having botox as a preventative treatment is becoming increasingly popular. Many facial wrinkles are caused by making the same expression over and over again, for example when you squint in bright sunlight.

Botox reduces the activity of the muscles which form these expressions, thereby reducing the number of skin lines and wrinkles which are formed.

What’s the difference between botox and fillers?

Botox and fillers work in very different ways. Botox reduces muscle activity to help minimise wrinkles. Fillers add volume and strength, for example to areas which have become a little sunken and weak with age. So they can both reduce lines and wrinkles but in different ways.

Patients often have a combination of botox and filler treatments, to achieve an overall rejuvenating effect.

What is brotox?

The term “brotox” was coined when botox treatments became popular for men. The actual treatments are exactly the same for men and women, although slightly higher doses may be required when treating men.

Which famous people have had botox?

There are plenty of famous people who love botox and its rejuvenating effects. Here are a few quotes from celebrity botox users:

“I have done botox, and I loved it.” – Olivia Colman

“I haven’t had any plastic surgery – despite what people think, this is my nose. I have had Restylane and botox, but I don’t think of that as plastic surgery any more.” – Tom Ford

“People say I look so happy – and I say, ‘That’s the botox’.” – Dolly Parton

“Botox not only helps with wrinkles, it actually makes you feel more relaxed as frowning causes tension.” – Patricia Cornwell

“I’ve had botox, but then again pretty much everyone I know has. To me, botox is no more unusual than toothpaste. It works. You do it once a year – who cares?” – Simon Cowell

“Thank God for botox.” – Bonnie Tyler

“My hope is that if I take good care of my skin and use botox, I won’t have to use anything else.” – Courtney Thorne-Smith

Other aesthetic uses of botox

Will botox help my hair grow back?

There is a claim that botox can stimulate hair growth by increasing blood circulation to the hair follicle. However, there’s currently no solid evidence that this treatment works.

What is a botox lip flip?

A botox lip flip is a procedure where botox is used to enhance the upper lip, often in conjunction with lip fillers. The botox is injected into sections of the lip muscle to help create a ‘poutier’ look. The trick is to do this without affecting the patient’s ability to use their mouth!

Specifically, the botox is injected into the orbicularis oris muscle (also known as the ‘kissing’ muscle) to relax its control over the top lip. By lessening the activity of this muscle, the top lip protrudes slightly more, giving it a fuller look (although it’s just the position that’s changed). This process is known as ‘flipping’ the lip outwards, hence the name ‘lip flip’.

Can botox treat acne?

Botox can be used to reduce sebaceous oils in the skin (it’s believed to block the chemical acetycholine from triggering sebum production), which is one cause of acne.

This only tends to be used in extreme cases where other treatments have been unsuccessful.

Does the botox brow lift work?

Yes, patients can achieve a lift of up to 1mm. However, the efficacy depends on how heavy the brows were to begin with.

In the treatment, botox is injected into the muscles underlying the eyebrows to relax them. This allows the forehead muscles to pull up slightly more, providing a lifting effect.

Can botox stop my neck sagging?

Botox can be used to reduce the activity of the platysma bands in the neck. These bands are the neck muscles which extend vertically from your collarbone to your jaw. If they become too tight then they can protrude and have an aging effect on your neck. Botox injections relax the muscles and give you a more natural neckline.

Skin sagging, however, is caused by loss of elasticity (generally due to age and sun damage) which should be treated with alternative options, such as dermal fillers or CACI.

What botox can’t help with

Why can’t botox help with all my wrinkles?

Botox can only be used to treat lines and wrinkles which are caused by muscle activity, so generally this means wrinkles formed by repeated facial expressions.

Fine lines and wrinkles found elsewhere can’t be treated with botox.

Can botox stop dark circles under my eyes?

No, the dark circles under your eyes aren’t caused by muscle activity, so botox can’t help with these. Dark circles are caused by hyperpigmentation, sun damage, visible veins and/or your genetics.

Can botox stop my skin sagging?

