Botulinum toxin type A (botox) is one of several naturally occurring protein toxins produced by a bacteria called Clostridium botulinum which is widely found in nature in forest soils and shellfish. Botox is precisely manufactured to be used in safe doses to soften wrinkles in the skin by weakening the action of the muscles which cause the wrinkles. It was first used in 1973 to relax overactive muscles which caused ‘crossed eyes’ (strabismus) and facial twitches (or ‘tics’) then gained wider use for other muscular conditions and for use as a cosmetic agent. Although used globally for cosmetic purposes for since 1990, it is still not officially registered for such use at the moment. Botox is manufactured pharmaceutically in the United States of America – an animal source of protein is used in the process.

When the solution is injected in precise doses directly into a specific part of a muscle, it stops the electrical signals from the brain reaching muscle by blocking the chemical transmitter acetylcholine from crossing between the end of the nerve and the muscle. As the muscle function is lessened, the overlying skin relaxes and any wrinkles caused by those muscle contractions are softened and may disappear. Some deep or long-standing wrinkles may have ‘memory’ and still be visible (like creases in a straightened out shirt) – in these circumstances, the best result may be gained with additional dermal filler injections to plump out such wrinkles. Since the protein in the solution is only attracted to muscles, it has no effect on the brain or central nervous system of the body. It is temporary because the blocked nerve sprouts a new ending which connects to and re-innervates the muscle within 3-4 months and this process has been shown to readily recur again and again after any repeated injections.

It is a safe and simple procedure when delivered by an appropriately trained practitioner. A tiny and precise amount of solution is injected with a very fine needle into several locations in the face precisely and individually mapped to the muscle action related to the wrinkles being treated. These injections are associated with so little pain that it specialist practitioners routinely would use no local anaesthesia – the needles are a similar diameter to acupuncture needles. You may well develop slight bruising at the injection sites and require cover make-up although every effort is made to reduce this risk to a minimum. There may be a pinky-red flushing of the skin for an hour or so as a reaction to the needle itself. Certainly, within a couple of hours, many clients have no visible signs of having had a treatment.

This kind of treatment is a temporary solution to unwanted dynamic wrinkles because the injections only last about 3 or 4 months. This has the benefit of allowing the first treatment to be as subtle as a client wishes if there is a preference for having a trial treatment first. You will need 3 to 4 treatments per year to maintain best results and it is common for treatments to be offered in packages of 3 over 9-12 month time periods.

You cannot be breast-feeding or pregnant when receiving Botox treatment. Those taking certain muscle relaxants and antibiotics such as aminoglycosides (e.g. gentamicin) or with bleeding disorders should not have the injections. Mr Blackburn will not treat patients under the age of 27 on ethical grounds. Those with infection or inflammation at the proposed treatment site should not have Botox injections at that site. Clients who take aspirin, clopidogrel, dipyridamole, warfarin and non-steroidal analgesics such as ibuprofen are at increased risk of bruising. Clients with certain neuromuscular disorders such as myasthenia gravis are not eligible for treatment – you should ensure you inform the consulting practitioner of your full medical history.

Botox has no effect on the fine lines on the upper and lower eyelids within the oval eye socket or those facial fine lines related to sun damage rather than muscle contraction. Any such unwanted fine lines are better treated with chemical peels or laser resurfacing treatments to achieve a widespread tightening of the skin. Many of us have asymmetric faces when studied closely and botox injections cannot be expected to correct or mask such underlying asymmetry effectively.

You must inform any medical practitioner who may prescribe you medication that you have had the injection treatment for up to 3 months after the treatment. After treatment, you should not exercise vigorously or have a hot bath for 12 hours and should not massage the area for 72 hours. You can gently perform the wrinkling muscular action several times during the day once you have had the injection e.g. frowning if frown lines have been treated.

No-one ‘needs’ cosmetic treatments, however, many thousands of these types of treatments are safely performed each year and it has emerged as a reliable and exciting treatment for improving the visible effects of ageing. Many patients report an enhancement to their quality of life – with greater confidence / enjoyment of social interactions; and reducing appearance-related anxiety in social, work and personal relationship interactions. Of course, the best long-term holistic approach for healthy youthful skin includes not smoking, protection from sun-radiation, keeping well hydrated, a healthy diet, exercise and plenty of sleep.