Botulinum toxin

25 June 2019

Article by: Dr. Felix Yap Boon Bin

What is botulinum toxin?

Botulinum toxin (BTX) is a neurotoxin produced by the gram negative bacteria, Clostridium botulinum that inhibits the chemical acetylcholine released from the nerve causing inhibition of muscle contraction. If used in large quantities, it can cause whole body muscle paralysis leading to death by asphyxiation. In medicine, BTX can be used to reduce the spasm in patients with spastic cerebal palsy, stroke, spinal cord injury; spasm of the neck; twitching and spasm of the face and eyelids, spasm of the bladder and spasm of the anal opening in anal fissures. In dermatology, BTX is used in a very small dosage to allow for inhibition of specific muscles to diminish the wrinkles and fine lines caused by the muscle contraction.


Is botulinum toxin same as BOTOX?

There are 2 types of BTX used in medicine ie. BTX type A and B BOTOX is a brand name for botulinum toxin A. Other brands include XEOMIN and Dysport.

How can botulinum toxin improve facial appearance?

Frown lines, crow’s feet and forehead lines are dynamic wrinkles caused by contraction of the frowning muscles, eye muscles and forehead muscles. They can be inhibited by small amount of BTX. BTX can also be used to reduce the side of the chewing muscles of the jaw allowing for V shaping of the face.

Botulinum toxin

How is botulinum toxin delivered?

It is directly injected into the desired muscles.


How long is the procedure?

Very fast, usually less than 10 minutes.


Is it painful?

Minimal, like an ant bite. Those who are very pain sensitive can always apply numb cream for 30 minutes before the procedure to numb the areas for injection.


How much botulinum toxin is needed for the wrinkles?

The treating doctor will discuss about the amount of BTX to be injected and the expected outcome. Generally, the forehead wrinkles need between 8 to 20 units, frown line 12 and 20 units, crow’s feet 12 and 28 units and jaw muscles 40 and 100 units per session.


Is it possible to go back to work right after the botulinum toxin injection?

Yes. There is minimal redness and bump that will disappear in approximately 30 minutes.


How long to see the effect?

Usually 3 to 5 days.


Are there any side effects of the injection?

It is a very safe procedure. The commonest side effects are bruising if a vessel is injected during the procedure and pain of the injection site. Other rare side effects include droopy eyes, eyelid swelling, headache, dry eyes, blurred vision, dry mouth, tiredness, neckache and allergic reaction.


Will the face appear unnatural and rigid after botulinum toxin?

No. It is likened to reversing the wrinkles by 20 years on the face.


How long does one session of botulinum toxin works?

3 to 6 months depending on the amount injected. Also dependent on the activities of the affected muscles; the more active the usage, the earlier the toxin effect wear off.


Is there a need to increase the amount of botulinum toxin over the years?

In most individuals, it remained the same. Some might need less as the muscle activity wane with time. Some might need more if there is the body immune system react against the toxin rendering the toxin less effective.