How Does Botox Work ?

What is Botox ? How does it work ? Will it make me gorgeous ? These are some of the questions that I am regularly asked. Below are some answers to the first 2 questions, as for the last one, well....

Botox is the crystalline form of the type A exotoxin of the bacteria Clostidium botulinum. It is this toxin that is responsible for the previously fatal disease botulism. The word is derived from the latin word botulus, which means sausage - since a particlarly nasty outbreak occured in Stuttgart as a result of tainted sausages!

It is purified from the Hall strain of the bacteria and amazingly all Botox sold throughout the world since 1997 comes from the same batch (BCB2024). Botox is the most potent biological neurotoxin known (one gram could kill every occupant in a major city) and so incredibly small doses are used for medical purposes.

Botox is sold in vials of 50 or 100 units. More correctly, it is sold in "mouse units". One mouse unit is the amount of Botox required to kill at least 50% of a group of 18-22 gram mice when injected to their abdomens. This is bad news for mice with wrinkles, but luckily these results can be extrapolated to human weights so that about 3000 units would be a similarly fatal dose. All cosmetic doses are nowhere near that figure and Botox is thus quite safe.

Botox works by preventing the release of the neurotransmitter from the end of a nerve to the muscle it innervates. It effectively "gags" the nerve to prevent the message from getting through. This effect lasts for several months (depending on the type of nerve).

Botox only works works on nerves which use the transmitter substance acetyl-choline (ACh) such as the nerves which control muscles and sweat glands. It does not affect sensory nerves. Well, that is not true. There are receptors in the sensory nerve endings which are also affected by Botox, but their specific purpose is not known. Normal sensation remains intact. It may be that the ability of Botox to relieve chronic migraines is related to these receptors.

When used correctly, partial or complete paralysis of the target muscle occurs. In the face, this has two consequences. Firstly, there is a decline (or absence) of muscle activity. This causes the appearance of wrinkles to diminish. Secondly, the facial muscles do not work singularly - they work in coordinated groups (unlike politicians). Weakening one member results in altered vectors. This is often unappreciated by inexperienced practitioners and may result in some pretty weird looking facial features. Jack Nicholson was born that way, most other people got Botox to look like that!

When properly executed and maintained, very pleasing results (and thus very pleased patients) are the norm. So in answer to the last question...

Best Regards

Marshall