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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:

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Learn advanced facial rejuvenation with the Aurora Lift

The Aurora Lift forms the basis of our advanced facial rejuvenation training – both for our team at Aurora Clinics, and our delegates at Cosmetic Courses.

It’s used by our trainers in their own clinics, and to date remains the best method our Clinical Director Adrian Richards has found to achieve natural results from non-surgical treatment.

It gives us a blueprint for treatment, helping us focus on the important areas to achieve the most natural and long-lasting facial rejuvenation.

So what is the Aurora Lift?

The Aurora Lift essentially involves looking at the face as an A-frame (see picture below) and treating it accordingly, using a combination of Botox and facial fillers.

A FrameWith age, facial volume migrates gradually southwards. This changes the shape of the face from the inverted triangle of youth, with its apex facing down, to the traditional triangle of middle age and beyond, with its apex facing up.

Using the A-frame concept, we’re able to focus on distinct treatment areas to effectively counter this ageing triangle inversion.

It involves subdividing the face into areas which lie along the limbs of an extended ‘A’. To achieve the most harmonious facial rejuvenation, we ask our practitioners and delegates to focus on these areas.

 Aurora Lift points for facial rejuvenationThe A-frame Zones for Facial Rejuvenation
  1. Glabella
  2. Cheeks
  3. Nasolabial Folds
  4. Marionette Lines
  5. Pre Jowl Salcus

Glabella

The apex of the A is located over the glabella. This is treated in most cases with our standard 5 point Botulinum toxin pattern. This involves a single sub-cutaneous injection over procerus and 2 into either corrugator.

We find that sub-cutaneous placement is more comfortable for the patient, produces less bruising and trauma and reduces the risk of toxin diffusion into orbit which can result in weakness of the eye muscles.

Cheeks

Working downwards, the next focus areas lie at the ends of the transverse limb of the A-frame – the cheeks.  Where possible, we ask clients to bring in old photos so we can assess their volume changes over time. Our aim is to restore their youthful volume, not add more than they had as this can produce an unnatural appearance.

We restore lost volume with filler within each of the fat compartments of the cheeks. Our preferred method of delivery is with a blunt-ended cannula rather than a needle, as we believe it gives us more control whilst minimising trauma.

Nasolabial Folds and Marionette Lines

Our next focus areas, along the limbs of the A-frame, are the nasolabial folds and marionette lines. Again our preference is a cannula, as there is only one point of entry and less trauma as a result.

Care must be taken not to add too much volume here, as excess volume in the lower face can age rather than rejuvenate.

Most patients treated with the Aurora Lift will also have toxin treatment to the depressor anguli oris muscle to upturn the mouth and reduce the amount of dermal filler needed.

Pre Jowl Sulcus

Finally, the base of the A-frame lies below the jowls. Again, our preference here is to use a moderate dose of toxin in this region to reduce the downward pull of the platysma on the jowls.

Find out more

At Cosmetic Courses, we teach the Aurora Lift at our bespoke advanced training sessions. Attend one of these hands-on training days and you’ll learn the principles of the A-frame approach, and how best to apply them to achieve harmonious pan facial rejuvenation for your clients.

For more information or to book a place on our advanced course, please contact the team on 01844 318317 or email [email protected].

 

 

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Allergan Vs Valeant – the takeover saga continues

Who knew a takeover bid in the pharma industry would be so thrilling? The battle between Allergan Vs Valeant is shaping up like an epic tennis match, with shot after shot screaming back over the net.

The last was from Valeant, who announced they were seeking to bypass Allergan’s board of Directors and take their hostile bid directly to shareholders.

But now Botox maker Allergan have hit a blistering return. To head off the $53 billion hostile takeover bid, the board are preparing a slew of measures – including taking on debt to buy back their own shares.

Also on the table is a plan to make acquisitions of its own (anything Valeant can do…), as well as a round of spending cuts to increase shareholder value, according to Chief Executive David Pyott.

