Botulinum Toxin (BOTOX)An Innovative TherapyFor facial expression lines and excessive sweating of palms & under arms.
What is Botulinum Toxin-A?
Botulinum Toxin (Botox) is a medicine produced by the bacteria that very rarely causes Botulism food poisoning. Botox is not alive but is a protein which weakens and inactivates muscles. This is another example where “natural” products are used for medicinal purposes: fungi produce penicillin; cowpox virus protects against smallpox and foxglove plant produces the “poison” digitalis which millions of patients take daily for heart disease. Now with bio-engineering it is common for bacteria to produce the necessary medicine for a specific disease.
What are the first clinical uses of Botox?
In 1973 Botox was used as a treatment for patients with crossed eyes (squint). By weakening the overactive eye muscles, this medicine provided an alternative to surgery. After this “breakthrough” Botox quickly gained acceptance for other ophthalmologic disorders including nystagmus and blephospasm (involuntary spasm of the eyelids) just to name a few.
What other specialists use Botox for their patients?
Neurologists have explored possible indications for botox therapy for their patients. It has now become the mainstay of non-surgical therapy for spasmodic neck muscles, spasmodical laryngeal muscles, writer’s cramp, certain tremors tics, multiple sclerosis, cerebral palsy, post stroke states, spinal cord injuries, nerve paresis, Parkinson disease and facial spasms. Other indications include swallowing problems and speech impediments. Also, genitor-urinary disorders of spastic bladder and other disorders have been studied. Congenital muscular disorders or acquired nerve injuries have been improved by balancing muscles with botox.
Is it safe?
While botox is very potent high in concentrations when used in very small quantities it has very high margin of safety. After a muscle is injected, its first effects are not seen for the first 48 hours and the complete effect on the muscle will not be seen for 2 weeks. Botox affects only the muscles that are injected and has no effect on the central nervous system or on the body if injected accidentally into a nerve or blood vessel. Another safety feature of botox is that complete recovery of the muscle occurs with time. This is possible due to the body’s ability to repair itself with the formation of new transmitters which allow reactivation of the muscle.
Can any one be toxicated from botox injection?
No – virtually toxicity is impossible. It has been calculated that the toxic dose for humans is about 40 U/Kg meaning that if person weighs 70 Kg., the toxic dose would be 40 x 70 = 2,800 U. That could never happen, as the maximum dose that can be given to any one in any given time is 100 U only.
What should be expected after botox therapy?
Botox is a safe therapeutic agent for wrinkles. Complications have been minor and only transient. Bruising may occur at the injection site and a brief pain or headache may follow.Bruising may be greater in patients who are taking aspirin or any blood thinning medicines. These products should be avoided if possible prior to the injection. Ice helps to prevent bruising. Muscle weakness is not immediate; it may be first noted at 24 hours.
How long does botox last?
Successfully therapy is signaled by muscle weakness that may begin between 24 hours to 48 hours after injection with a peaking weakness at 10 days. Paralysis after the initial injection lasts between 3 and 7 months for most patients.
How often is re-injection needed?
Re-injection is suggested every 3 to 4 months to keep the muscles paralyzed and allow the furrows to completely smooth out. Once an area is smooth, patients are instructed to return for therapy only when they notice a return of muscle movement which may not occur for 4 months to 1 year or even longer has been reported.
Who should not use botox?
1. Although there have been no reports of birth defects with this medicine, no pregnant patient will be treated. It is also Dr. Sahar Ghannam’s policy not to inject botox to nursing mothers.2. Patients with history of neuromuscular disease (multiple sclerosis and myasthenia gravis) or other types of disease involving neurotransmission should avoid this medicine.3. Patients taking the following medicines may potentiate botox, aminoglycoside antibiotics (streptomycin, tobramycin and garamycin injections), penicillamine, quinine and calcium channel blockers (calan, cardizem, dilacor, norvasc, procardia, verelan).
Have there been any reported cases of allergic reactions or hives to botox?
No reported cases of a true allergic reaction have been reported. Nevertheless, theoretically people who are known to be allergic to Botulism Toxin or albumin should avoid botox.What happens if a female patient becomes pregnant shortly before or after treatment?A number of neurological and ophthalmologic patients have delivered normal children after receiving their injections. For safety reasons no pregnant or nursing females will be treated.
