Botox: The Cosmetic Use of Botulinum Toxin

Botox: The Cosmetic Use of Botulinum Toxin Botox injections are well known primarily for the ability to decrease the appearance of facial wrinkles. Botox injections are also used to treat the conditions such as neck spasms (cervical dystonia), excessive sweating (hyperhidrosis), an overactive bladder and lazy eye. Botox injections may also help prevent migraines which […]

Botox: The Cosmetic Use of Botulinum Toxin

Botox injections are well known primarily for the ability to decrease the appearance of facial wrinkles. Botox injections are also used to treat the conditions such as neck spasms (cervical dystonia), excessive sweating (hyperhidrosis), an overactive bladder and lazy eye. Botox injections may also help prevent migraines which are chronic.

A Botox injection uses a toxin called onobotulinumtoxinA which helps temporarily to prevent a muscle from moving. This toxin is produced by the microbe that causes botulism, a type of food poisoning.

To use botulinum toxin Botox was the first drug. Other products now include abobotulinumtoxinA (Dysport), rimabotulinumtoxinB (Myobloc) and incobotulinumtoxinA (Xeomin). Each one of them is a little different and are not interchangeable, particularly when it comes to dosage units.


Botox – Why it’s done

Botox injections are used to block certain chemical signals from nerves, signals that mostly cause muscles to contract. The most frequent use of these injections is to temporarily relax the muscles of the face that causes wrinkles in the forehead and around the eyes. Botox injections are also used to treat conditions that affect the functioning of the body functions. Examples include:

  • Cervical dystonia is a painful condition in which the neck muscles contract involuntarily causing the head to twist or turn into a position which is not comfortable.
  • The most common cause of lazy eye is an imbalance in the muscles which are responsible for positioning the eye.
  • Some neurological muscle contracture conditions, such as cerebral palsy, can cause the limbs to pull in toward the center. In some of the cases, Botox injection can be used to relax these contracted muscles.
  • Hyperhidrosis is a condition where excessive sweating occurs even when the temperature isn’t hot and exertion also is not done.
  • If migraines are experienced for more than 15 days a month, to reduce frequency of the headache Botox injections might help.
  • Botox injections can also help decrease bladder dysfunction such as urinary incontinence caused by an overactive bladder.
  • Botox injections may help relieve contracture or twitching of eye muscles


What is botulinum toxin?

Botulinum toxin is an injectable muscle relaxant, commonly known by one of its trademarked brand names, BOTOX®.

Botulinum toxin is responsible for causing botulism, the paralysing and potentially fatal foodborne illness. The name botulinum is derived from the Latin word botulus (sausage) because the illness was once believed to originate from sausages. We now know that the botulinum toxin is produced by Clostridium botulinum bacteria.

C. botulinum produces eight types of toxins, labelled from A to G. Since the 1950s, research has focused on developing the muscle-relaxing properties of botulinum-A, and more recently botulinum-B, for therapeutic use.

How do botulinum toxins work?

Botulinum-A and botulinum-B block nerve signals in the muscles. In order to contract, a muscle must receive a signal from peripheral nerve endings. This signal is the neurotransmitter, acetylcholine, which binds the receptors with the muscle, initiating muscle contraction. Botulinum toxin inhibits the release of acetylcholine and therefore also inhibits muscle contraction.

More specifically, botulinum-A and botulinum-B target a group of proteins called SNARE (soluble NSF attachment protein receptor). The function of SNARE is to release neurotransmitters from their storage vesicles by helping vesicle membranes fuse with the cell membrane. Because SNARE is also involved in the release of other neurotransmitters, botulinum toxins have additional effects. For example, by preventing the release of glutamate and substance P, botulinum toxin lessens the sensation of pain.

Muscle weakness is typically seen within two to four days, and maximal weakness or paralysis is noted around ten days. The effects of botulinum toxins are not permanent, because the affected nerves sprout new endings. After around three months, a working connection between the nerve and muscle is re-established. However, an element of atrophy (muscle wasting) occurs with each injection. This incremental atrophy explains why the interval needed for a second treatment can gradually lengthen following repeated injections.

What are the differences between the different types of botulinum-A?

In New Zealand, there are three commercially available brands of botulinum-A:

  • Botox® (onabotolinumtoxinA)
  • Dysport® (abobotulinumtoxinA)
  • Xeomin® (incobotulinumtoxinA).

Each form has a unique molecular structure but shares the same core elements of the botulinum-A. The majority of research for cosmetic uses of botulinum-A have been based on onabotolinumtoxinA.

It is important to note that there is no standardised international unit that can be used to compare or to measure the amount of botulinum toxin administered. This means the effect of one unit of Botox is different than one unit of Dysport. The approximate conversion factor is 1:2.5 to 1:5 between Botox and Dysport; and 1:1 between Botox and Xeomin.

Myobloc (rimabotulinumtoxinB) is a commercially available brand of botulinum-B. Myobloc is used mainly in other medical specialities outside of dermatology.

