Clinic of Dermatology

What is botuline toxin?

Botuline toxin is synthesized and secreted by a specific bacterial type, called Clostridium botulini. They exist in nature in non-oxygenous environment only. A few types of botuline toxin are known – A, B, C, D, E, F and G; type A is used in medicine predominantly and in very rare cases-type B.

Toxin administration directly into the muscles in tiny amounts leads to their relaxation and smoothness of the skin above. The muscle injections cannot cause the disease known as botulism.

In what cases and since when is botuline toxin used?

Botuline toxin is discovered in 1822. Its application in human medicine dates merely since 1968. Ophthalmology starts to use the toxin since 1978 in the treatment of strabismus in children, blepharospasm; neurologists apply it in facial hemispasm therapy, torticolis, etc. Since 1992 it is successfully used for treating mimic wrinkles on the face and hyperhydrosis - a rare, but unpleasant condition, characterized by excessive sweating.

Before	Before
After	After

What is the mechanism of action of botuline toxin?

The botuline toxin is a neurotoxin. It is blocking the nerve signal transmission from the neuron to the muscle cell, which leads to a constant relaxed state of the muscle; therefore it is deprived from contractions and cannot wrinkle the skin that lies above it.

Curious, but still unclarified remain the data about possible painkilling properties of the botuline toxin. Application of botuline toxin in patients with migraine leads to cessation of migraine attacks during its action.

Is BT therapy suitable for me?

BT is successfully applied in the treatment of mimic wrinkles. These are the wrinkles, that originate from the constant contraction of the facial muscles, whenever we express emotions like joy, rage, sadness, surprise, etc. The young skin is elastic and supple; it restores its smoothness rapidly. The first lines and furrows may be noticeable at the age of 25 and the first mimic wrinkles become visible above the age of 30. The most suitable age group for BT therapy is 30+ (30-55 years of age). At this age the skin has retained its elasticity and does not "droop" after muscle relaxation. BT can be administered in younger or elderly patients, according to the individual features or a combination between BT and other methods (peel, laser, lifting) can be chosen by the medical specialist.

Why should I prefer BT therapy?

BT is the best non-invasive method for treating mimic wrinkles in the area of the forehead, around the eyes and between the eyebrows. No special preparation is required before and after the procedure, it is adjusted individually for each patient and the effect is reversible. BT application lasts around 15 minutes. There is no recovery period, during which people will notice that you are undergoing “something”. An ultrafine needle is used for injecting BT, therefore local anesthesia is unnecessary. The changes in your appearance are striking and noone can guess the reason for that. BT lifts the eyebrows, reveals the eyes and leads to fresh complexion appearance. The eyes look calm and opened. The facial expression becomes feminine, lacking the stress signs.

Which part of the face is amenable to BT therapy?

BT is a first-line choice in the treatment of mimic wrinkles, located in the upper part of the face: forehead (surprise wrinkle), between the eyebrows (the leonine furrow during anger) and around the eyes (crow’s feet during a big smile). These wrinkles are formed due to contraction of certain muscles, which can be precisely blocked.

Why is BT not recommended for other facial parts?

The muscles tend to form a complicated network in the lower part of the face. The possibilities for anatomic variations between the different patients are increased and that may cause perplexity and discrepancies when trying to determine the BT application sites. Therefore, fillers are a possible option for this part of the face.

I decided to try BT therapy, how does the procedure run?

The procedure is performed on a preliminary set date and hour by a medical doctor certified in dermatology or plastic surgery. The make-up is removed and the skin areas, determined for BT application are cleansed. The locations for BT administration are specified and marked. The doctor àssesses the amount of BT to be injected. The patient is sitting or reclining. A photo of the patient is taken before the BT application for the purpose of result estimation after. The patient may experience sensation of pricking, burning or stretching that goes away immediately after the procedure. A cold mask may be applied for 10 min. at the end of the procedure.

What should I do after the procedure?

It is recommendable for the patient to contract and relax the mimic muscles by producing the gesture for 2-3 hours after the procedure. That facilitates the even and thorough distribution of the active substance in the muscle injected.

What shouldn’t be done after the procedure?

The patient should not press and massage the injected locations. No active cosmetic products should be applied- creams, gels and masks, and no cosmetic procedures-peel or facial massage should be performed for at least 72 hours.

What is the duration of BT effect?

The first changes are registered after 72 hours and the maximum effect unfolds after 14 days. The effect lasts for 4-6 months. A second injection can be given within the first 14 days for the reason of required correction, and after that at least 2 months have to pass until reinjection. The next BT application is after 6 months and the duration of the effect is prolonged to 8-12 months.

Are there any possible side effects after BT therapy?

The patient may experience sensation of heaviness, stretching or headache. Thåse symptoms are normal and resolve rapidly after solution resorbtion. The most serious adverse event during BT therapy is ptosis- dropping of the eyelid, which prevents the complete opening of the eye. This condition occurs very rarely and it resolves completely in a few weeks. In order to prevent this, BT is applied by a qualified doctor only in a specialized medical office.

How can I estimate that the time for a next procedure has come?

As time goes by the toxin activity depletes and the wrinkles restore their appearance. BT advantage is in that it provides mimic muscle relaxation, therefore the existing lines and furrows do not deepen and formation of new ones is prevented. A second or next BT injection can always be administered, in case the patient is not satisified with the result, i.e.1-3 times per year. Application can also be done before a special for the patient occasion.

How many years can I apply BT therapy?

There is no limit in the number of BT procedures applied, but 6-8 applications are usually sufficient to preserve the youth and beauty of the face for years ahead.