A needle down, eye circles crows feet disappear for months, round face suddenly into a melon face, this “beauty needle” is often used by many celebrities Botox. It only takes 10 minutes to do a treatment like this, so you can use your lunch break to get a shot, and then you can go back to work in the afternoon, so some people call it “lunchtime beauty”. At present, Botox has become the most popular cosmetic item, according to the American Academy of Cosmetic Surgery, 1.6 million people received “toxin wrinkle removal” in 2001, an increase of 46% over the previous year. 2006 reached 3.18 million, becoming the most common cosmetic item for both men and women. In fact, the discovery of botulinum toxin for wrinkle reduction was a beautiful accident: in 1986, Joan Carothers, a professor of ophthalmology at the University of British Columbia in Vancouver, Canada, accidentally noticed that the wrinkles on her patients’ faces disappeared when she injected botulinum toxin into them to treat eye muscle spasms, and in 1987, she collaborated with dermatologists to introduce botulinum toxin type A into the cosmetic field for research. She was the first to report this in 1992, and became the founder of Botulinum toxin type A for cosmetic use. The Discovery of Botulinum Toxin Botulinum toxin is produced by a specialized anaerobic clostridium (bacterium), Clostridium botulinum, which is present in the cytoplasm of the bacteria and is released upon death as a neuroexotoxin. Botulinum toxin was successfully isolated in 1897, and in 1920, Somers obtained the natural form of botulinum toxin. 1946, Schantz purified it to obtain the crystalline form, and in 1949, Burgan elucidated its mechanism of action and used it in the treatment of muscle spasms. In late 1979, Schantz’s botulinum toxin type A was approved by the U.S. Food and Drug Administration (FDA). Botulinum toxin can be divided into eight types, of which type A is the most potent and is the main commercially available botulinum toxin. Currently, there are three similar products in the world: BOTOX in the U.S., Dysport in the U.K., and BTXA in China, and one unit of BOTOX is equal to four units of Dysport. Botulinum toxin type A is the only commercially available botulinum toxin. Although botulinum toxin types B and F are almost as effective as botulinum toxin type A, they are still in clinical trials and are mainly used in patients who have developed botulinum toxin type A antitoxin. Botulinum toxin principle Botulinum toxin type A acts specifically on the presynaptic membrane of the motor nerve end plate, blocking the release of acetylcholine into the synaptic gap and causing the affected nerve to fail to stimulate the contraction of innervated muscles. It causes a temporary weakening or paralysis of the muscles, resulting in relaxation of the over-contracted muscles of the face and disappearance of dynamic wrinkles. It does not block the transmission of nerve excitation, and there is no excitatory or conductive damage to either nerves or muscles, an effect also known as chemical denervation. The paralyzing effect of botulinum toxin appears 1 to 7 days after injection, reaches its peak in 7 to 14 days, lasts for 12 to 24 weeks, and gradually decreases and disappears with time. Botulinum toxin type A permanently inactivates the neuromuscular junction with which it comes into contact, while the muscle regains function through normal renewal and repair. The germination of new axons and neuromuscular junctions and the absorption of aging or dysfunctional neurons are necessary ongoing processes. Within 10 days of toxin exposure, axonal sprouting can occur both presynaptically and postsynaptically, and these sprouts are connected to newly formed neuromuscular junctions; a single neuromuscular junction can be innervated by more than one sprout, and vice versa. These new axonal sprouts and neuromuscular junctions return to function after 3 to 6 months and the associated muscle strength increases, at which point the muscle has regained normal strength and maintained normal responses. Botulinum toxin applications In 1973, Scott et al. reported the results of a study of botulinum toxin type A injections into monkeys’ extraocular muscles, confirming that the paralyzing effect of botulinum toxin type A on these muscles lasted 1 to 3 months, and in 1980 Scott et al. reported the use of botulinum toxin type A for the treatment of strabismus in humans. These pioneering studies confirmed that botulinum toxin type A can be safely and effectively used to treat muscle disorders. In addition to its use for strabismus, Scott et al. began studies on the treatment of dystonia such as blepharospasm, which later expanded to include the treatment of other facial dystonia, spastic