How painful are the injections?
The smallest needles are used and the medicine itself does not sting as much as the usual local anesthetic. Most patients feel it less than collagen. Pain can be minimized by the use of ice cooling the skin just prior to injections or the use of anesthetic cream. It is advised not to use aspirin or any coagulant drugs as this can increase bruising risk.
Is botox comparable with fillers as Restylane or Perlane?
No, each of these work differently but they can be combined to achieve maximum effects.Restylane and Perlane are hyaluronic acid which is a filler to augment cheeks, lips, etc. while botox affects mimetic muscles (muscle movements).
How exactly does botox inactivate the muscle?
Botox inhibits the release of acetylcholine (a nerve transmitting chemical) at the joining site of the nerve to the muscle so as the muscle never gets the message to contract. To rejoin the nerve to the muscle, the body organizes and produces new motor endplates which re-establishes the connection.
Does the body make antibodies to the botox protein?
Yes, especially if enough toxin is injected often enough. The crucial amount is several 100 units (much more than the usual cosmetic dosage) and perhaps booster injections placed within 1 month of the initial injection. When sufficient amounts of antibodies are formed, the therapeutic effects of botox are greatly reduced.Antibodies have been more of a problem for neurological disorders where larger amounts of botox are required. That is why Dr. Sahar Ghannam will administer the least effective dose for your first treatment.
Can some people not react at all?
A very small number of people have antibodies that inactivate the botox (probably from foods eaten previously). They will not improve significantly if at all.
What unexpected benefits have come from botox?
Tension headaches for some patient have disappeared. These occurred in patients who were recruiting forehead and brow muscles during periods of stress and tension. When these muscles were relaxed, the headaches faded. People suffering from post herpetic neuralgic after herpes zoster infections can be relieved as well.
What can be done for the drooping eyelid if this occurs?
Temporary drooping of one or both eyelids is the most significant complication and occurs in well below 1% of all injections. This was the percentage in the past but now this percentage had decreased significantly due to increase in our learning curve with good knowledge of proper injection techniques and proper placement of the injection as well as keeping the patient in an upright position for 3 to 4 hours after injection.Although it could rarely happen if the patients muscles are anatomically different. If drooping eyelids occur, it is usually minimal and usually resolves spontaneously by 2 weeks. Special eye drops may temporarily reduce eyelid droop.
When injecting muscles at one site will this affect remote muscle?
Botox spreads slightly along muscle fibers about 1 cm from each injection site and does not spread distantly by way of the blood stream.
Can botox be used to weaken not totally paralyze a muscle?
Yes, in fact this is done in some areas so that the face will not be left expressionless. It can also be used to balance a weak muscle on the opposite side. By injection of the medicine into the subcutaneous tissue not the muscle and by using a smaller dosage, a weakening of the muscle is more likely to occur.
What is the best method for getting deepest frown furrows to disappear?
Actually this is one of the very difficult areas to smooth completely. In the medical literature and Dr. Sahar Ghannam’s experience (over 5 years of using botox), improvement after the initial injection lasts about 17 weeks. Re-injection every 3 to 4 months is recommended rather than waiting for the muscle to recover. This keeps the muscle paralyzed and allows the skin to completely smooth out over the next 12 months.
Note:Some individual patients may require 2 or more courses of injections of botox to see an effect. A very small percentage of people are resistant (not responsive) to botox.If you do not see any results after 10 days we will repeat the injection at a minimal cost to you. However you must have contacted this office and made a future top up botox appointment within 14 days of your original injection in order to be given this top up injection charge.
Post BOTOX instructions:

1. Stay upright for 2-3 hrs. After      injection (do not lie down or sleep and bend over), we do not want the      medicine to go to other muscles or areas other than the injected ones.
2. Do not massage or play in the area      injected for 2 hrs for the same above reason.
3. Make faces (frown and laugh), the      medicine goes to the most active muscles so work these muscles (frown,      raise eye brows, smile) for 2 hrs post treatment.