BOTOX

Thoughts on Botox in general
by Calvin Lee, MD, Modesto Botox Injector and Surgeon
co-founder of Surgical Artistry
with Tammy Wu, MD, Modesto Plastic Surgeon

Botox, what is it?

It is a drug used to treat muscular issues which result in relaxation of muscle spasms or cosmetic wrinkles which are attached to underlying muscles.  As a drug it is usually used as an injection. There are medical and cosmetic uses of Botox.  Botox is made by the pharmaceutical company, Allergan, which specializes in ophthalmologic diseases.

What does Botox do?

Botox relaxes muscles.  

When used cosmetically, Botox injectors target muscles which are connected to wrinkles on the skin.  By relaxing the muscle under the skin, the wrinkles overlying can't contract as much - thus can't wrinkle as much.

The Neuroscience behind Botox

• Biochemical activity occurs at the neuron side (rather than the muscle) of the neuromuscular junction (NMJ)
• Two chain polypeptide with a heavy chain and light chain.
• Heavy chain of Botox targets axon terminals of neurons.
• After the heavy chain of Botox attaches to the surface of axon terminals, the toxin is taken into the neurons by endocytosis.
• The light chain is released inside the neuron cytoplasm.
• The light chain has protease activity and degrades the SNAP-25 protein (Synaptosomal-associated protein 25) which is physiologically required for vesicle fusion which releases neurotransmitters from the axonal endings - usually acetylcholine (ACH).
• Without acetylcholine being released the muscles no longer have their signal for contraction.

Video of the mechanism of Botox (YouTube - embedded in blog)

Botox compared to WiFi (an original analogy by Calvin Lee, MD)

Where can Botox be injected for medical purposes?

There are many muscles in the body from head/face to toe, including bladder muscles, which can benefit from Botox injections.  Some are considered FDA approved uses of Botox, and some are not.  Some of what's done with Botox is considered off-label FDA usage of Botox, such as treatment of trigger points and pain from various sources such as trigeminal facial pain.  On label FDA use of Botox include: overactive bladder symptoms, headaches of sorts, upper limb spasticity, cervical dystonia, strabismus, eye twitches, and axillary hyperhidrosis (sweating).

Where can Botox be injected for cosmetic purposes?

This list is huge if considering off-label FDA usages of Cosmetic Botox.  This would include calf tapering, to jowel tapering, reduction of square face, reduction of vertical neck bands, reduction of lip lines (smokers lines), turning the corners of the mouth, reducing dimpling of the chin, relaxation of bunny lines around the nose, reduction of gummy smile (where the gums show a great deal with smiles), relaxation of forehead lines, lifting of eyebrows, lifting of eyelids, reduction of nasal flare, and there are various applications of mesobotox which can reportedly tighten skin.  These off-label FDA usages require careful discussion and monitoring with your own injector and/or doctor.  On label FDA usage of Botox include treatment of Glabellar wrinkles between the eyebrows and crows feet wrinkles on the side of the eyes.

Can Botox Cause Botulism?

If limited to just Yes/No answers, then my answer is "yes."  But please read this blog entry for further details:

Can Botox Cause Botulism? - Modesto Blog by Calvin Lee, MD - details of Botulism here.

But one elegant way to think about Botox is this analogy:  "Botox is to Botulism as Penicillin is to Mold."  That statement is trying to say that Botox is harnessing the good powers of something considered harmful.  Thus with cosmetic dosing and usage, the chance of overdose related (iatrogenic) Botulism is small.

More information about Botox

• Visit my Modesto Botox Injection home page
• A listing of possible injectors of Botox in Modesto, California - but of course, visit us!
• Botox Cosmetic - Allergan official page
• Modesto Botox Blog
• Modesto Botox Update - the newer blog starting 2015.
• Modesto Botox Blog Listing - best Modesto Botox blogs are listed in bold

External links related to Botox and other Neuromodulators.

Botox Medical - Read about my blog regarding any differences between Botox Cosmetic and Botox Medical

Botox Chronic Migraine website - another medical indication for Botox is for headaches.

Xeomin - a neuromodulator, incobotulinumtoxin A

Dysport - another neuromodulator, abobotulinumtoxin A