The hope is that these measures will be enough to persuade shareholders that Allergan is better off going it alone.

It’s thought that Allergan will officially reveal their masterplan when they release their second-quarter results later this month. But even then it seems the battle won’t be over.

Valeant have hit back, saying they already have enough shareholders on side to call a meeting to try and replace Allergan board members with nominees who support their takeover bid. They need the support of shareholders who hold at least 25% of the company’s shares.

Financial Analyst Ronny Gal says that while it’s possible for Allergan to swing things in their favour, they will find it challenging.

“When I run my numbers, a buyback alone doesn’t quite cut it. A buyback plus another round of cost cuts, or the acceleration of the discussed cost savings, does.”

An acquisition could help them, according to Gal, but only if it increases their profits – and quickly. To win round short-term investors, he says, Allergan needs to deliver another $10 per share in 2015 or $11 per share in 2016.

Get comfortable. Allergan Vs Valeant is going to run and run…

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Is that illegal Botox in your face? Not sure really…

We recently reported on the scandal of illegal Botox being used in Australia. And now worrying findings in the UK have revealed that more than five in six people who have had Botox treatment admit to having essentially no idea what was injected into their face.

An alarming 84% of Botox patients questioned admitted they didn’t know what product was used on them when they had treatment. Nor did they know for sure whether it even contained the essential ingredient that makes the treatment effective – Botulinum toxin.

Other findings in the national study, carried out by a large cosmetic surgery group, included the fact that nearly a third (29%) of respondents said they had undergone illegal Botox treatment at a local beauty salon, 10% had Botox injections at home or at a friend’s house, and 3% were treated at a Tupperware-style beauty treatment party.

In keeping with these findings, and perhaps most worryingly of all, many of those questioned admitted they had no idea if the person administering their treatment was appropriately trained to perform the procedure.

But amid all these horrifying stats, there is perhaps a little hope on the horizon. Almost two-thirds of respondents (62%) who had either had or considered having non-surgical treatments agreed that the industry was not properly regulated, or that enough was being done to protect people having non-surgical treatments.

Tighter regulation can’t come soon enough.

Who are Cosmetic Courses?

Cosmetic Courses is the UK’s leading and longest established aesthetic training provider developed by Plastic Surgeon Mr Adrian Richards. We have 6 state of the art training clinics across the UK and over 50 online and offline courses available to medical professionals in botox and dermal fillers. Cosmetic Courses have trained over 8000 delegates to date.

To find out more about our aesthetic training courses for medical professionals please click here! 

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UK Approves Botox to Help Stroke Patients

Botox manufacturer Allergan have just announced the latest in a long line of approved uses for the product – treating ankle disability in stroke victims.The UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) have approved the drug to treat cases of ankle disability caused by the lower limb spasticity for Botox to Help Stroke Patients.

Spasticity is one of the most common after-effects of stroke and can have a far-reaching emotional and physical impact on  sufferers. Lack of mobility often leads to a complete lack of independence, which can in turn breed frustration and, in some cases, depression.

This approval represents a major leap forward, offering healthcare professionals an important new treatment option and providing real hope for patients suffering from lower limb spasticity.

To date, Botox to Help Stroke Patients will be the twelfth indication approved for Botox in the UK.

Professor Anthony Ward of the North Staffordshire Rehabilitation Centre had this to say about the new treatment:

“This is one of the most important advances the post stroke spasticity community has seen for years and will hopefully bring additional recognition to this complex and disabling condition.

“Studies show that Botox treatment can significantly improve the muscle tone in stroke survivors with lower limb spasticity. By allowing the ankle to function more normally, this can bring important mobility and physical benefits to patients, even those who have been suffering from this condition for many years.”

There are currently more than a million stroke survivors in the UK, with around 152,000 new cases every year. Many of these will face huge challenges in the aftermath of their stroke.

Some degree of disability is a common consequence of stroke, with 36% of survivors reporting moderate to very severe disabilities, with problems performing everyday tasks such as walking, washing, getting dressed and eating.