Can botulinum-A reverse the effects of ageing?

The appearance of ageing skin arises from a combination of factors. Rhytides (wrinkles) are caused by altered pigmentation, redundant and sagging skin, and loss of soft tissue. Rhytides caused by muscle movements are called dynamic rhytides, while those rhytides that do not change with muscle movement are called static rhytides.

As an injectable muscle relaxant, botulinum-A is effective in treating dynamic rhytides and is currently FDA-approved for the treatment of rhytides occurring in the upper face.

What is the Botox lip flip?

As the name implies, the Botox lip flip involves using Botox to enhance the upper lip. Just a few quick injections can help the upper lip relax and roll slightly upward, which allows more of the upper lip to be visible. It is an excellent alternative to fillers for patients who want a more subtle enhancement than fillers provide, or for those who want to enhance the shape of their upper lip with minimal effort.

How does the lip flip work?

To perform a Botox lip flip, our injectable specialists make a series of injections just above the upper lip, into the orbicularis oris muscle, which encircles the mouth. Botox temporarily relaxes the part of the muscle over the upper lip, causing the lip to roll slightly upward so it appears more voluminous and defined. This muscle relaxation can also help smooth vertical lines around the lips.

Most patients notice the effects within a few days of treatment, with full results in about one week. The effects of Botox for lips lasts up to three to four months.

Be sure to choose a qualified provider who has plenty of experience performing the Botox lip flip. Overtreating is a real risk and can limit your ability to move your lips normally. It takes a high level of skill to achieve the right effect.

Botox lip flip vs. lip fillers

The Botox lip flip isn’t a substitute for lip fillers. We perform both at Kalos Medical Spa, as we have patients who are better suited to one treatment or the other, or both. Our injectable specialists consider your natural lip anatomy, your desired outcome, and your personal preferences when deciding whether Botox or a dermal filler, such as Juvéderm XC or Volbella XC, is the best lip enhancement option for you.

You likely will be happy with the Botox lip flip if: 

  • You would like a subtly more prominent “pout” to your lips
  • You feel your upper lip looks invisible when you smile
  • You want fuller-looking lips but do not want additional volume
  • You want a more temporary treatment (3-4 months)

Fillers are likely a better lip enhancement option if: 

  • You would like additional volume in the upper and/or lower lip
  • You would like to address more severe vertical lip lines
  • You would like to improve overall lip shape and symmetry
  • You want a longer-lasting lip enhancement (6-12 months)

In some cases, the best solution for a patient is to combine Botox with fillers. Using fillers to enhance lip volume and Botox to lift the upper lip slightly can achieve a beautiful effect for patients with very thin lips.



Botox Allergan
36-year-old female patient used a BOTOX injection to the forehead and eyebrows to improve her fine lines and wrinkles – front view

BOTOX is a brand name for the botulinum toxin produced by the bacteria Clostridium botulinum. BOTOX Allergan refers to the company that produces BOTOX Cosmetic, which is the most well-known brand of botox on the market.

BOTOX is FDA approved for the treatment of moderate to severe frown lines, forehead lines, and crow’s feet. Botox is well-tolerated and quick treatment to treat fine lines and wrinkles.

The difference between BOTOX and other brands lies in the potency of the proteins, making some botox products more powerful than others. BOTOX Allergan comes in 50, 100, and 200 unit vials. Because vials are made for single-use, patients may need to purchase the entire vial.

Other popular brands of botox include Dysport, Xeomin, and Myobloc. BOTOX comes as a powder vial made for single-use and is reconstituted with saline prior to injection. Once mixed with saline, it should only be stored for a maximum of 24 hours.

Botox used after this may give results that do not last as long. In general, the forehead lines require 20 units of botox, crow’s feet require up to 24 units, and glabellar lines (frown lines) require 20 units.

For any type of botox, there may be mild side effects which could include slight pain, swelling, and discomfort at the injection site. BOTOX begins to take effect in 24-72 hours after injection. Results for botox generally last from four to six months.

BOTOX is continuing to grow in popularity. It is important to find a professional who has experience in botox injections to get the desired results.



If performed by an experienced doctor, Botox injections are relatively safe. Possible side effects and risks associated may include:

  • Pain, swelling or bruising at the site injected
  • Symptoms of Headache or flu
  • Droopy eyelid or cockeyed eyebrows
  • Crooked smile or drooling
  • Eye dryness or excessive tearing

Although it is very rare, it’s possible for the toxin in the injection to spread in your body. The doctor should be consulted as soon as possible if noticing any of the effects hours to weeks after receiving Botox:

  • Muscle weakness
  • Vision problems
  • Trouble speaking or swallowing
  • Breathing problems
  • Loss of bladder control

In case a candidate is pregnant or breast-feeding, doctors usually not recommend using Botox. And Botox should not be used in people who are allergic to protein of cow’s milk.

