How Can You Increase Your Botulinum Toxin Safety

It’s become a favourite within the world of aesthetic tweakments and even used to treat such concerns such as migraines and jaw grinding. How safe is Botox, how long does it actually last for, whats the best age for Botox and can you become immune to Botox? We answer all in the following blog.

How Can it Be Safe?

Practitioners inject the popular treatment for reducing wrinkles, Botox, that contains botulinum toxin, directly into the facial area of their patients. You may wonder how this can possibly be safe. The secret is that manufacturers of Botox use purified, extremely small quantities of the toxin.
How Does it Smooth Wrinkles?

Botox works beneath the skin, targeting the muscles that underlie wrinkled facial areas. While it cannot erase existing lines or eliminate sagging, it temporarily immobilizes the muscles of the face where injected by blocking communication between nerve endings and the brain. By forestalling the normal contractions that take place during facial expressions, Botox makes wrinkled skin appear smoother and immobilizes its tendency to sag.

Botox is especially effective in the upper facial area, around the eyes and forehead where it can reduce crows’ feet, creases, and other wrinkles. Depending on the patient, the effects of a Botox injection last three to six months.

History of Botox Use

First utilized for facial applications by medical professionals in the 1970s to treat squinting in young children, British dermatologist Nick Lowe studied and developed Botox in the 1980s for treating frown lines.

The product received its licensing for general use in 1994, and since that time nearly 500,000 British citizens have undergone injection treatments.

While the best administrator for treatments is unquestionably a qualified professional, the rapid spread of Botox use has occasioned a similar growth in the sphere of application choices. After being approved for cosmetic use in the UK in the mid 2000s, beauticians, dentists, or the barber down the street may offer Botox treatments. If you are the practical sort, you can even purchase a do it yourself kit online.

How long does Botox last for?

The Allergan product Botox used in the suggested dose range is usually thought to last about twelve before having no clinical effect.

The action of Botox means that it is possible to see some return of movement from the six week stage as the therapeutic effect of the product starts to diminish and the nerve end plates start to reconnect with the muscles.

If you are finding that your patients are not seeing this duration of treatment there may be a few things to consider:

  • Is your patients expectation of treatment realistic?
  • Have you considered the appropriate dose for muscle mass, surface area, gender and ethnicity?
  • Does your patient have a swift metabolism
  • Are they taking any medicines including vitamins and herbal preparations that could speed metabolism?
  • Has your patient had any illnesses or events to cause a steep change in their recent aging process?
  • Is your patient a smoker?
  • Have you compromised your product by using alcohol to clean the skin or swab the vial top?
  • Have you denatured the product by inconsistent storage, excessive movement or too speedy a reconstitution?
  • Has your placement site and depth of injection been appropriate for the area being treated?
  • Did you advise your patient on aftercare?

The results are generally predictable but each treatment with toxin will produce a slightly different result. Any of the above factors could influence the outcome.

What is the best age for Botox?

Is there really an “Optimum Age” for Botox treatment? Or is this some kind of myth

Similarly…what is “too young” or “past the point of help”?

Up to a point, “Too Young” is obvious. We’ve all heard the recent controversy over the San Francisco Mom who gave Botox treatments to her Pageant-queen 8 year old daughter. There has been a media frenzy of similarly ridiculous stories. And any medically qualified Aesthetic Practitioner worth their weight in botulinum toxin knows that there is simply no question about the right or wrong in these cases. But over the age of about 18? 20? 25? Where does it begin… And where does it, or should it end?

Perhaps the debate can be split into two: the perspective of the Practitioner, and the Perspective of the Patient (note we say Patient, not Client: at Cosmetic Courses, we feel it is so important to remember that Botox is still a medically prescribed drug not just a beauty treatment…ethical decisions need to be made around this topic as with other medical procedures).

