Botox® and Dysport® are the specialities used in medical indications (ophthalmology, neurology, and otorhinolaryngology). Vistabel® and Botox-Cosmetic are the specialities of the Allergan laboratory, which obtained the marketing authorization (A.M.M and FDA approvals) for wrinkle correction, but their action is exactly identical to that of Botox®.

Botox is one of the many trade names for the neurotoxic protein called Botulinum Toxin that is produced by the bacterium clostridium botulinum. In large doses, the protein causes botulism, a rare paralytic illness often linked to food poisoning.

The protein is used in cosmetic medicine to treat moderate to severe brow frowning (glabellar lines), uncontrolled blinking, lazy eye, wrinkles, and upper facial creases. These procedures use a small amount of diluted Botulinum Toxin that enables controlled weakening of muscles.

Botulinum Toxin is sold commercially under the brand names Botox, BTXA, Dysport, Myobloc, Neurobloc, Xeomin, Botox Cosmetic, and Vistabel.
Botox widely used for non-cosmetic medical procedures.

In addition to cosmetic use, Botox is used to treat cervical dystonia, writer's cramp, excessive sweating, achalasia (an esophagus problem), chronic pain, neuropathy, and migraine headaches.

For people with overactive bladders, Botox can improve their quality of life, say researchers from King's College London School of Medicine, London, England. Botox administered to the bladder is as good as prescribed medications for tackling urinary urgency and twice as effective in eliminating symptoms completely.

Men with enlarged prostates benefit from Botox injections directly into the prostate, a study at University Medical College, Taiwan found.

It is also a possible treatment for some cases of depression.

Some studies have indicated that Botox used for aesthetic purposes can help people with mental illness. A study published in Dermatologic Surgery found that treating clinically depressed patients with Botox on the frown lines of their faces actually got rid of their depression.

Anti-wrinkle injection - Botox works by blocking the signals from the nerves to the injected muscles. The muscles can no longer contract strongly, causing the wrinkles to relax and soften. It is most often used on forehead lines, laughter lines and frown lines.

Anti-wrinkle injection- Botulinum Toxin is a naturally occurring substance, it can be used as an effective and powerful medication.

Botox works to relax the contraction of muscles by blocking nerve impulses. The result is muscles that can no longer contract, and so the wrinkles relax. It usually takes two to ten days to see cosmetic improvement and the effects tend to last from four to six months.

Most patients require retreatment to remove wrinkles and lines as they begin to reappear, but after each injection the wrinkles return less and they are not as severe, as the muscles are trained to relax.

Researchers discovered in the 1950s that injecting overactive muscles with minute quantities of Botulinum Toxin type A would result in decreased muscle activity by blocking the release of acetylcholine from the neuron, by preventing the vesicle where the acetylcholine is stored from binding to the membrane where the neurotransmitter can be released. This will effectively weaken the muscle for a period of three to six months.

Anti-wrinkle injection treatment areas may include:

Frown lines between the eyebrows and on the bridge of the nose
Squint lines (Crow's-feet ) at the corners of the eyes
Forehead creases

Not all facial wrinkles benefit from anti-wrinkle injections. Anti-wrinkle injection won't reverse wrinkles caused by sun damage. It is also less desirable to treat the lines around your mouth because muscles in this area are needed for eating and talking.

The skin type, skin thickness and degree of wrinkling all play a role in determining whether these injections are effective or not.

Patients should only get anti-wrinkle injections in a clinic by a doctor. They should never share a tube of anti-wrinkle injection. Anti-wrinkle injections should be performed by doctors who are experts in skin care and facial anatomy

Since anti-wrinkle injections don't work for all wrinkles, a consultation with Dr Ayham Al-Ayoubi is essential.

Those below should not have Botox:

Clients who are pregnant or trying for pregnancy, breastfeeding
Patients with certain neuromuscular conditions (e.g. myasthenia gravis)
Those with infections at the treatment site
Patients taking aminoglycoside antibiotics or captopri preparation/typical procedure

The anti-wrinkle injection is injected with a fine needle into specific muscles with only minor discomfort. A topical ice pad should be applied to the skin to decrease the sensation of the injection. It generally takes between two to fourteen days to take full effect and it is best to avoid alcohol and exposure to excessive sunlight at least five days prior to treatment. Aspirin should be stopped two weeks before treatment in order to reduce bruising.

