By Dr. Cindy Kerbel
Muscle relaxing injections have become a staple in the toolkit of aesthetic medicine practitioners around the world. Its popularity amongst patients continues to grow and it is now one of the most common aesthetic procedures performed. Its discovery for use in aesthetic medicine is fascinating. Like many great breakthroughs in medicine, its use for aesthetic purposes in relaxing muscles and reducing wrinkles was discovered by accident.
Botulinum Toxin injections were initially used therapeutically by Ophthalmologists to treat strabismus (squint) and spasms of the eye (blepharospasm). It was Dr. Jean Carruthers who first noticed that when she treated her patients for strabismus and blepharospasm the appearance of the lines around her patients’ eyes would decrease. Together with her husband Alistair Carruthers, they published the first paper on the cosmetic use of neuromodulators and became pioneers for the use of Botulinum Toxin injections in aesthetic medicine.
Table of contents
- What is Botulinum Toxin?
- How does Botulinum Toxin work?
- What are the benefits of Botulinum Toxin injections??
- How long will Botulinum Toxin results last?
- Who is the ideal candidate for muscle relaxing injections?
- Non-cosmetic uses for Botulinum Toxin
- What is the best age to get Botulinum Toxin injections?
- Can Botulinum Toxin be reversed?
- Do’s and don’ts after getting Botulinum Toxin
- Muscle relaxing injections’ side effects
- Are Muscle Relaxing Injections Safe?
- How do I know which treatment to get?
What is Botulinum Toxin?
Botulinum Toxin is a neurotoxin that is produced by the bacterium Clostridium botulinum. The form of Botulinum Toxin that is used today for its muscle-relaxing properties is a purified form of botulinum toxin type A which is used to block the release of acetylcholine and, in turn, relax the muscles in that region.
How does Botulinum Toxin work?
Botulinum Toxin works by temporarily blocking nerve signals that make muscles contract. The benefit from an aesthetic perspective is that the relaxation of these muscles leads to the diminished appearance of lines and wrinkles, thereby allowing patients to look more refreshed and youthful.
What are the benefits of Botulinum Toxin injections?
Muscle relaxing injections are best known for the beneficial role they play in combatting the gradually evolving signs of ageing. Botulinum Toxin injections are used primarily to treat the static lines and wrinkles that form on our faces as a result of repetitive muscle movement, smoothing out lines and providing a rejuvenated appearance. Botulinum Toxin can also be used for ‘prejuvenation’. This involves its use, in smaller doses, to treat the early signs of wrinkle formation in order to prevent those deeper static lines from forming in the first place. Therefore, when used correctly, it has a place for both younger and more mature patients alike.
How long with Botulinum Toxin results last?
The effect of the Botulinum Toxin injections will start to fade gradually over time and as facial movement resumes, patients will be ready for their next treatment. For most areas, particularly in the face, the effect of Botulinum Toxin will last for three to four months. There are some patients, however, who will still have a result for up to six months. Whilst Botulinum Toxin is not reversible, it will eventually be cleared completely from the body.
Who is the ideal candidate for muscle relaxing injections?
Any patient who is starting to see early signs of wrinkle formation or who already has established wrinkles is a good candidate for muscle-relaxing injections.
There are many areas that can be treated. The most common areas are the frown (glabellar complex), forehead, and around the eyes (crow’s feet).
Botulinum Toxin injections can also be used to treat ‘bunny lines’ (those little lines that appear on either side of your nose when you scrunch it up), smokers lines around the lips, as a ‘lip flip’ (to gently evert the appearance of the upper lip giving the subtle impression of more volume), to correct a gummy smile, to help neutralize the downward pull on the mouth corners and for overactive chin muscles (where dimpling of the chin becomes prominent). It can even be used to inject into the platysma bands in the neck to minimize the downward pull of the neck on the lower face.
It is important to remember that whilst Botulinum Toxin is often used for anti-ageing and aesthetic purposes there are also several other conditions that it can treat.
Non-cosmetic uses for Botulinum Toxin
When injected into the Masseter muscles, Botulinum Toxin can also be used to help relieve the symptoms of Bruxism which involves painful jaw clenching and teeth grinding. It is therefore used to relieve pain, protect the surface of the teeth from wearing down, and slim the jawline in the process.
