Botulinum toxin (botulinum, Botox®, Vistabex®): what it is, what it does and how it works
Botulinum toxin is a neurotoxin produced in nature by the bacterium Clostridium Botulinum. Botox® (or Vistabex®) is a synthetically produced toxin that blocks the mechanism of muscular contraction, as does natural botulinum, but to a lesser degree.
Botulinum toxin was initially used for therapeutic purposes as early as 1989, for example to treat involuntary muscular spasms of the face and neck, laryngospasm, headache, anal fissures and other disorders.
Its use for cosmetic purposes was definitively approved by the American FDA (Food and Drug Administration, www. fda. gov) in 2002 and subsequently also by the Italian Ministry of Health

It serves cosmetically to attenuate dynamic wrinkles, i.e. those caused by continual contraction of the facial muscles and aging, especially glabellar frown lines at the root of the nose (on label), wrinkles of the forehead and crow’s feet at the outer corners of the eyes (off label).
For example, the vertical lines formed between the eyebrows that give a constantly frowning expression are caused by two specific muscles that push the eyebrows against one another when they contract. With the passing of time, the skin loses elasticity and the result is the formation of permanent wrinkles of greater or lesser depth. The injection of botulinum can improve or eliminate these lines by relaxing the muscles in question.

Where botulinum acts

As stated above, botulinum is most effective for wrinkles of the forehead, frown lines between the eyebrows and crow’s feet. Other areas of the face can also be treated but these are the ones that offer the best results and the greatest safety.
Botulinum is injected subcutaneously in very small set amounts into the muscle to be relaxed. It is the relaxation of the muscle beneath the skin that helps to eliminate the wrinkle.
Use is made of a very thin needle (30G) that causes practically no pain at all. The whole procedure takes just a few minutes.

The first changes will be noted only 24–48 hours after the injection and then become increasingly evident in the following 5–7 days. They can last between 4 and 6 months, after which they will slowly begin to fade. The effects of are never permanent and can be obtained only on dynamic wrinkles.

Botulinum is contraindicated for patients suffering from neurological syndromes such as myasthenia gravis and amyotrophic lateral sclerosis (ALS). It cannot be used in the presence of infection in the area to be injected. It is also contraindicated in pregnancy or when certain treatments are under way.



Some frequently asked questions

Is the injection of botulinum painful?
Used is made of the thinnest commercially available needle and most patients report no pain at all. Some feel a slight burning sensation while the liquid is being injected, but this passes almost immediately.

How soon can I go back home?
Immediately after the treatment. There will be no visible signs, except in very rare cases, and because the action is gradual, nobody at home or at work will notice what has happened. All you have to do in the next few hours is avoid sources of heat and refrain from smoking.

Is treatment with botulinum safe?
After twenty years of use on millions of patients all over the world, botulinum is now definitely safe on the following conditions: that it is administered by a qualified physician, that he or she possesses the requisite experience, and that the drug used is a certified import approved by the Italian Ministry and diluted to the correct degree.