A few simple measures may optimize the safety and improve the results of treatment. To minimize the risk of later bruising, it is recommended that patients discontinue any non-essential medications or dietary supplements that can cause thinning of the blood:

Aspirin (2 weeks prior)
Non-steroidal anti-inflammatory medications (ibuprofen, naproxen, etc)
Fish oil supplements
Vitamin E
Gingko and ginseng
Red wine

A typical visit usually takes thirty minutes, with a slightly longer visit in the case of a first-time patient, as a lengthier discussion is needed to explain the procedure and its possible side effects.

Anti-wrinkle injections require no downtime, however, at the London Medical and Aesthetic Clinic we advise not to drink alcohol or exercise within twenty four hours of the procedure. It is also advisable to not lie down for a few hours after the treatment.

You may have headaches for a few hours after the treatment. Take care, though, not to rub or massage the treated areas. This can cause the toxin to migrate to a different area of your face. If this occurs, temporary facial weakness or drooping is possible.

It is reccomended to schedule treatments around every six months to help maintain a consistent appearance in the first year, from then on treatment can be delayed by a few months each time, as wrinkles have become less apparent.

Botox has been used in medicine for almost 30 years. There are approximately 1800 published studies about it, making it one of the best-researched medicines ever. Dosages used to treat children with cerebral palsy may range from 100 to 400 units, whilst typical dosage for cosmetic use is 20-50 units.

The cosmetic effect of Botox on wrinkles was originally documented by a Plastic Surgeon from Sacramento, California, Dr. Richard Clark, and published in the journal Plastic and Reconstructive Surgery in 1989.

Canadian husband and wife Ophthalmologist and Dermatologist Physicians, JD and JA Carruthers, were the first to publish a study on Botox for the treatment of glabellar frown lines in 1992. Similar effects had reportedly been observed by a number of independent groups (Brin, and the Columbia University group).

After formal trials, on April 12, 2002, the FDA announced regulatory approval of Botulinum Toxin type A (Botox Cosmetic) to temporarily improve the appearance of moderate-to-severe frown lines between the eyebrows (glabellar lines). Subsequently, cosmetic use of Botulinum Toxin type A has become widespread, with many people viewing it as less intrusive and/or artificial than other types of plastic surgery.

Who can benefit from Botox treatment?

Obviously only a consultation with a cosmetic doctor will be able to establish this. Generally speaking, if some have dynamic lines around the upper part of the face, which are caused by muscle contraction, i.e. in the frown area between eyebrows, forehead and latrel of the eyes, then Botox will help smooth this.

Depending on how deep the line is, Botox will undoubtedly help and most times smooth it away, however, if the line is very deep, sometimes further treatment with an injectable skin filler is required in order to get total smoothing of the skin.

It is important to understand that whilst Botox is well tolerated by most people, patients who are pregnant, breast feeding or have neurologic or muscle disease should not be treated.

If dynamic wrinkles make you look older than you are, cosmetic 'denervation' can smooth these out and give you a more youthful and pleasing appearance, however, this treatment cannot improve wrinkles due to aging and sun-damaged skin, since they are unrelated to upper facial muscle contractions.

Muscle relaxing injections will not improve sagging skin or replace the need for a facelift or brow lift.

The early clinical studies indicate that the duration of the treatment benefits, increased over time, so that you should require fewer injections in the future. The duration of the effect varies from patient to patient and may be less effective for those over 65 years of age.

Not all facial wrinkles benefit from anti-wrinkle injections. They won't reverse wrinkles caused by sun damage. It is less desirable to treat the lines around your mouth because muscles in this area are needed for eating and talking.

The skin type, skin thickness and degree of wrinkling all play a role in determining whether these injections are effective or not.