Treatment of lower limb spasticity after stroke currently includes physical therapy, drug treatments and, in some cases, surgery.

Joe Korner, director of External Affairs at the Stroke Association, said of the news:

“There can be significant advantages in using Botox to treat people whose movement and walking ability have been affected by stroke. Up to 30% of stroke survivors are living with muscle stiffness, known as post-stroke spasticity, which means they have abnormal tightness in some of their muscles.

“Whilst this treatment might not be suitable for every stroke patient, we encourage stroke survivors living with spasticity in their arms or legs to talk with their GP about management options that might be right for them.”

Who are Cosmetic Courses?

Cosmetic Courses are the Uk’s longest running aesthetic training provider offering botox and filler courses to medical professionals both online and offline. Find out more here! 

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Botox’s ever-increasing medicinal repertoire may soon include pain relief for cancer and arthritis sufferers

The positive uses that Botox can have on the body are well known within the medical industry, despite it being most commonly thought of as an anti-ageing cosmetic procedure.

Traditionally (indeed prior to its use as an anti-ageing injectible), it was formulated for and administered to those with eye problems, and has continued to be used in ophthalmology as well as helping to treat other ailments. These include hyperhidrosis (excessive sweating), overactive bladders and migraines.

Now though, one university professor has discovered a safe way that botulinum toxin (the full term for Botox) can be used to treat chronic pain, which would be tremendous news for those suffering from pain associated with cancer, arthritis and long-term back pain, for example.

The potential for Botox to be used as pain relief is not in itself a brand new discovery – it works by paralysing nerve endings to stop their usual function, so for example, in the case of wrinkles it freezes their movement and with bladder incontinence it stops the signal to urinate – by the same token it is known that it can suppress pain.

Until now though there was no known way that Botox could be administered without it paralysing the area in question and stopping it from functioning altogether, rather than simply paralysing the pain. But now Professor Bazbek Davle from Sheffield University has discovered a way that it might be used.

He and his research team have discovered that when using part of the botulinum poison and sticking it to extracted poison from the tetanus bug (the ‘friendly’ part of it) it can send signals from the painful area to the spinal chord, thus sending a message to the brain to freeze the pain rather than the area that it is administered to.

So far animal trials have proved positive, with large-scale human trials planned next. If these are successful then the drug could be available on the market within three years. It is not expensive, either – it will cost £1000 annually to produce, meaning that it should be readily available on the NHS. For those who suffer from long-term pain it should be welcome relief, especially as it will also negate the need for daily pill-popping.

Cosmetic Courses offer foundation, advanced and bespoke Botox courses to medical professionals seeking to enter the aesthetic industry. See our list of upcoming courses on our homepage.

 

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FDA approves Botox for the treatment of crow’s feet

September 11 witnessed new legislation for the use of Botox in the US – it is now legal to administer it to the fine lines around the eyes.

Up to now the Food and Drug Administration had only approved the cosmetic use of Botox for lines across the forehead and between the brows, however doctors have been using Botox in the treatment of lines around the eyes for a number of years.

The approval came after a study led by Allergan, the manufacturer of Botox, into its efficacy as an anti-ageing injectable. In a controlled group of 833 adults one half received Botox injections to the eye area and the other half received placebo injections to the same area. The group that received Botox displayed the most sign of a reduction of wrinkles.

Although Botox was being used by doctors ‘off-record’ in this way, the approval will mean better safeguards and guidelines. Dr Marco Harmaty, Plastic and Reconstructive Surgeon at Mount Sinai Medical Center in New York, told CBSnews.com that Botox has been used not only for crow’s feet for a number of years but also other unapproved parts of the face including creases by the side of the nose. However he also added:

“(It) does give you an added benefit and safety of saying that I’m not doing anything illegal or potentially harmful.”

The FDA approved Botox use for lines on the forehead in 2002.

