BOTULINUM TOXIN
Pharmacological use of a toxin already present in nature, the effect of which is to neutralize muscle activity in a district and specific manner. In the field of aesthetic medicine it is used on the face and in cases of hyperhidrosis (excessive sweating). The controlled injection of suitably diluted doses of toxin determines, for a variable time, the inactivity of a portion of the treated furrier muscle and therefore the disappearance of deep wrinkles from the overlying skin. It is the most common aesthetic medicine treatment in the US and can be considered, after hundreds of thousands of cases treated worldwide, to be safe and effective.
It has a variable duration from 4 to 6 months and is repeatable.
General information: Clostridium Botulinum is an anaerobic bacillus responsible for the clinical signs and symptoms of botulism. It produces seven types of toxin (the most powerful of which is botulinum toxin A which is contained in the VISTABEX drug we use) which exert their action by blocking the presynaptic release of acetylcholine, thus preventing nerve transmission. Muscles affected by the toxin undergo temporary flaccid paralysis. In fact, a new nerve transmission is restored in a variable time (at least three months) obtaining the complete reversibility of the function of the neuromuscular plate. The lethal dose for 50% of subjects is about 40 international units (IU) per kg of body weight; this quantity corresponds to approximately 2530 bottles of botulinum toxin A (VISTABEX); an amount equal to approximately ½ bottle is used during a session (1 whole bottle to treat axillary or palmoplantar hyperhidrosis). The drug works by relaxing the underlying muscles responsible for the formation of wrinkles, causing the overlying skin to become smoother and giving the face a more naturally relaxed appearance.
Indications: Botulinum toxin type A is indicated for the correction of glabellar lines (wrinkles that form between the eyebrows). Its use has also been validated for lateral wrinkles of the eyes (crow’s feet), forehead or other locations of the face, neck and décolleté as well as for axillary and palmoplantar hyperhidrosis where it is particularly effective (induces the disappearance of sweating for a time ranging from 6 to 9 months).
Carrying out the injections: Fasting is not required on the day of the injections. In the two hours following the treatment it is recommended not to do intense sports and not to stretch. It is also necessary not to manipulate the treated area within 24 hours after the session. In the 15 days before and after the treatment it is very important to minimize the risk of bruises or blood loss from the treated regions (in order to limit the risk of the product leaking towards the peripheral muscles and therefore the undesirable effects). Moreover, in the three days following the injection it is advisable to strongly contract the treated muscles at least 3 times a day to optimize the effect of the drug. This simple and safe operation, which involves the injection of a few units of toxin through a small syringe equipped with a very thin needle, lasts about 10 minutes and can be performed by the doctor in the clinic. The treatment is not surgery and the patient can resume normal activities immediately after the session.
Effects: The results will be visible within a few days, but for about 15 days the effects on the face may be variable before stabilizing (temporary asymmetries are possible). After 15 days from the execution of the treatment, a check will be set to ascertain the effects obtained and to make any corrections and / or adjustments. The effect of the drug usually lasts for a time ranging from 4 to 6 months; the effects may last longer if the treatments are performed at regular intervals every 6 months. After this period, the effect gradually disappears until the original situation is restored.
Frequency of injections: The injections must be performed at least 5 to 10 times, at an interval of 5/6 months, to obtain a certain stability of the result. It is recommended to NEVER approach the sessions to less than three months to avoid the socalled vaccine effect which consists in the development of a certain resistance to the product.
Information on potential risks: The possible complications described so far are a temporary descent of the upper eyelid or eyebrow or an excessive elevation of the terminal portion of the eyebrow, difficulty in swallowing, disturbances in facial expressions. If theydoo cur,the esideefectspersistforafeww eks. Thereisaneyedr ponthemarketthatcanreducethedescentoftheu p reyelid.Thesetransient adverse reactions have also been rarely described: headache, facial pain, erythema, localized muscle weakness, skin tightness, edema, paraesthesia, nausea, dizziness.
Absolute contraindications: Known hypersensitivity to each component of the formulation (human albumin, botulinum toxin, sodium chloride). Generalized disorders of muscle activity (myasthenia gravis, amyotrophic lateral sclerosis, myopathies …). Treatment with aminoglycoside antibiotics or spectinomycin in the days prior to treatment. Presence of infection or inflammation at the level or s inoculation sites. Pregnancy and breastfeeding.
Relative contraindications: Coagulopathies, Anticoagulant or antiplatelet therapy, Poor patient compliance, Subjects under the age of 18 and over 65
AFTERTREATMENT INSTRUCTIONS
1. DO NOT rub or massage the treated area(s) for 24 hours after the treatment
2. DO NOT apply any makeup or cosmetics for 4 hours after the treatment
3. DO NOT perform heavy physical exercises, stretches, do not lie down o bow the head for 4 hours after the treatment. However, feel free to wash and participate in regular daily activities.
4. Be sure that any swelling or marks on the treated area will disappear within hours after the treatment. 5. Try to exercise the treated muscles for 2 to 3 hours after the treatment eg by frowning or raising your eyebrows. This movement will help the action of the toxin within the muscles. Although this simple exercise helps the action of the drug, there is no problem if it is not performed.
6. The results of the treatment may become more clearly evident from the next 10 days.
7. The results of treatment with botulinum toxin are not permanent and you may realize that the approximate duration is 3‐4months:ifyouperformthetreatmentswi hthereco mendedfrequency,the duration of the results over time may be even greater of 4 months.
8. For this reason, we recommend that you contact our doctor’s office for a new check‐up to be carried out approximately 4 months after the date of the last treatment.