Botulinum toxin demystified - 10 most frequently asked questions

Although it gives excellent results, some people demonise it or ridicule it. Botulinum toxin - for that is what we are talking about - has become surrounded by many myths. Yet it is a substance widely used in medicine, and not only in aesthetic medicine. To dispel patients' doubts about how it works, we have prepared answers to the most frequently asked questions.

What is botulinum toxin?

Botulinum toxin, also known as sausage poison, is a protein neurotoxin produced by the bacterium Clostridium botulinum. Depending on the strain of this bacterium, as many as 8 types of botulinum toxin can be distinguished - they are designated by the letters A to H. Three of them are used in aesthetic medicine - A (by far the most often), B and E.

What is botulinum toxin used for?

Botulinum toxin is best known as a substance used in aesthetic medicine to smooth wrinkles and improve the facial contour. However, contrary to popular belief, it is not a cosmetic - it is a medicine which, apart from aesthetic purposes, is also used to treat certain conditions, e.g. excessive sweating, bruxism, migraine pain or muscle spasms.

Is botulinum toxin safe?

Botulinum toxin is a poisonous substance that can lead to botulism - an acute illness requiring urgent medical intervention. However, botulinum poisoning most often results from eating poorly preserved, contaminated food - this is known as foodborne botulism. Iatrogenic botulism, which develops after an injection of botulinum toxin, is very rare and mainly results from administering too high a dose of the substance.

Botulinum toxin used in medicine is a tested and safe medicine, administered in small doses. You should be aware, however, that injecting the substance is a medical procedure that involves administering a medicine - for this reason it should be performed by a doctor. It is the doctor who can assess your health before the treatment, choose the dose of the toxin and respond appropriately in the event of adverse reactions of the body, such as anaphylactic shock or an epileptic seizure.

What are the contraindications to treatment with botulinum toxin?

Treatments with botulinum toxin are not suitable for pregnant and breastfeeding women, people suffering from muscle diseases or people taking certain medicines (e.g. anticoagulants). Inflammation or a skin infection at the treatment site are also contraindications. The patient can clear up any doubts about the treatment during a medical consultation.

How long does botulinum toxin last?

The effects of a botulinum toxin treatment usually last from 3 to 6 months. The exact duration depends on many factors, including the dose of the substance, the treatment area and the patient's individual characteristics. The skin and the facial expression muscles return to their previous state gradually.

Can botulinum toxin be dissolved?

This fairly common question arises because some patients confuse botulinum toxin with hyaluronic acid. These are two different substances. Hyaluronic acid can be dissolved with a substance called hyaluronidase, but there is no such option for botulinum toxin. You therefore need to wait until the substance stops working.

How does botulinum toxin change the face?

Botulinum toxin blocks the release of acetylcholine, the neurotransmitter that carries signals between neurons and muscles. This happens as a result of the degradation of proteins from the SNARE group, which are responsible for the transport of acetylcholine. As a result of this action, the muscles are weakened or paralysed.

The aim of using botulinum toxin on the face is to reduce expression lines, most often on the forehead and around the eyes. Choosing the right dose of the medicine makes it possible to achieve a natural rejuvenating effect. However, if the person performing the treatment gives the patient too much of the product or injects it incorrectly, this can lead to the so-called mask effect, i.e. a stiff, motionless face that appears devoid of emotion. That is why it is so important for the toxin injection to be performed by a professional doctor.

What happens to botulinum toxin over time?

The substance is metabolised, which means that the body gets rid of it on its own. From the time of the treatment until the botulinum toxin is completely eliminated, usually 3 to 6 months pass.

How often should botulinum toxin treatment be repeated?

The answer to this question follows from the previous one - botulinum toxin treatments should be repeated no more often than every 3-6 months. Such an interval reduces the risk of antibodies forming, which have a negative effect on the results of subsequent injections.

How should you prepare for a botulinum toxin treatment?

The treatment should be preceded by a medical consultation, during which the doctor will assess the condition of your skin and rule out contraindications to the medical procedure. It is recommended not to drink alcohol and not to take anticoagulants or painkillers for a few days before the injection.

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Sources:

[1] Kozioł A., Werwińska N., 2019, Toksyna botulinowa – zastosowanie w zabiegach estetycznych i w medycynie, Kosmetologia Estetyczna

[2] Drożdżyńska M. et al., 2015, Do czego służy toksyna botulinowa?, Journal of Laboratory Diagnostics

[3] Mazurkiewicz-Pisarek A., Płucienniczak A., 2009, Toksyna botulinowa – cudowna trucizna, Biotechnologia

[4] Drużyńska M., Kubek M., 2024, Młodość, wieczna młodość, czyli chemia w medycynie estetycznej, Analit 14

[5] Hagas T.F. et al., 2018, Duration of effectiveness of Botulinum toxin type A in excessive gingival display: a systematic review and meta-analysis, Brazilian oral research 32