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Pharmaceutical giant in hot water for alleged improper marketing of Botox

Pharmaceutical giant GlaxoSmithKline has come under fire in China for allegedly marketing Botox through improper practices, as well as being investigated for possible tax and invoice fraud.

The Wall Street Journal earlier this week reported that investigations are being carried out on the corporate behemoth for possible bribery and corruption, in a planned marketing strategy to boost sales in the emerging market. They claim to have seen evidence of emails targeted at 48 doctors which include cash and other incentives as a reward for prescribing Botox for therapeutic reasons.

The marketing strategy even took the name of a Russian World War II sniper, ‘Vasily’, after Vasily Zaytsev, with communication regarding the incentives supposedly sent to and from the private email addresses of GSK’s sales personnel.

GlaxoSmithKline have responded by announcing their own internal investigation and say initial findings show there has been no improper sales and marketing conduct carried out by sales staff at their organisation. A spokesperson for GSK in London announced:

“…we are investigating these new claims. However, our inquiries to date have found no evidence of bribery or corruption in relation to our sales and marketing of therapeutic Botox in China”

“GSK has some of the toughest compliance procedures in the sector. We are proud of our high standards and operate in accordance with them.”

GSK’s distribution of Botox in China is for therapeutic use (such as facial spasms) rather than cosmetic use ie. for the treatment of wrinkles.

Cosmetic Courses offer a wide range of aesthetic training courses to medical professionals. For information on any of our courses, contact the team on 01844 390110 or email [email protected].

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The ‘new Botox’ – or Frotox – arrives in the UK

One London clinic is now offering a Californian-produced alternative to Botox which promises the same results minus the toxins, which may come as welcome news to those who are interested in the results of the treatment but uncomfortable with the thought of what is in it.

iovera has been dubbed ‘Frotox’ due to its use of cryotherapy, effectively freezing, to produce the same results as Botox. Its results are said to be instantaneous as opposed to the few days that it can take for Botox to take effect. However its lifespan is slighter shorter lasting a maximum duration of four months.

Developed by medical technology group myoscience, it currently tackles forehead lines (running vertically or horizontally) through administering the treatment to either temple. A device filled with liquid nitrogen is placed next to the nerves which freezes the muscles used to control particular wrinkles. Advocates suggest that the accuracy of the nerve targeting is such that it still allows movement in the muscle.

The treatment lasts for 15 minutes and is so far retailing at £300 at a Harley Street Clinic. Some detractors insist that it poses no viable alternative to Botox, which has been used for several years, until its long-term safety and capability has been demonstrated.

Cosmetic Courses are the UK’s first surgeon led Botox course provider. Contact the team on 01844 390110 or email [email protected] for more information on any of our training courses.

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Botox and Dermal Fillers Foundation Training Course – Our Latest Feedback

We’ve collated the results of the feedback for our latest training course – and the results are very encouraging.

On Saturday 7th July, we ran another successful Foundation course in Botulinum Toxin and Dermal Fillers.

Though the course was fairly small, the feedback we received showed that satisfaction levels are going from strength to strength.

In fact, it was among the best feedback we have received since we began. We’re very proud to share the results with you here.

The Verdict

Here’s how our delegates rated us:

  • 100% would recommend the course and return for further training
  • 100% thought the speakers communicated effectively
  • 100% thought the venue was suitable for the training
  • 100% thought the demonstrations were well presented and informative
  • 100% thought the hands-on experience was valuable
  • 98% thought there was sufficient time for discussion

A fantastic set of feedback, and we hope that many of our Foundation course delegates choose to continue their study with Cosmetic Courses – either by moving up to the next level on our Intermediate and Advanced courses, or broadening their expertise into other areas like Dermaroller and Skin Peels.

If you would like to attend our next Foundation Botulinum Toxin and Dermal Fillers course, it will be held on Saturday 11th August. Click here to book your place. Alternatively, we are always happy to arrange bespoke one-to-one training sessions at a time that’s convenient for you. Contact us for more information on 0845 230 4110 or email [email protected].

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