No, sagging skin is the result of damage to elastin and loss of collagen, which is a natural part of the aging process. Sun exposure can accelerate the problems. Botox doesn’t stimulate the growth of collagen or repair of elastin. However, there are plenty of treatments which will help with sagging skin including dermal fillers and CACI.

Medical uses of botox

Can botox help with migraines?

Yes, botox can help to reduce the frequency and severity of migraine headaches for around 70% of sufferers. It is thought that botox blocks the nerve signals which trigger the migraine pain.

The treatment involves the careful injection of botox into various sites around your head and neck. Patients generally find that two or three treatments are needed to get noticeable results.

Find out more about botox for migraines.

Can botox reduce an enlarged masseter jaw muscle?

An enlarged masseter jaw muscle can cause your jawline to become unnaturally square, which can be problematic for women as it can result in quite a masculine appearance. The enlargement is often caused by Bruxism (teeth grinding) or a temporomandibular disorder (TMD).

Botox injections lessen the activity of the masseter jaw muscle, so its size subsides, and the patient returns to a more natural, oval-shaped jawline.

More about botox for enlarged masseter jaw muscles.

Can botox help with Bell’s Palsy?

Yes, botox can help to reduce the synkinesis (facial twitches) which are often associated with Bell’s Palsy. By temporarily reducing the muscle activity, botox injections can be targeted to stop specific twitches from occurring.

Please note that botox won’t reduce any ‘drooping’ of the face caused by Bell’s Palsy.

Can botox be used to treat Raynaud’s?

Yes, botox is increasingly being used to treat the symptoms of Raynaud’s. Botox is carefully injected into the muscles which control the blood vessels in the affected part of the body (often the hands).

By relaxing these muscles it prevents the blood vessels contracting, which would otherwise cut off the blood supply and cause the Raynaud’s symptoms.

Can botox reduce hyperhidrosis (excessive sweating)?

Yes, this is very popular use of botox.

Botox is used to stop the nerve signals reaching the sweat glands and, as a result, can have a significant effect in reducing the levels of sweat produced.

More about botox for hyperhidrosis.

Can botox stop me blushing?

Yes, botox can be used to reduce the activity of the muscles around the blood vessels responsible for blushing. As a result, the blood vessels don’t dilate so readily and blushing is lessened.

Can botox stop crossed eyes?

Yes, in fact this is one of the earliest medical uses of botox. Crossed eyes, or strabismus, can be caused by some muscles which control eye movement being weaker than others. This imbalance means that sufferers are not able to fully control where the affected eye or eyes look.

Botox is used to weaken the stronger muscles so that they don’t dominate, balancing them with the weaker muscles.

Can botox help with excessive blinking?

Yes. Excessive blinking is known as blepharospasm and is caused by muscles around the eyes spasming involuntarily. When botox is injected into the affected muscle it relaxes it and reduces the severity of the spasms.

Can botox treat urinary incontinence?

Yes. Where urinary incontinence (the inability to control urination) is due to the bladder wall muscle spasming or being over-active, botox is an effective treatment.

Botox is injected directly into the bladder wall and, by relaxing the muscles, it means that patients need to urinate less frequently and less urgently.

Can botox help with muscle spasms?

Yes. Botox relaxes muscles, so it’s useful for treating a wide range of muscle spasms. This can include involuntary muscle activity (such as twitches) and chronic pain caused by muscle spasm (including neck and back pain).

Can botox help with tennis elbow?

Tennis elbow, or lateral epicondylitis, is a condition where the muscles and tendons in your forearm have been overused. This results in the muscles and tendons becoming strained, torn and inflamed. It can be caused by any repetitive, strenuous action, including playing tennis.

Research has shown that injecting botox into the elbow area can significantly relieve the pain of tennis elbow.

Can botox reduce tremors?

Tremors, including dystonic tremors, essential tremors and parkinsonian tremors (ie caused by Parkinson’s disease) may be reduced through treatment with botox.

Botox is injected into the muscles which are associated with the tremors in order to reduce their activity and ease the shaking.

