Defining Botulinum Toxin

The experts provide you with everything you need to know about anti-wrinkle injections

There aren’t many people these days who haven’t heard of the term ‘Botox’. With botulinum toxin being the most popular non-surgical cosmetic procedure for men and women, there’s no wonder it’s heavily talked about. Unfortunately, many people don’t have very positive views about it. Why? Mostly because of the countless celebrities who look ridiculously frozen, completely without expression and utterly unnatural. Oh, and isn’t it toxic…? What you don’t often see, however, is the outstanding results making so many people delighted with the way they look. So how exactly does this anti-wrinkle treatment work and can it benefit you? We spoke to two expert practitioners to find out.

Anna Baker,

aesthetic nurse prescriber, Harley Street Skin London & The Retreatery, West Sussex

IG: @annabakeraesthetics

Dr Souphiyeh Samizadeh,

aesthetic practitioner, Revivify London Clinic, Facial Rejuvenation, London & Shanghai

IG: @drsouphi

What is botulinum toxin?

Nurse Anna explains that botulinum toxin type A (also known as toxin) is a purified protein derived from the Clostridium botulinum bacteria that blocks the nerve signals to the muscle. When it’s injected, this temporarily paralyses the muscle so it can’t contract and move the surrounding skin, meaning you get a nice smooth canvas! Toxin is commonly known as ‘Botox’, but this actually refers to a brand name, much like Hoover is colloquially used to refer to any type of vacuum cleaner! “There are other brands including Bocouture, Azzalure, Jeuveau and others from Asia that are now entering the European market,” explains Dr Samizadeh, adding, “The choice of product will be made by your medical professional after a thorough consultation.”

How was toxin discovered as a wrinkle treatment?

It all started with a bad batch of German sausages; Dr Samizadeh laughs. “Poorly prepared sausages were causing botulism outbreaks, which is a very rare but life-threatening condition where the nervous system is attacked, causing muscle paralysis and death. Scientists spent years isolating the botulinum toxin protein, which eventually led to it being used

"Toxin injections using a licensed product for therapeutic and cosmetic purposes are considered safe when injected by a knowledgeable and skilled healthcare professional"

Nurse Anna Baker

for medical treatments such as strabismus in the 1970s,” she says, explaining that strabismus is when the eyes don’t properly align with each other. “While treating these patients, scientists noticed that an interesting side effect of the treatment was that it reduced the frown lines and crow’s feet of the patients, and hence the treatment has since been used widely due to its cosmetic benefits!” Dr Samizadeh says.

Is botulinum toxin toxic?

Technically yes, the so-called ‘miracle poison’ can be life-threatening, but it isn’t deadly in the cosmetic form. Nurse Anna explains, “The doses we work with for cosmetic uses are extremely small – certainly in comparison to the known lethal dose. For example, the lethal dose for a person of 70kg is calculated to be 2,500-3,000 units. For cosmetic purposes usually less than 30 units are injected directly into the targeted muscle,” she explains. Dr Samizadeh adds, “Toxin injections using a licensed product for therapeutic and cosmetic purposes are considered safe when injected by a knowledgeable and skilled healthcare professional. It is the most popular non-surgical procedure carried out internationally and this is testament to its effectiveness and safety.”

How can toxin benefit you?

Toxin is commonly known to reduce the appearance of your pesky forehead lines, frown lines in-between the brows and smile lines around the eyes. However, toxin can be used to improve an array of cosmetic and medical conditions. Nurse Anna explains, “Because the toxin relaxes the muscles, reducing movement, it can not only improve fine lines and wrinkles around the eyes, but it can balance areas of facial asymmetry, improve the signs of ageing around the neck area, reduce underarm sweating (hyperhidrosis), improve an overactive bladder or eye spasms and can even help migraines!” Dr Samizadeh, who has a dental surgery background, also adds that it can help teeth grinding (bruxism) as well as so many other medical and cosmetic concerns. It should be noted that many toxin uses are considered ‘off-label’. This means it is not licensed to treat certain concerns but it doesn’t mean it is less effective. You should always ask your medical practitioner if the product is licensed for a particular use and if it's not, ensure they explain the research, evidence and its pros and cons.

Once injected with toxin, it usually takes a few days to become effective, nurse Anna notes, and the effect may initially last for approximately three months. “At this point, the toxin will be broken down and metabolised by the body and often results may last longer than three months with repeat treatments. Patients may wish to repeat the treatment twice a year or so, depending on their preference,” she adds.

“After getting toxin, most people say their friends and family comment how refreshed and happy they look, which is the kind of result you want!”

Dr Souphiyeh Samizadeh

Are there any risks to getting toxin treatment?

As with most non-surgical aesthetic treatments, side effects and complications are possible. “In expert hands, with the use of approved and licensed products, risks are minimal,” Dr Samizadeh emphasises, while nurse Anna states, “The side effects can include temporary bruising and pain at the site of injection, headaches, nausea, redness, drooping of the the brow or eyelid flu-like symptoms and temporary muscle weakness.” According to Dr Samizadeh, there are also other rarer side effects that are less likely to occur. “These include things like muscle

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PHOTOGRAPHY: VISIBLE BY HANNAH

"The reason people look too stiff after treatment is because the practitioner may have injected far too much into the muscles, which doesn't create a natural result"

Nurse Anna Baker

weakness, vision problems, trouble speaking, swallowing or breathing, as well as a few others depending on the area injected.” To address most toxin complications, Dr Samizadeh notes that often there is no quick fix. She points out, “If you don’t like your result, or have a complication, there is no immediate antidote to help resolve it, so this is why it’s important to choose your practitioner wisely.”

Will you look frozen?

Of course, another potential side effect of toxin treatment is looking TOO frozen. Nurse Anna says, “If injected correctly by a highly-trained and experienced medical professional, you will not look frozen or fake and people won’t even be able to tell you have had toxin treatment. The reason people look too stiff after treatment is because the practitioner may have injected far too much into the muscles, which doesn’t create a natural result.” Dr Samizadeh adds that you can work with your practitioner to get your desired result and can keep some natural facial movements remaining. She says, “The key is not to think of the desired outcome as a ‘poker face’ but one that is youthful, natural and beautiful or handsome. A natural youthful face is not expression free! After getting toxin, most people say their friends and family comment how refreshed and happy they look, which is the kind of result you want!”

How do you choose a toxin practitioner?

Although toxin is a prescription-only medicine, meaning only a medical professional such as a doctor, dentist or prescribing nurse can prescribe it after an in-depth consultation, in the UK any lay person can legally inject the product. “I would advise against choosing someone who does not have a medical qualification. This qualification in addition to further aesthetic medicine training, will give them a solid foundation in anatomy, physiology, pharmacology, correct assessment and complications recognition and management that would allow them to reduce the likelihood of complications and poor aesthetic outcomes,” says Dr Samizadeh. Nurse Anna adds, “You should ensure you choose a medical practitioner who is insured and registered with their regulatory body (such as the General Medical Council, Nursing and Midwifery Council or the General Dental Council). They should be rigorously trained, experienced, and insured in administering toxin injections, as well as competent in managing any side effects or complications from treatment."

Finally, Dr Samizadeh says the key is to go to a practitioner that will give YOU the specific result that YOU are after, not the result that they give everybody. She adds, “If you are of non-Caucasian origin, consider that many practitioners are not as accustomed to treating various ethnicities and facial features, so look for examples in their portfolio that match your expectation, desires, facial characteristics and ethnicity.”