The Patient’s Perspective:

Botox provides a safe and effective means of looking more youthful and banishing wrinkles like no other treatment, for up to 4-6 months at a time. Robert Kotler (Md, FACS) makes the valuable point that, to the Patient, the best age at which to begin Botox treatment is largely based on their personal interpretation – on “what you see when you look in the mirror”.

In other words: no matter how many hundreds of times friends, family and surgeons try to persuade a 20-something patient that they have beautiful skin, if all they see when they look in the mirror is one huge wrinkle, they will fixate on it. It can make them genuinely very unhappy, however silly this may seem to other, possibly older, patients. But does this make them any less “eligible” for treatment?

Of course, the highly image-conscious environment of the Western world plays a large part in this. Women and men alike are bombarded by airbrushed images of silk-skinned celebrities. Many feel retaining youthful looks is integral to keeping ahead in their careers.

As a Practitioner, when judging the need of the Patient, it is therefore hugely important to be able to empathise: to think, why is this important to this Patient, is there some way that I can work with the area concerning them to improve it (even if it is not as pronnounced as in other Patients) and not merely to dismiss them as “not needing it” until you have tried to get inside their shoes and seen their reflection in the mirror through their eyes.

In some cases it may be a lot easier…patients who have had a lot of sun exposure, for example, often do have genuine significant forehead wrinkling, squint and glabellar lines even at a very early age.

The attitude towards patients of 65+ wanting Botox tends to be much more liberal, i.e. “Well, if they want to pay for it!” . Many people are going on working to a much older age nowadays so increasingly defending this choice through preserving their youthful looks is important. Plus the generations of highly glamorous older celebrities are making the trend for much older Botox requests just as likely as unusually young Botox patients.

The Practitioner’s Perspective:

Of course, regardless of ability to Empathise and weigh up the emotional implications for your patients (i.e. do they really need this treatment to make them feel better about themselves?) there are still practical implications for the Aesthetic Practitioner, such as the health considerations caused by age.

“Too Young” and a patient is still developing – both physically and emotionally. With the 18’s – early 20’s age group, if you strongly believe that your Patient does not have any lines to treat and is simply feeling the pressure to live up to celebrity airbrushed distortions of  reality, then perhaps it is your ethical duty to explain this. At Cosmetic Courses we believe you should never, ever perform an Aesthetic Procedure purely for the money if the patient does not need it: this will not build up trust and is abusing your medical position.

On the opposite scale, whilst there is technically no reason why Botox treatment is unsafe for patients aged 65+, such treatment is considered “off label” i.e. not the norm. You may need to check out the patient’s skin elasticity, check extra carefully that they are in good medical health with no contraindications (watch out for blood thinning medications or neurological diseases). If all this is fine, then they are as good to go as any other patient!

With all patients who fall outside the “typical” age bracket for Botox treatments (i.e. those who could obviously and easily benefit from it), it is best for both the Patient and the Practitioner if the Consultation process involves a clear explanation of the results that may be achieved and the Patient’s expectations. This will ensure that the patient is not disappointed, and the Practitioner is not expected to perform impossible miracles!

Can you become immune to Botox?

The answer to this is yes you can become immune to Botox! But it is extremely uncommon.

There are a number of different types of botulinum toxins available currently in the United Kingdom.

These include Botox, Xeomin and Azzalure.

If your patient becomes allergic/immune to one of these types of toxin it is likely one of the others will work satisfactorily for them.

Botox is normally associated with botulinum toxin as hoover is to vacuum cleaners. However not all vacuum cleaners are hoovers and not all botulinum toxins are botox.

If your patient does feel their botox treatment is becoming less effective, you need to offer them a full consultation during which you may suggest using an alternative type of botulinum toxin.

Botox Training

If you would like to advance your Botox training options we have a variety of routes for you:

Dr Fiona Durban qualified from St Mary’s Hospital Medical School (Imperial College, London) in 2000 and also gained a Batchelor of Science degree in Medical Anthropology from University College London. She then went on to do training in General Practice and MRCGP (merit) in 2005 and also became a full member of the British College of Aesthetic Medicine.