Since anti-wrinkle injections don't work for all wrinkles, a consultation with Dr Ayham Al-Ayoubiis essential, however, those below should not have Botox:

Clients who are pregnant or trying for pregnancy, breastfeeding
Patients with certain neuromuscular conditions (e.g. myasthenia gravis)
Those with infections at the treatment site
Patients taking aminoglycoside antibiotics or captopri preparation / typical procedure

Which Areas can be treated with Botox?

Any muscle activity on the body can be targeted with Botox, however, it is most commonly performed in the upper face.

The most common areas requested are: the forehead lines, vertical frown lines between the eyebrows, and crows feet or laughter lines, radiating away from the eyes. Whilst it does work around the mouth, chin and neck area, the benefits must always outweigh any possible weakness of the mouth muscles. This of course will be discussed with Dr Ayham Al-Ayoubi prior to any treatment. Smile lines are usually best dealt with either by injectable fillers, or CO2 Laser Resurfacing.

How does Botox work?

Anti-wrinkle injection - Botox works by blocking the signals from the nerves to the injected muscles. The muscles can no longer contract strongly, which causes the wrinkles to relax and soften. It is most often used on forehead lines, laughter lines and frown lines.

When injected into a given area Botox, which is the trade name of Botulinum Toxin type A, reversibly blocks the impulses from the nerves to the tiny facial muscles that are related to expression lines. By doing this, the muscles cannot contract or move well enough and therefore tend to relax. When muscles relax, the overlying skin remains smooth and unwrinkled, while the untreated facial muscles continue to contract in a normal fashion, allowing normal facial expression to be unaffected.

Anti-wrinkle injection Botulinum Toxin is a naturally occurring substance, it can be used as an effective and powerful medication.

Botox works to relax the contraction of muscles by blocking nerve impulses. The result is muscles that can no longer contract, and so the wrinkles relax and soften. It usually takes two to ten days to see cosmetic improvement and the effects tend to last from four to six months.

Most patients require re-treatment to remove wrinkles and lines, as they begin to reappear, but after each injection less severe wrinkles return, as the muscles are trained to relax.

Researchers discovered in the 1950s that injecting overactive muscles with minute quantities of Botulinum Toxin type A would result in decreased muscle activity by blocking the release of acetylcholine from the neuron by preventing the vesicle where the acetylcholine is stored, from binding to the membrane where the neurotransmitter can be released. This will effectively weaken the muscle for a period of three to six months.

Anti-wrinkle injection treatment areas may include:

Frown lines between the eyebrows and on the bridge of the nose
Squint lines (Crow's-feet ) at the corners of the eyes
Forehead creases

Not all facial wrinkles benefit from anti-wrinkle injections. Anti-wrinkle injection won't reverse wrinkles caused by sun damage. It's is less desirable to treat the lines around your mouth because muscles in this area are needed for eating and talking.

The skin type, skin thickness and degree of wrinkling all play a role in determining whether these injections are effective or not.

A typical visit usually takes thirty minutes, with a slightly longer visit in the case of a first-time patient, for a lengthier discussion that explains the procedure and its possible side effects.

Typically Botox treatments start to take effect from about the third day after the injections. It may or may not be associated with some very minor tingling, which disappears within a day or so, however, patients must understand that it may take up to ten days for the full effects of your treatment to be seen.

The full effects of a Botox treatment are not apparent for three to ten days. As mentioned the effects are temporary. The toxin is slowly metabolised by the body in approximately four to six months. Even if most patients are happy with the effects of Botox, a top up injection will be required after this period of time to maintain the skin smoothing effects.

How is Botox administered?

The procedure itself is simple and safe. The facial movements and expressions will be assessed prior to treatment. Depending on the areas, Dr Ayham Al-Ayoubi will endeavour to explain how effective the treatment will be. Very deep ingrained lines sometimes require an injectable skin filler after a couple of weeks. In order to get the skin completely smooth he will advise accordingly.

