Signs of aging such as fine lines and wrinkles, and sagging skin are a woman’s major skin concerns. In Singapore and elsewhere in Asia and in the West, more and more people are turning to doctors for aesthetic solutions beyond skincare, to address those concerns. Injectables such as Botox is one of the most popular and accessible in-clinic procedures used to combat the signs of aging.
What Is Botox?
Botox is the brand name of a neurotoxin produced by the bacterium Clostridium botulinum. This bacteria thrives under low oxygenated conditions, usually found in soil and untreated water. In Singapore, it is being used medically to treat certain muscular conditions, and cosmetically to erase fine lines and wrinkles by temporarily freezing your facial muscles.
How Does Botox Work?
Botox blocks the signal from the nerve to the muscles, thereby paralyzing them. The injected muscle is rendered unable to contract, causing the area to relax and smoothen as a result. Despite Botox being a powerful poison, it is still very popular due largely to its offerings of therapeutic applications if used correctly.
Botox is administered by diluting the powder in saline and is then injected with an ultra-fine needle directly into the neuromuscular tissue. There are currently four HSA-approved brands of botulinum toxin in Singapore: Botox by Allergan, Dysport by Ipsen, Xeomin by Merz and Neuronox by Medy-Tox. The four approved labels are prescription drugs, for use only in a clinic and performed by a licensed and trained doctor. The number of units required for each area varies between individuals, with some areas requiring more units than others.
Botox can be used to treat many concerns including fine lines and deep wrinkles, excessive or unwanted sweating, to correct imperfections in facial symmetry, to name a few. As Botox only works on dynamic wrinkles or “expression lines” – those that are caused by muscle movement, it is predominantly used to smoothen glabellar lines (frown lines) and forehead wrinkles, prominent lower eyelids, canthal lines (crow’s feet), bunny lines (beside the nose), perioral lines (around the lips), marionette lines (corners of the mouth), chin creases as well as neck folds. By strategically targeting specific muscles, facial aesthetics can be much improved such as raising the eyebrows to widen the eye area and give the face a more open, youthful appearance, or lowering the upper lip to help create a less gummy smile. Botox will not work on static wrinkles or fine lines and wrinkles caused by sagging such as those lines on the cheek, neck and jowl areas.
What Can Botox Do For You?
Beyond aesthetic applications, Botox can be used to treat over 20 different medical conditions including chronic migraines, eye squints, strabismus (crossed eyes), primary hyperhidrosis (excess sweating), incontinence and post-stroke upper limb spasticity. Research has also shown that Botox can affect sebaceous or oil glands, blood vessels in the face, even frozen shoulder and bruxism.
Women with a square jaw find their appearance rather severe and masculine and would much prefer a slimmer and more feminine jawline. Chewing on foods such as dried squid or teeth grinding can result in overdeveloped muscles in the jaw area also known as Masseter Hypertrophy or square jaw. This is where Botox comes in.
Botox can be injected to de-activate the nerve impulse in the sweat glands to temporarily block and stop sweat production in the treated area. Patients have reported a substantial decrease in sweating within two days and even stopped perspiration following the treatment. Repeat treatment is usually recommended within five to seven months.
Frozen shoulder or adhesive capsulitis, is a disease of chronic inflammation and fibrosis involving the shoulder joints. In clinical practice, treating the disease can be challenging due to painful treatment course and disease evolution, leaving patient to experience significant discomfort and functional loss. Depending on the cause of frozen shoulder, Botulinum toxin (BTX) may be used for pain management and it is also found to retard the process of fibrosis.
Bruxism is the medical term for unconscious teeth clenching and grinding, whether awake or asleep. It can lead to painful and severe dental problems such as loss of tooth enamel, increased tooth sensitivity, flattening, chipping or cracking of the teeth, sore jaw, earaches, and migraines. Bruxism can also lead to hypertrophy of the masseter muscle or severe square jaw. Treatments with BTX can help to soften the appearance of the jaw line and provide tremendous relief to these painful and unpleasant problems associated with Bruxism. Yet many other treatments such as anti-inflammatory medications and dental devices are not able to address the root of the problem.
New research shows that repeated treatments of botulinum toxin type A (BoNTA) over one year after a stroke can improve muscle tone and reduce pain in the arms and hands, making it easier for patients to perform personal hygiene and simple tasks such as dressing oneself.
Procedure and Treatment
The procedure takes only a few minutes to perform but may take up to three days to take effect. But in very rare circumstances, it may take as long as three to seven days or even as long as two weeks to take full effect. In Singapore, the muscle-relaxing effect of Botox lasts between four to six months. As Botox is not a one-time fix and is fully reversible, repeated treatments two to three times a year are recommended.
Risks and Side Effects
Botulinum toxin injections are generally well tolerated with very few known side effects. But only in rare cases does an individual have a genetic predisposition towards the drug, resulting in a mild, temporary responses such as redness.
Common side effects like bruising, erythema (reddening of the skin) and slight pain and swelling at the injection site may be experienced but are transient. Headaches can also occur but this is rare and it usually goes away in 24 to 48 hours. Depending on where the Botox is injected, eyebrow or eyelid drooping, drooping of the corner of the mouth, or inability to use a straw may be experienced. Refrain from rubbing the treated area and avoid lying down for three to four hours after injection.
Other known side effects include local edema, mild nausea, numbness, temporary weakness or paralysis of nearby muscles, weakness of the lower eyelid or lateral rectus (a muscle controlling eye movement), dysphagia (trouble swallowing), diplopia (double vision), dry mouth, rashes or hives and wheezing.
To reduce chances of any side effects, make sure your practitioner is a respected medical professional with lots of experience in Botox injections. During consultation with your doctor, be truthful and declare any health problems (no matter how mild they are) that you may have. Do inform your practitioner of any medications or supplements that you are taking, especially injected antibiotics, muscle relaxants, and especially medicines for allergy, cold and sleep because some combinations of these medication and supplements with Botox can cause some serious side effects.
Follow the post-injection instructions very carefully and report any persistent side effects (if any) as soon as possible.
Who is not suitable for Botox?