Botox must be used only under the supervision of a doctor. It’s important that the position of the injections should be placed precisely in order to avoid any side effects. Botox therapy can be risky if it’s not administered correctly. a referral from the primary care doctor should be sought or a doctor who specializes in your condition and who has experience in administering Botox treatments should be consulted.

A skilled and properly certified doctor can advise you on the procedures of the Botox and help in determining if it best suits the candidate’s needs and health.

Botox – Preparation

The doctor should be made aware of any type of Botox injection taken within the past four months. And is any medications are taken such as muscle relaxants, sleeping aids or allergy medications. If blood thinner medication is consumed, it may need to be stopped several days before the injection to reduce the risk of bleeding or bruising.

Botox – What one can expect?

Before the procedure

Most of the people don’t suffer much discomfort during the Botox procedure. But the skin should be numbed beforehand, especially if the palms or soles are being treated for excessive sweating. The doctor might use one or more of different methods available to numb the area, such as topical anesthesia, ice and vibration anesthesia, which uses massage to decrease discomfort.

During the procedure

The procedure for Botox injections is usually performed in a doctor’s office. The doctor uses a thin needle to inject tiny amounts of botulinum toxin into the skin or muscles. The number of injections needed depends on a number of factors, including the extent of the area being treated.

After the procedure

For at least 24 hours the treated areas are not to be rubbed or massaged. This will help to prevent the toxin from spreading to a any other area. Normal activities can be performed right after the procedure.



Botox injections usually show the results in about one to three days after treatment. Depending on the issue being treated, the effect may last for about three months or longer. Regular follow-up injections may be needed to maintain the effect of the Botox.


What does Botox even do?

Botox is the name of the brand botulinum toxin, and it’s produced by the bacterium Clostridium botulinum which is found in plants, soil, water, and animal intestines. This bacterium blocks the neurotransmitter acetylcholine, causing the muscle paralysis that lasts for several months.

Botox is a highly poisonous substance that can affect the nervous system. But when it is used to minimize wrinkles, it’s directed in super small doses. And it is also used to treat some other medical conditions. The muscle paralysis effect is how a Botox shot reduces the crinkling and wrinkling that naturally happens when certain expressions are made.

For the sake of beauty, is Botox actually safe?

However, researchers consider Botox is relatively safe in comparison to other, more-invasive cosmetic procedures. Although risks associated with Botox do exist, a recent study found that when performed by a board-certified dermatologist, less than 1 percent of patients experience any issue.

Before getting Botox

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  1. Choosing the right clinic

Botox is currently one of the top nonsurgical procedures of cosmetic in the United States. That means there are a lot of options to choose a clinic which is right.

Next is to check the social media and the website of the doctor to see if their work matches the desired requirements.

It’s also important to know the dermatologist in order to feel at ease. Read online reviews to get a take on about the doctor’s.

Once the list of clinic or doctors has been narrowed down, schedule a consultation to see if the doctor’s philosophy aligns or not. To find a correct Botox doctor one may consider the following:

  • Credentials and experience.
  • Research of the doctor’s previous work.
  • Online reviews.
  • Meeting the doctor face to face for a consultation.
  • Does their philosophy align with the goals or not
  1. Planning Botox with the doctor

When a physician is selected, a Botox plan should be made and discussed with them.

And depending on the goals of the candidate, they may need to visit the clinic up to six times a year for various treatments. The dermatologist should outline all the options available, including treatments which are not related to Botox.

The doctor should also evaluate all the muscle movements which are dynamic. With regards to the forehead lines, the doctor may examine how a patient looks with eyebrows raised, at rest, and with eyes closed.


  1. Guiding the decision financially

What’s in the wallet also plays a vital role in the Botox plan of action. Botox is temporary, lasting for about four to six months. If the results are satisfactory, it can be continued with several treatments a year.

The Botox impacting the skin should also be discussed with the doctor. Aging occurs because of both internal and external factors which can be our genes, ethnicity, and even certain medical conditions are internal which cannot be controlled. Control over extrinsic factors is more as compared to internal factors, like air pollution, stress, or smoking.

Botox – Cost

  • Treatments for Botox can range from $100 to $400 to treat a single area.
  • Botox is more than one injection. Different areas of the face may need to be treated depending on your facial muscles
  • Botox upkeep may be required somewhere around from two to six sessions per year.

Botox – Risks

Botox is a treatment for looking younger, but it is still a spring chicken itself. Although clinicians have considered Botox relatively safe, studies are still in progress regarding long-term effects of Botox and other factors.

Additional risks of Botox may include a botched job if the neurotoxin used is too much or it is injected in the wrong area. Bad Botox might include the effects such as “frozen” or expressionless face, asymmetrical issues, or drooping. Since Botox is not permanent, any of the above mishaps will eventually wear off. Any light bruising also has the same case that may occur after receiving injections, which will disappear after a few days.

The doctor should be consulted immediately if anything of the below happens:

  • swollen or drooping eyes
  • headache
  • neck pain
  • double vision
  • dry eyes
  • allergic reaction or difficulty breathing



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