Although Botox was first used in eye diseases, Botox injections have not been used by ophthalmologists for aesthetic purposes for years.
So, how about a journey into the history and areas of use of Botox?
Following mass Botulinum toxin poisoning in Belgium in 1895, Belgian Emile Pierre van Ermengem isolated Clostridium botulinum (a Gram-positive, anaerobic, spore-forming, motile bacillus that secretes botulinum neurotoxin) from processed pork meat. Clostridium botulinum toxin is a pure poison. It causes paralysis and death in humans and animals. There are 8 types from A to G. Types A and B are used in clinical practice.
The name botulinum comes from the Latin word botulus, which meant sausage at that time. Sausage poisonings were common in 18th and 19th-century Germany and were most likely due to botulism poisoning.
Botulinum toxin was first used in the 1970s by Alan B. Scott in San Francisco, with FDA permission, to correct strabismus in the eye. It has been observed that when botuninum toxin is injected into an overactive muscle, the muscle is temporarily weakened or paralyzed. This weakness is due to the inhibition of acetylcholine release at the nerve-muscle junction. Nerve endings regenerate (renew themselves) within 120 days, so Botox is repeated for a permanent effect.
In 1987, Allergan, while a small company focused on the eye field, purchased the product rights, thus Botox entered the field of ophthalmology. The first areas of use are eye misalignment (strabismus) and excessive contraction of the eyelids (blepharospasm). FDA approval was received for these two uses in 1989. Later, Dysport, Xeomin and Neurobloc were developed for different indications with C. Botulinum toxin. The use of Botox in the cosmetic field was first reported in a study published in 1992 by Alastair Carrutrhers and Jean Carruthers.
In the beginning, the use of Botox was mostly through trial and error. Because doctors did not know where and in what dosage they should use it. Over time, Botulinum toxin has been used in the fields of neurology and physical therapy for the relaxation of spasming muscles, migraine treatment, It has been used for a wide range of indications such as preventing excessive sweating in the armpits/palms and even in the head, urinary incontinence, excessive teeth clenching, showing gums when smiling, even lifting the tip of the nose and reducing décolleté wrinkles.
Botox injection is a cosmetic non-invasive surgery for wrinkles on the forehead, crow's feet (wrinkles around the eyes), 11 lines due to frowning, cigarette (barcode) lines on the mouth, downward turning of the corners of the lips (gives a sad expression to the face). It can be used in a wide variety of situations such as age-related nasal tip sagging, orange peel appearance on the chin, sagging under the chin as a result of excessive contraction of the muscles in the neck, smile disorder, and horizontal wrinkles on the nose.
When planning Botox injection, the patient's age, the way and frequency of using facial muscles, and the need for filler in sunken areas to shape the face should also be taken into account.
Complications related to Botox occur mostly when used in high doses and are rare in cosmetic Botox use. Bleeding, bruising, swelling, and increased eye dryness in patients who have had Botox before and have dryness complaints are temporary side effects. It may be appropriate to take a break from blood thinners a few days in advance. Botox is not applied in cases such as wounds, infections or herpes on the skin. Pregnancy, breastfeeding, muscle diseases, use of Aminoglizoside type antibiotics (sensitivity reaction) and egg allergy (botox contains human albumin) are red lines.
Botox may spread from the injection site to other areas and affect unwanted muscles. In this case, the most common side effects are drooping eyelids and double vision. Since the effect of Botox is not permanent, these side effects disappear in a short time like 2-3 weeks. Bleeding may also occur late. In such cases, it is important for the patient to contact his doctor. If difficulty in swallowing or respiratory distress occurs depending on the injection site, it is necessary to apply to the hospital immediately.
Botox effect begins slightly after 3 days. The desired effect is seen within 10-15 days. Since the patient's reaction cannot be known in advance, excessive load should be avoided in the first session. Application in single doses is not recommended. At the 15-day follow-up, if necessary, additions can be made or any asymmetry that has occurred can be corrected. Photographing old asymmetries is important in terms of evaluating the treatment. 2. Injection is not recommended after the session. Immunity to the toxin may develop and subsequent treatments will be ineffective. You should wait 3 months for the next Botox injection.
Although the effect of Botox varies from person to person, it may last up to 3-6 months. After this period, it is recommended to repeat the injection. As muscle contraction decreases, muscle memory and facial expression habits will decrease, and injection intervals will lengthen accordingly.
As a result, Botox application has found a wide range of applications, especially in cosmetic non-invasive surgery. This adventure, which started with the aim of correcting misalignment in the eye, has diversified over the years and become an issue that concerns many different fields and professional groups. Nowadays, it has started to be applied more intensively by ophthalmologists for cosmetic and other purposes.
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