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Show me the Botox!

Hello ... this week we talk about everyone's favorite topic... and it's no secret that everybody is searching for the fountain of youth. Luckily for us we have this wonderful thing called Botox to help keep all our beautiful faces youthful for longer! Today we will be giving you all you need to know about Botox including how it was created, what disease states it can cause, how to inject properly, what to use it for and things to know before as well as, after your doctors appointment. Everyone thinks they are an expert in botox but are they really? Make sure to listen to the episode now (link can be found above under the podcast tab which will redirect you to the platform you listen to our podcast on) and then come back here to read about whatever you may have missed.

Everybody loves botox. You love it, we love it, our parents love it... even cousins, uncles, sisters and everyone else in the world does! Botox has given us the gift of staying forever young and with little downtime everyone goes back to their regular scheduled programs in no time. With that said, there’s a lot of things we don’t know about botox. So we wanted to tell you the whole truth (and nothing but the truth) to get you to understand what it is. We will get down and dirty into the toxin itself, who to go to and how to not look like a botched Barbie.

The use of Botox in today's day and age is to reduce the appearance of wrinkles, right? It’s popularity stems from the fact that it is a non-surgical procedure with minimal downtime and actually works!

Aesthetically, it most commonly treats glabellar lines (which are those frown lines between the eyebrows that we hate so much) and canthal lines also known as the crow's feet. But, there are other benefits to Botox and it is used to treat over 20 different medical conditions!

It's approved for the treatment of the following:

- Neck spasms

- Hyperhidrosis (excessive sweating in your underarms or at the bottoms of the feet)

- Overactive bladder thereby reducing urinary incontinence

- Chronic migraines (for those who have migraines more than 15 days/month and has been unresponsive to other treatment)

- Lazy eye

- Post stroke upper limb spasticity

- Hemi-facial spasm (where half of your face exhibits muscle spasms)

- Blepharospasm (eye twitching)

It has also been used for a bunch of off label reasons such as:

- Achalasia (a GI disorder where patient’s have difficulty swallowing due to one of the sphincters in the esophagus being unable to relax)

- Anal fissures or Anismus

- Sialorrhea (too much saliva production)

- Allergic rhinitis

- Sphincter of Oddi dysfunction (a syndrome that manifests with abdominal pain)

- Muscle contractures (like in cerebral palsy)

- Oromandibular dystonia (forceful contractures of the jaw, face, or tongue)

- Laryngeal dystonia (contraction of the vocal cords)

With all these uses what is Botox exactly? It’s real name is onabotulinumtoxinA and just like this fancy name sounds it is indeed a toxin made by a bacterium known as clostridium botulinum. It can be found in lakes, forests, soil, in the intestines of certain mammals, fish and in the gills as well as organs of shellfish (like crabs). The bacteria itself is harmless but the spores can transform in certain situations leading to the production of botulinum toxin (a type of neurotoxin).

What is a neurotoxin you may ask? Like the name suggests it targets the nervous system disrupting the signaling processes that allows neurons to communicate with one another. The toxin is sooo dangerous that it is estimated that one gram of botulinum toxin can kill over one million people and two kilograms can kill the entire human population of Earth! This toxin can be passed on to someone through food, wounds and rarely, through inhalation. In adults it will present with an upset stomach, visual or swallowing disturbances, autonomic dysfunction, breathing or speech difficulties, muscle weakness and paralysis. In children, this condition is known as infant botulism and presents with flaccid paralysis which is associated with ingestion of expired or old honey.

What does Botox do? That’s obvious now right? It paralyzes your muscles! In today's world we use extremely small concentrations of Botox which works by preventing the signals from the nerve cells reaching local muscles and this leads to paralysis of those muscles (temporarily, of course). This process can be completed by a neurotransmitter known as acetylcholine that is released from the nerve endings and attaches to the receptors on muscle cells causing the muscle to either contract or shorten. So when you inject the toxin you prevent the release of this neurotransmitter and prevent the contraction of the muscle cells leading to relaxation or paralysis. The end effect when it comes to aesthetics is that the parts of the face we use so actively don’t get used as much after the Botox, so the wrinkle is either smaller, less obvious or not present for a little while (aka for as long as the Botox lasts).

What are the types of Botox? So there are different brand names for Botox aside from the one we just mentioned and there are different variations of the same toxin. Some other common brands and their toxins include Dysport (abobutolinumtoxinA), Xeomin (incobotulinumtoxinA), Myobloc (rimabotulinumtoxinB), among other brand names. All have the same effect and there is a clinician preference for which one is used as well as a different cost per vial.

Lets talk about statistics we love to give you this because it puts everything in perspective! How many people use botox? More than 6 million Botox treatments are done each year.

We spoke about who uses Botox but who shouldn’t? The obvious answer is those who don’t need it! As the saying goes.. If it ain’t broke don’t fix it. Others include those who are pregnant or breastfeeding, anyone with an allergy to cow’s milk protein, and those who have previously had a bad reaction to Botox.

What professional to choose for this procedure? At the very least please see someone who is certified in administering Botox. Preferably, this will include healthcare professionals like an RN, NP, MD or DO. There are instances that dentists are also certified in these procedures. Do not hesitate to ask for proof of certification as not only is this your body which will affect your external or cosmetic appearance but if someone is not properly trained your health can be in danger as well (if you read above you now know that this is a no-brainer!)

