Botulinum Toxin (Botox)

For many women, including women with brown skin, our faces tend to show the signs of aging before other parts of our body. After years of making the same facial expressions, coupled with the effects of gravity, lines and folds begin to form. With repeated facial expressions, the muscles under our skin contract and pleat the skin creating “frown” lines that appear between the eyebrows (also called glabellar lines), on the bridge of the nose, across the forehead, and at the corners of the eyes. These lines become much more pronounced as we age and are often more noticeable in women, whose faces are naturally more animated than men’s. In recent years, the use of different muscle relaxants has become popular as a way to reduce some of these prominent folds, and help us look more youthful. There are three different muscle relaxants available today, Botox, Myobloc, and Dysport, with Botox being the most popular.

What exactly is Botox?
Botox is the trademarked name for the neurotoxin, botulinum toxin A (manufactured by Allergan). It is produced by the bacterium Clostridium botulinum and the cosmetic form of this toxin is injected directly into muscles to reduce the visibility of “frown” lines. The toxin actually blocks the nerve impulses from the brain to your muscle. It does this by blocking the release of a chemical called acetylcholine. When a small amount of Botox is injected, for example, into the muscle that causes the glabellar frown line, relaxation and weakness of the muscle occurs and it therefore gives the skin a smoother, less wrinkled appearance. The injection may also slow the formation of deeper or new wrinkles. Studies have also suggested that Botox can be used to relieve migraine headaches, excessive sweating and muscle spasms in the neck and eyes.

What happens when you get Botox? If you are thinking about having Botox, you need to know that the procedure is fairly simple, requires about 15 minutes of your time and the recovery period is very short. Typically you would sit in a chair similar to a dentist’s chair, your skin would be cleansed with alcohol and the dermatologist would administer the Botox injections with a tiny needle directly into the muscles causing your frown lines. Since discomfort is minimal and brief, no anesthesia is required. You may feel between five and ten tiny pinpricks as the Botox is being injected into your frown lines. Although the Botox will immediately begin to relax these muscles, you will not notice any physical changes for several days. Since the size, location, and use of facial muscles differ with every person, your doctor will decided where you need the injections, how many injections you will need and how much Botox you will be given during the treatment. Regular activity may be resumed immediately after the procedure, although you will be asked not to lie down for 4-6 hours after the procedure. Makeup may be worn afterwards, but care should be taken to avoid applying pressure to the area for several hours.

What else do you need to know about Botox?
You will notice a marked improvement within the first week of treatment, and this improvement often continues into the first month. As time goes on, you will notice that the effects of Botox will gradually wear off. Treatment effects can last anywhere from 3-5 months, but most people consider re-injection after 3-4 months. Doctors, however, discourage having injections too often (less than every 3 months), since repeated treatments could cause atrophy (thinning) of muscles.

As with all procedures, there are some potential risks and side effects, most of which are minimal and typically relate to the local injection. You may experience soreness or mild bruising around the injection site after the treatment. Should soreness and bruising occur, they resolve within 5-7 days without treatement. Some patients, in rare occasions, have developed temporary weakness of the neighboring muscles, or a temporary droopy brow or eyelid (ptosis). Less frequent adverse reactions have included pain in the face, and redness at the injection site. Overall, patients found these reactions to be temporary, but some lasted several months. None, however, significantly limit routine activities. Also, there is no chance of contracting botulism from Botox injections.

If you decide to begin Botox treatments, it is very important to discuss any health issues with your doctor before starting your treatment. Tell your doctor if you have any diseases that effect your nerves or muscles, are breastfeeding or hope to become pregnant soon. Also, you should not undergo treatments if you have an infection at the injection site, are allergic to any of the ingredients in the injection, or if you are pregnant. Lastly, be sure that your doctor knows the names of all the medicines you are using and also any over-the-counter medicines or herbal products you use, since your other medications may interact with the Botox.

Botox should only be administered by a healthcare professional. You should also know that these treatments are only approved by the FDA for people between the ages of 18 and 65. It is advisable to go to someone with more experience, so a dermatologist is generally your best bet. Also, your dermatologist will be the only person who can really decide if Botox treatment is right for you, so it is important to obtain a consultation before making any decisions about muscle relaxant treatments.

Botox injections are one of the fastest-growing cosmetic procedures. In April 2002, the FDA granted approval of the drug for reducing frown lines up to 120 days. However, Botox is often used by licensed practitioners to treat wrinkles in areas of the face other than those specified by the FDA, such as the lip, eye and neck areas. It is very important to realize that Botox is a prescription drug that should only be administered by a qualified physician in an appropriate medical setting. Avoid having unqualified people perform injections of Botox in places such as salons, gyms, hotel rooms, home-based offices, and other retail venues. Also to be avoided are Botox “parties”. When you receive inexperienced or unlicensed treatments, you risk encountering improper technique, inappropriate dosages, and unsanitary conditions. Since there is always a risk of a patient reacting adversely to any medication, it is important that people receiving the treatment be in an environment equipped to handle any emergencies that may arise.

Another important use of botulinum toxin is in the treatment of hyperhydrosis--severe underarm sweating--which cannot be managed with antiperspirants or other topical treatments. Botulinum injections help control excessive sweating in the same way that they treat facial wrinkles. The chemical is injected into the underarm area (axilla) and then acts by temporarily blocking the chemical signals that stimulate your sweat glands. When your glands don’t receive the signals from your brain, they stop overproducing sweat. Although the injection acts in the same manner as the facial injections, the results take a bit longer to set in. Patients usually notice a reduction in sweating within several weeks of their initial treatment, with results lasting 3-8 months. After repeated treatment, patients often report a more permanent reduction in sweating. However, it is possible that some glands may not respond and you may still experience some sweating in select areas. Side effects are similar to those for injections of the frown lines. However, some patients may also experienced injection-site pain, bleeding, a complete lack of underarm sweating, or infection.

Dysport and Myobloc
Two other common types of botulinum toxin are Dysport and Myobloc. Both treatments are preformed in the same manor as Botox and have the same effects, but with a few small differences. Dysport, Botox’s counterpart used in most of New Zealand, England and other parts of Europe, is manufactured by Ipsen Limited, and is used to treat patients in the same manner as Botox. It is also the same toxin, botulinum strand A, as Botox and was initially used in treating motor disorders and various kinds of involuntary muscular spasms. In New Zealand, Dysport now has registration approval under the Medicines Act for the treatment of frown lines and for excessive sweating in the armpits. It also shares the same risks and results as Botox; however, Dysport is sometimes injected more often than Botox. Doctors abroad who use the toxin tended to perform the injection every 8-12 weeks. This injection schedule has not been reviewed by the FDA.

Myobloc, a product of Elan pharmaceuticals, and its European counterpart, Neurobloc, are also very similar to Botox. Instead of deriving from the "A" Strand of botulinium Toxin, Myobloc is from the "B" strand. . Myobloc may have a somewhat quicker onset of action, but begins wearing off more quickly than Botox injections (6-8 weeks for Myobloc compared to 3-5 months for Botox), Myobloc shares the same general risks as Botox and Dysport.

Bottom Line
Botulinum Toxin injections have grown in popularity because they are a fast and minimally invasive way to give brown skin a quick "pick-me-up". Because the procedure is not permanent and requires no recovery time, it is often a smart and easy alternative to the more drastic anti-aging procedures, which are often not necessary for brown skin. Just as with any medical procedure, the choice to receive injections should always be well thought out and discussed with your dermatologist.

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