Botox is injected with a very tiny needle into the desired area. Depending on the areas treated, between six to eight injections are necessary. The needle is so fine and only a small amount of liquid is used, so the pain is usually very minor, like a sting for a few seconds. Once the injection is complete there is usually no discomfort. Patients might feel slight sensitivity in the area for the next twelve to twenty four hours, which settles on its own.

No sedation or local anaesthesia is required, and as no recovery is required, patients can resume normal activities immediately and can even drive home or back to the office. Very occasionally, some patients experience slight temporary bruising or redness at the injection site. This can be covered with makeup, as necessary.

An Anti-wrinkle injection is injected with a fine needle into specific muscles with only minor discomfort. A topical ice pad should be applied to the skin to decrease the sensation of the injection. It generally takes between 2-14 days to take full effect and it is best to avoid alcohol and exposure to excessive sunlight, at least five days prior to treatment. Aspirin should be stopped two weeks before treatment in order to reduce bruising.

Aspirin (2 weeks prior)
Non-steroidal anti-inflammatory medications (ibuprofen, naproxen, etc)
Fish oil supplements
Vitamin E
Gingko and ginseng
Red wine

Patients should only get anti-wrinkle injection in a clinic by a doctor. They should never share a tube of anti-wrinkle injection. Anti-wrinkle injections should be performed by doctors who are experts in skin care and facial anatomy. A typical visit usually takes thirty minutes, with a slightly longer visit in the case of a first-time patient as a lengthier discussion is needed to explains the procedure and its possible side effects.

Anti-wrinkle injections require no downtime, however, at the London Medical and Aesthetic clinic we advise not to drink alcohol or exercise within tewnty four hours of the procedure. It is also advisable not to lie down for a few hours after the treatment.

It is recommended to schedule treatments around every six months to help maintain a consistent appearance in the first year, from then on, treatment can be delayed by a few months each time, as wrinkles have become less apparent.

Post treatment care

Anti-wrinkle injections require no downtime, however, at the London Medical and Aesthetic Clinic we advise not to drink alcohol or exercise within 24 hours of the procedure. It is also advisable to not lie down for a few hours after the treatment.

It is recommended to schedule treatments about every six months to help maintain a consistent appearance in the first year, from then on, treatment can be delayed by a few months each time as wrinkles have become less apparent.

Possible side effects

There are very few side effects to the Botox procedure. While allergy to any medicine is possible, it is rare indeed with Botox.

Safety of Botox is clear, however, some patients may experience side effects.

The most common side effect of Botox is temporary, slight bruising that can sometimes occur, however, this can usually be covered with make-up.

Headaches, which get betther within twenty four to fourty eight hours, can occur, but these are rare.

Inappropriate facial expression, such as drooping eyelid and a very small amount of brow drooping can occur when injected in this area, this can usually be avoided by not treating the 1-cm area just above the eyebrows. Despite precautions in exceptionally rare circumstances this can still occur, however, due to the non-permanent nature of Botox this is always temporary.

Uneven smile or loss of the ability to close the eyes. This will wear off in around two- six weeks.

Other adverse events from cosmetic use, include: headaches, dysphagia, flu-like syndromes, blurred vision,double vision, dry mouth, fatigue, allergic reactions and swelling or redness at the injection site.

Individuals who are pregnant, breastfeeding or have egg allergies or a neuromuscular disorder are advised not to to have Botox treatment at all.

Rarely, patients may develop eyelid drooping. This usually resolves in three to four weeks. This development is usually caused by migration of the anti-wrinkle injection and for this reason, you shouldn't rub the treated area for twelve hours after injection or lay down for three to four hours.

Patients can reduce the risk of bruising by avoiding aspirin or ibuprofen-type drugs in the week prior to treatment (as these drugs thin the blood and are best avoided prior to any injectable treatment).

Also Botulinum Toxin type A (Botox) was approved for the treatment of excessive sweating in the United Kingdom in July 2001.

The drug has been used in medicine for almost thirty years. There are approximately 1800 published studies about it, making it one of the best-researched medicines ever. Dosages used to treat children with cerebral palsy, may range from 100 to 400 units, whilst typical dosage for cosmetic use is 20-50 units.