Beginning in 1988 and reported in 1991, Botulinum toxin was used for frown
lines, and other hyperactive facial lines including brow lines, crows feet, and
banding in the neck.

Botulinum toxin can also paralyse the sweat glands of the skin alleviating
excessive sweating. This includes injecting the underarm or palms of the hands
and soles of the hand or foot. Occasionally it may be used at the scalp line.
These injections provided months of relief repeated indefinitely once or twice a
year to maintain dryness.

Cosmetic Use of Botulinum Toxin

Botulinum toxin is used for treating glabella lines, these vertical frown lines are
largely the result of over-activity of the corrugated muscles, with contribution from
other muscles around the eye. The only function of the corrugators is to draw the
eye brows together as an expression of emotion. Botulinum toxin also is used in
the treatment for squint lines or crows feet at the corners of the eyes and brow
lines. When the muscle has relaxed and weakened, it can't contract. The lines
gradually smooth out from disuse and new wrinkles are prevented from
developing. The muscle action on smile lines around the mouth needed for
expression and important functions such as eating, may not be as effective with
botulinum.

Side Effects of Botulinum Toxin/Treatment

The dose used is far below the toxic dose of Botulinum toxin. There have been
no reports of allergic or urticarial reactions. Occasionally transient bruising
occurs in the injection site, or the injection is followed by brief pain or headache.
Transient eye lid ptosis (drooping of the eye lid) is the most significant
complication of injection in the glabella area, and occurs in 1-2% of patients.
When it occurs, the drooping tends to be minimal and short lived, 2-12 weeks.

Contraindications

You should not have Botulinum toxin if you are breast feeding, or you have a
pre-existing neuromuscular condition (myasthenia gravis), or if you are allergic to
Botulinum toxin or human albumin, or if you are on an antibiotic known as
aminoglycosides.

Before & After Therapy

Treatment involves injection of very small amounts of botulinum toxin into the
underlying muscles to immobilize them. Botulinum takes effect about 3-7 days
after treatment and lasts about 3-4 months. After therapy, patients are asked not
to manipulate the treatment site, and to remain upright for 4 hours to avoid the
spread of toxin to other near-by muscle groups. Since the toxin appears to have
an affinity to bind to actively contracting muscles, patients are advised to
exercise their frown line muscles immediately after injection, and for a
subsequent few hours. Muscle weakening begins 24-48 hours after injection,
peaking at one week. Repeated treatments are generally performed at 3-8 month
intervals, as muscle function returns. However, in some individuals muscle
weakness can last up to 12 months before re-injection becomes necessary.

Details of Treatment

Pre-Treatment: No preparation is required prior to treatment.

Anaesthesia: No anaesthesia is required.

Treatment: Botox is injected using fine needles into the muscles under the skin
in the affected area.

Post Treatment: Immediately after treatment some swelling may be noted in the
area. This swelling will last approximately 2-3 hours. Occasionally bruising can
occur. We request that you do not lie down after treatment for over 4 hours, the
muscles that were treated have to be constantly contracted.

Complications: The only major complication is a temporary short lived drooping
of an eye lid. This complication is very rare.




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