Having botox in the UK

Who can give botox injections?

While a healthcare professional/medical prescriber must prescribe your botox, they can delegate the responsibility for actually injecting it to another person, although the healthcare professional remains responsible for ensuring you are treated safely.

The upshot of this is that, theoretically, anyone can administer a botox injection.

We would always encourage you to ensure that it is a healthcare professional who is injecting you, not just authorising someone else to do it.

Is botox regulated in the UK?

No, the only controls in place are those relating to botox as a prescription medicine – ie that it has to be prescribed by an appropriately trained medical professional.

Does botox require a prescription?

Yes, botox is a prescribed drug, therefore an appropriately trained healthcare professional/medical prescriber (eg a doctor, dentist, pharmacist or nurse) needs to write a prescription for it before it is used.

How do I choose a botox practitioner?

You should be fully confident that the person who is administering your botox injections is suitably trained, qualified and experienced.

We’d recommend taking the following into account:

  • Ask what training and qualifications the practitioner has. We would recommend only having treatment from the registered nurse or doctor who prescribed the botox for you.
  • Only used well established medical or aesthetic clinics. The clinic should be clean and safe. If you don’t like the look of it when you walk in, walk out.
  • Chat to family and friends to see if they can recommend a clinic to use.

What should I ask before my treatment?

You should have a face to face meeting with the healthcare professional who is prescribing the botox treatment (who, ideally, will also be the person administering the botox). We recommend discussing the following with them:

  • Explain what outcome you’re looking for and discuss whether botox will give you the results you desire.
  • Ask for the qualifications and training of the person who will be injecting you. Ideally, they should be a registered doctor or nurse.
  • Ask about the side effects of treatment. Make sure you receive information on aftercare and what should you do should you have side effects.
  • Ask how much the treatment will cost and if there are any additional charges for follow-up appointments and top-ups.

What will I be asked when I have botox treatment?

You will be asked whether you are breast feeding or if there’s any chance you could be pregnant. If you answer yes to either of these, you won’t be treated.

Your practitioner should ask for your full medical history and any medical treatment (including medication) you are currently undergoing.

You should be asked questions about why you want to have botox and what results you want to achieve. A reputable practitioner will not treat anyone who they feel is having botox for the wrong reasons or may be suffering from Body Dysmorphic Disorder (BDD).

How much does botox cost?

Different clinics have different ways of charging. Some may charge on the basis of the area to be treated (eg £199 for crow’s feet) while others may charge by how many units of botox are used for the treatment.

You should expect to pay around £150 to £350 for anti-wrinkle treatments, potentially up to £600 for medical treatments (such as for hyperhidrosis).

What it’s like to have treatment

Do botox injections hurt?

The needles used for botox injections are very small and only need to go in just under the skin. Generally speaking little or no pain is experienced.

If you are feeling nervous about the treatment, then please make your practitioner aware of this so they can discuss options with you.

How long should a botox treatment take?

For a single area the appointment should take between 20 and 30 minutes – which would include your pre-treatment consultation and a discussion of aftercare. The injections themselves will take around 10 minutes.

It may be slightly longer if it’s the first time you’ve had botox; simply because you’ll probably have more questions to ask.

How much botox will be injected?

This can vary significantly depending on the strength of the muscle being treated and the desired outcomes.

Will I be sore after treatment?

No. You may have a little redness, and occasionally a small amount of bruising, at the site of the injections, but it shouldn’t feel sore after treatment.

Does botox bruise you?

Very occasionally you may have a small amount of bruising at the site of your injections, but this is rare. When bruising does occur, it should resolve itself within a few days.

If you frequently bruise following botox treatments then it may be related to the technique of the practitioner and we would recommend changing clinic, particularly if the practitioner you had been visiting isn’t medically trained.

Does botox work immediately?

No. Botox starts working after about three to five days. It can take up to two weeks to achieve the full result.

Is there anything you shouldn’t do after botox treatment?

Avoid lying completely flat for six hours after treatment.