Excessive sweating (hyperhidrosis) is another condition that can be successfully treated with Botulinum Toxin injections when it is injected into the axillae (armpits). Can you just imagine the relief of not having to worry about sweating through your clothes or the constant concern about the odour that excessive sweating carries?
Yet another use for Botulinum Toxin that is rarely spoken about is its role in treating Vaginismus (the involuntary, painful spasm of the vaginal muscles). Whilst the treatment of this condition may be challenging and often requires a multi-disciplinary, holistic approach, the use of muscle relaxing injections to aid in relieving the spasm is key.
What is the best age to get Botulinum Toxin injections?
There is no specific or ideal age for when a patient should start with muscle-relaxing injections. As previously mentioned, young patients who are starting to see lines and wrinkles appear on their faces (particularly frown lines, lines on their foreheads or around their eyes) may want to start with a small amount of Botulinum toxin injections to treat those lines and prevent them from deepening or becoming ‘etched in’.
Older patients who already have established lines and wrinkles will also still benefit from muscle-relaxing injections. In this case, the use of Botulinum Toxin may not necessarily eradicate all the visible lines but will rather lead to a softening of the lines and a more refreshed appearance for the patient. Regular, repeated treatments will further aid in relaxing these lines even further over time.
Can Botulinum Toxin be reversed?
Unfortunately, Botulinum Toxin is not a reversible agent, so it is important to use an experienced injector and start with lower doses if deemed necessary by the doctor. One can always add more by topping up with a few units 2 weeks after the initial treatment or increase the dose (number of units used) at the next treatment if the dose is too low. The effect of Botulinum Toxin will wear off completely as your body metabolizes the product and clears it but that will usually take 3 to 4 months.
Do’s and don’ts after getting Botulinum Toxin
Once you have had your muscle relaxing injections you will be asked not to lie down or lean forward (keep your head above the level of your heart) for the next 6 hours. It is also important not to rub the area injected to make sure that the product remains where it has been placed, spreads in a predictable manner, and that it does not spread to areas where it was not intended to reach. Patients are also asked to refrain from any high-impact exercise for at least 24 hours.
Muscle Relaxing Injections side effects
The most common side effects are mild pain, swelling, or bruising at the site of the injections. These are transient and improve quickly.
Allergic reactions to Botulinum Toxin injections are extremely rare but are possible. It is for this reason that these injections should always be performed by an experienced aesthetic practitioner and in a medical practice that is fully equipped to deal with such a situation should one arise.
Are Muscle Relaxing Injections safe?
If used correctly by an experienced injector then yes, Botulinum Toxin injections are generally safe. As with any injectable, there is always the potential risk of a bruise, so it is advisable not to do a treatment too close to any special events (ideally not within two weeks). This ties in perfectly with Botulinum Toxin as the results take 2 weeks to settle completely and take full effect.
The use of Botulinum Toxin is contraindicated in patients with a personal or family history of Myasthenia Gravis (a rare neuromuscular disease that causes muscle weakness). It is important that this history is taken prior to the administration of any muscle relaxing injections as it may worsen their condition.
We are often asked if pregnant or breastfeeding patients can have Botulinum Toxin injections. Whilst there is no definitive evidence showing that it will cause harm, there is also not sufficient evidence to prove that Botulinum Toxin injections are safe for use during pregnancy and lactation. Due to ethical and understandable considerations, these are patient groups who have not been included in clinical trials. Most doctors will therefore recommend deferring muscle relaxing injections until after the baby is born and until breastfeeding has ceased.
How do I know which treatment to get?
As with any aesthetic treatment or injectable procedure, it is always best to start with an in-depth aesthetic consultation. This is to ensure that a complete medical and aesthetic history is taken, and a facial analysis is performed. At Dr Nerina Wilkinson and Associates we use the initial consultation to understand our patients’ individual and specific desires and needs. In this way, a bespoke treatment plan can be created to help each patient feel like their best, most confident self.
To embark on your aesthetic couture journey, email capetown@drnwilkinson.co.za to get started today.
Written by Dr. Cindy Kerbel
