Botulinumtoxin Botox®

A biological bacterial protein that inhibits nerve signals.

What is Botulinumtoxin("Botox")?

Botulinum toxin or Botox® is a neurotoxic protein produced by the bacterium clostridium botulinum and others, having a potent and specific effect on the transmission of nerve signals to muscles and glands. This macromolecular protein is similar to the tetanus toxin. The American pharmaceutical company Allergan was the first to receive medical approval for the drug Botox®. In the meantime, the name of this famous muscle relaxant is used today for all generic products in its category. There are six compounds with botulinum toxin A authorized for use in Germany.

Botulinum toxin A: use against facial wrinkles

Treatment time:	15 min
Hospital stay:	ambulatory
Anesthesia:	local
Follow-up treatment:	-
No Exercise or sports:	1 day
Fee according to GOÄ:	From 230 €

With the right dosage and accurate application of botulinum toxin A / Botox® certain mimic muscles can be relaxed, thereby creating a fresher appearance. A long-term, low dosed botulinum toxin treatment regime keeps an adult face youthfully smooth. In combination with a healthy lifestyle and botulinum toxin, the appearance of slower-aging is possible.

How does botulinum toxin work?

A substring of the protein botulinum toxin A fuses to molecules of a neurotransmitting ion channel of acetylcholine synapses. Through this fusion of botulinum toxin the transmission of nerve signals is irreversibly blocked. Meaning the transmission of nerve signals is no longer possible. The number of blocked channels correlates to the amount of botulinum toxin administered. Acetylcholine synapses are located on the neuromuscular end-plate of muscular and glandular cells

How can wrinkles be treated with botulinum toxin?

Wrinkle treatment with botulinum toxin takes advantage of the inhibiting effect it has on nerve signals. Depending on the dosage, and with the exact injection of this neurotoxin, the wrinkle producing mimic muscles treated are either weakened or paralyzed completely. The accompanying bending and compressing movements of mimic muscles is then reduced smoothing out the overlying skin.

For which facial wrinkles is botulinum toxin suitable?

Botox® is generally used on the upper facial area. Good treatment results can be achieved with botulinum toxin on frown lines, forehead wrinkles and crow’s feet. Other treatable areas in aesthetic medicine are the lower eyelid wrinkles, smoker’s pucker and chin wrinkles (strawberry chin). Botulinum toxin can also be used to raise the eyebrows or weaken strong chewing muscles to give the face a slimmer appearance. Treating the mouth, lower facial area and chin should, however, be left to our experts to avoid asymmetry. Prominent platysma bands along the neck (turkey neck) can be relaxed with Botox giving the neck a smoother, tighter appearance. In addition, excessive sweating (hyperhidrosis) can also be treated with botulinum toxin.

Is wrinkle treatment with Botulinumtoxin painful?

Pain thresholds are individually quite different. Several injections with a fine needle into the skin must be tolerated. Some patients find the treatment painful, while others not. An anesthetic ointment provides relief along the eyes and lip areas.

How long does a botulinum toxin treatment last?

The effect of the botulinum toxin to synapses is irreversible, and therefore permanent. The recovery of the innervation of muscles or sweat glands is directly related to the sprouting of new nerve endings. Depending upon the dose injected, all or usually only part of the nerve endings are paralyzed by the botulinum toxin. The durability of the botulinum toxin is dependent upon the amount administered and the patient’s muscular activity. The choice of Botox® preparation is less significant. Follow-up treatments generally need only to paralyze partly innervated muscle groups, thereby lengthening treatment intervals. The complete transmission of nerve signals, depending on dosage, recovers completely between 2 to 6 months. The desire of prolonging the effects of the botulinum toxin is in direct conflict to preventing an expressionless, mask-like or even a deformed face. The patient and the practitioner should work out a strategic plan for preventative and/or wrinkle treatment.

When does the botulinum toxin take effect?

The muscle relaxing effects of botulinum toxin is generally noticeable on average after 5 to 7 days after treatment. The desired smoothing of wrinkles requires a few days more. The full effect is complete after 14 days. From this point forward the activity of the mimic muscles starts to increase.

What side-effects does Botulinumtoxin have?

The protein takes effect after endocytosis and the splitting of specific and certain synapses. Read more detailed information about the side effects of a botulinum toxin treatment here.

Who is allowed to inject botulinum toxin?

Botulinum toxin is available only on prescription. Therefore, it may only be injected by a physician. It is illegal to give treatment with botulinum toxin if you are not a doctor. The meticulous and continuous refrigeration delivery chain of botulinum toxin makes it therefore very dangerous to purchase on the black market.

How do I find a specialized physician?

Wrinkle treatment is provided by dermatologists, plastic surgeons and other physicians. You may expect to find the most experience and routine at an office mainly focused on non-surgical wrinkle treatment. Our Faceshop offices are located in Duesseldorf, Berlin, Frankfurt, Cologne, Dortmund and Constance.

How expensive is a botulinum toxin injection? How much does a botulinum toxin treatment cost?

A botulinum toxin treatment is relatively expensive. It costs roughly between 230^* and 600^* Euro. It is not uncommon to spend between 600^* and 1200^* Euro per year. The price is directly related to the units of botulinum toxin used. At an office mainly focused on non-surgical wrinkle treatment you will receive the best results at a good price. The price advantage of buying this preparation in larger amounts and therefore cheaper, can then be passed onto the patient.
The sooner a wrinkle treatment with botulinum toxin takes effect, the more likely the treatment cost will be less expensive. A botulinum toxin treatment should fundamentally be used on more than one region. Areas without significant wrinkles can be treated prophylactically using very small amounts. Please read about our prices for more exact information.

How many units of botulinum toxin / Botox do I need?

Whether you only want to treat one area or the entire face and eventually the neck with Botox®, you will need anywhere between 5 and 100 Allergan units of Botox® per treatment. Typical amounts are: 15 units for eyebrows, 30 units for the neck, 20 units or less for crow’s feet, 20 units for forehead wrinkles, 5 units for smoker’s pucker, 25 units or less for frown lines and 100 units for hyperhidrosis (excessive sweating).
For optimal results a partial dosage on the individually chosen injection points is more important than the total dosage.

Which injection technique is the right one?

At the onset of wrinkle treatment it was normal to inject the botulinum toxin deep into the muscle. Today a subcutaneous injection technique is more customary. The practitioner should have conducted approximately 1000 treatments including follow-up treatments to acquire the precise injection technique with reproducible results.

^*The price is individual and according to the GOÄ.