For 24 hours after treatment:

  • Don’t rub your face or have any sort of facial massage.
  • Don’t consume large amounts of alcohol.
  • Avoid strenuous exercise.
  • Don’t have a facial (eg exfoliation or facial masks).
  • Don’t use a sauna or steam room.

It’s fine to resume your normal skin care regime immediately after treatment.

Gently exercising the facial muscles of the treated area (eg by frowning, smiling or lifting your eyebrows) will help to optimise the final result.

What are the side effects of having botox?

There can be some redness at the point of injection and, on rare occasions, bruising.

Very rarely, some patients have a headache or flu-like symptoms in the first 24 hours after treatment.

There is a risk of your eyelids or eyebrows temporarily drooping if the botox was injected near to the muscles which control them, as botox can disperse a little after injection. Typically, this will sort itself out within four to six weeks and you practitioner may be able to offer a solution, for example eye drops or additional botox injections, to counteract the unintentionally relaxed muscles.

In very rare cases you can develop serious problems immediately after treatment or in the following weeks. If you had botox injections near your eyes and develop blurred or double vision, then you should contact the clinic where you had treatment and your GP. If you received botox injections in your neck and start to have any breathing difficulties, seek medical attention immediately and contact the clinic where you had treatment.

Should you wish, you can report the side effects through the NHS Yellow Card Scheme.

Will I feel ill after having botox?

Very occasionally patients have a mild headache or flu-like symptoms after treatment, which last for around 24 hours.

Can I fly after having botox?

There’s no scientific evidence to state that you shouldn’t fly after botox.

What if I’m not happy with my botox treatment?

If the outcome isn’t quite what you were looking for then you should go back to the clinic and ask for a follow-up appointment to discuss your options. Most reputable practitioners will err on the side of caution and not inject too much botox, so it might simply be that you need a top up to achieve the desired results.

If you are concerned about the side effects of the treatment then you should contact the clinic immediately and, if appropriate, seek medical attention from your GP or A&E.

Reputable clinics will all have an easily available complaints process you can follow if you feel that the treatment you received was not appropriate or good enough.

How long does botox last?

The benefits of your treatment will last between three and six months. The first time you have treatment the effects will wear off more quickly – but after several treatments you’ll find that the benefits will last longer and longer.

Does botox stop working if you have it too often?

It is possible for the body to build up a resistance to botox through antibodies which can neutralise the effectiveness. This particularly happens if you have the injections too frequently.

You may need an increased dose of botox to counteract the resistance or take a break from your treatments.

Deciding if botox is right for you

How old do I need to be to have botox?

You need to be 18 years or older to have botox without consent from your parent/guardian.

The ‘ideal’ age to start having botox will vary from person to person, depending on your skin type, lifestyle, etc.

Can I have botox if I’m pregnant?

No. There’s no evidence to suggest that botox could be harmful to your unborn child, but since extensive research has not been done in this area, and therefore the effects are unknown, you should avoid botox while pregnant.

Can I have botox if I’m breast feeding?

No. As with pregnancy, there’s no evidence either way on whether there could be side effects for your baby, so you should avoid botox if breast feeding.

Can I have botox if I have an infection?

No, not if the infection is at or near the site of your botox injections.

Can I have botox if I’m diabetic?

Yes.

Can I have botox if I’m on antibiotics?

If you are on antibiotics, then you should tell your botox practitioner and give them the name of the antibiotic. On the whole, it’s fine to have botox with antibiotics, but you need to make your practitioner aware.

How can I tell if I’m allergic to botox?

Botox allergies are extremely rare and there isn’t an allergy test available. If you notice any symptoms which might indicate an allergic reaction you should seek medical attention immediately. Allergic reactions can include symptoms such as:

  • Itching or swelling around the area which was injected.
  • A rash.
  • Severe dizziness.
  • Difficulties breathing.

This isn’t an exhaustive list. If you experience any serious side effects, you should seek medical attention immediately. Any mild side effects should be addressed to your botox practitioner and your GP.


 

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