What to do before you go? If you had botox done before great! You basically know the drill but a reminder never hurts. Personally, I have been getting spray tans like nobody’s business however, each time I still have to reask the same questions because you can never be too careful. Remember this is your appearance and you want it to look good! Maybe that’s the control freak in me, who knows? So, when you go to your physician, let him or her know if you’ve had Botox injections as well as, which one you used and when your last session was. Part of a new patient visit in general requires a list of your medications and to note any allergies to medications or products (such as latex gloves!). It is important to notify your physician regarding these or if anything has changed since the last time you saw them. Furthermore, be sure to let them know if you are on any muscle relaxants, sleeping medications, allergy meds, or blood thinners (aspirin is included in this list and you may need to stop this to reduce bleeding risk, again this will be provider dependent).

Botox generally works on wrinkles or expression lines! This is important to know, so that you don’t have a false perception of what it can or cannot do. Most commonly, it is used for lines on the upper face (the 11 between the brows or horizontal lines on the forehead and crow's feet). There have been other uses of course like for jaw contouring and the famous lip flip. However, Botox will not work on fine lines and wrinkles which are known as the static wrinkles. Static wrinkles include the lines in the cheeks, neck, and jowl areas. For this you would need to do fillers!

How is it injected? They take the toxin which is in a powder form and dilute it in saline. Then they inject it directly into the neuromuscular tissue. Sounds pretty simple right? It is, except that whoever is doing it needs to know the anatomy which includes which vessels (arteries and veins) as well as, nerves run through there.

Secret Tricks to prepare you for your next treatment?

1. Numbing cream because you want your face drenched in lidocaine (just kidding… kind of) especially, if you don’t tolerate pain well. Most facilities will have a topical lidocaine cream that you can apply on your face and leave on for a certain period of time before your procedure.

2. We have noticed that for a lot of patients ice is very effective to combat bruising so as soon as you are poked we put ice on that area as well as, a cool vibrating anesthesia device that is meant to relax the muscles and relieve pain! This little tool is so good that everyone is now using it.

What are the complications or side effects?

1. Bruising at the site of injection

2. Pain and swelling of course (local fluid collections)

3. You can also have reddening of the skin at the injection site

4. Some patients may experience numbness, headache and cold or flu-like symptoms (feeling sick, nauseous).

Other side effects:

5. Temporary unwanted weakness or even paralysis of nearby muscles

- These symptoms are mild and usually self resolve

6. Sometimes these procedures can lead to a droopy eyelid, exaggerated elevation of the brow, crooked smile and drooling. These can be reversed either by waiting for the agent to start to dissolve or coming back for a follow up treatment.

Complications include eye dryness or excessive tearing. The most rare but serious complication is when the toxin is injected in a way where it can spread to your body leading to the same effects as seen with botulism itself. These symptoms include muscle weakness, vision problems, trouble speaking or swallowing, shortness of breath or the inability to breathe due to paralysis of the respiratory muscles, loss of bladder control in other words incontinence.

Please be aware of these side effects as well as, severe hives, wheezing, decreased eyesight, double or blurred vision and call your doctor immediately if any of these signs are noticed!

Note: 1% of people develop antibodies to the toxin that make subsequent treatments ineffective. This has been seen with botulinum toxin type A.

How much botox will you need? This is case by case dependent. Multiple factors go into this depending on what you want done, what you need done and how much you plan on doing in one sitting. Also you need to consider that wrinkles come in all shapes and sizes which will come into play when deciding how much of the product you will require.

Can all wrinkles disappear? The answer is obviously, no. The deeper the wrinkle the harder it will be to get rid of. Also in areas of skin thinning (like around the eye), Botox will not be effective but it will help with crows feet.

When should you start doing Botox? There is a new craze for preventative botox and we see girls starting as early as 20 years old. Personally, we feel it is absurd but we will say it depends on your skin type. Yes, your skin starts to age around 25 however, depending on how it was taken care of as well as, your genetics will influence whether you should start then or can still wait. If you have a deep forehead wrinkle for example, go get it done but that doesn’t mean your entire face needs to get probed and poked.

To delve into this further eliminating things that cause aging skin should be the first priority as Botox is only a temporary measure and not a cure. Things to do include wearing SPF (limiting sun damage), quitting smoking, eating a well balanced diet, staying hydrated, having a good skin care regimen (most importantly here washing your makeup off before bed), limiting alcohol, getting an adequate amount of sleep, trying other procedures like facial massage, facials, among others.

Once you complete all of this, then you can start treating your face as needed with other more invasive measures. But don't forget that using Botox frequently and improperly can actually age you. One more thing, paralyzing some muscles may lead to overuse of other muscles leading to new wrinkles in places they wouldn't be in in the first place!

How quick does Botox take effect and how long does it last? It usually works within 1 to 3 days after the treatment. The lasting effect however varies from person to person. On average, Botox will last anywhere from 3-6 months but some people state there’s has lasted less or even longer (personally, we have heard people say as far out as 12 months). This of course depends on many factors including on the person and area of injection. Either way to maintain the look you need to follow up regularly and repeat the procedure.

Things not to do immediately after Botox: do not rub or massage the area, avoid exercise or strenuous activity, avoid alcohol or blood thinners, avoid excess heat exposure and don’t lie flat on your face! These are recommended for the first 24 hours after your procedure.

But the main thing is do not inject yourself and do not go to someone who is not a licensed professional!

We love Botox and we truly believe it is a great addition in the cosmetic as well as, medical industry but like everything else it comes with risks and everyone should be aware of them. There has been a lot of head way made in the anti-aging world and a lot of promise for the future. Which we are hoping to one day dabble our feet in but until then and on that note, stay fabulous and Botox wisely!

That's all for this week, don't forget to leave us feedback, rate, review, subscribe and send in your questions so we can continue to improve as well as, provide you high quality content!

Disclaimer: The Content on our podcast/website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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