squints, and limb dystonia, and even abnormal muscle function, including spastic states, tremor, clonus, and abnormal sphincter function, and finally its effect on abnormal smooth muscle function. Canadian ophthalmology professor Joan Carothers began using botulinum toxin type A in 1987 to treat cosmetic problems caused by normally functioning muscles, and it was officially reported in 1992. The U.S. FDA has allowed Botox since 1989 for the treatment of strabismus and disorders associated with restrictive dystonia over the age of 12. Canada was the first to approve Botulinum toxin type A for cosmetic medical use in 2001, and the U.S. FDA approved Botulinum toxin type A for cosmetic projects to improve moderate to severe frown lines between the eyebrows on April 12, 2002. Since then, as research has progressed, Botox has been used in a variety of fields including ophthalmology, neurology, orthopedics, and plastic and cosmetic surgery. This is an anatomical diagram of the facial muscles. Because of the complexity of the facial expression muscles, the location and dosage of each injection is the key to wrinkle reduction. In the field of cosmetic surgery, the main applications are as follows: Initially, Botulinum toxin type A was used to eliminate wrinkles in the upper half of the face, such as horizontal forehead lines, frown lines, crow’s feet and wrinkles on the back of the nose. Later, the application was gradually extended to the lower half of the face, such as perioral wrinkles in the elderly, cervical striae, and power folds in the nasolabial folds. Besides using it alone, Botulinum toxin type A can also be used with other wrinkle reduction methods to increase the efficacy and duration of treatment, such as as as an adjunctive treatment before endoscopic forehead lift, laser wrinkle reduction, and during soft tissue filling procedures. Nowadays, in addition to wrinkle removal, there is also the use of Botulinum toxin type A to treat dystonic disorders such as brow asymmetry, facial palsy, and spastic sloping neck, which are treated with Botulinum toxin to adjust the power contrast and achieve a coordinated state. Another scope of application is to adjust muscle volume, which includes bite muscle hypertrophy, lower eyelid orbicularis muscle hypertrophy, facial asymmetry and calf muscle hypertrophy, etc. By paralyzing the nerves that innervate the muscles, the muscles maintain a relaxed state, thus slowly atrophying and achieving the effect of reducing muscle volume. There are also functions such as treating armpit odor by inhibiting the secretion of sweat glands and inhibiting scar growth. However, botulinum toxin, as a toxin, is prohibited or needs to be used with caution in certain cases. Botulinum toxin type A treatment is extremely safe and has not been reported to be teratogenic, but after all, experience is limited, therefore, the use of botulinum toxin type A is not recommended for pregnant or breastfeeding women. Botox should not be used in people with neuromuscular disorders, especially those affecting the neuromuscular junction, such as myasthenia gravis and Lambert2Eaton syndrome. People who apply Botox for cosmetic purposes should first ask for a general history, including a history of medication use and allergies. Again, the toxin should not be used in people who are allergic to any of the components of BOTOX products, such as toxin, saline and human albumin. Drugs such as aminoglycosides and quinine can interfere with neuromuscular transmission, thereby enhancing the effects of botulinum toxin type A. Although no problems have been reported in individuals with appropriate dosages for cosmetic treatment, caution should be used for those who are using such drugs. For elderly people with significantly sagging upper eyelids or significantly weakened lower eyelids, Botox injections can cause weakness in eye opening or lower eyelid ectropion, and should be used with caution. Botulinum toxin application misconceptions Botulinum toxin tube one year or even claim two years. In the clinic, we often encounter such patients who say that some beauty salons or plastic surgery institutions claim that their botulinum toxin is new or imported and can be used for two years, or even ten years. In fact, considering the principle of action of Botox, it is easy to understand that such claims are obviously misleading consumers. After entering the human body, Botox causes a temporary weakening or paralysis of the muscles to achieve the purpose of removing wrinkles, but the muscles will gradually metabolize this drug. Moreover, the nerve endings appear to regenerate and the muscle regains innervation and gradually regains its function. This process is certain, about 3 to 6 months, so the treatment with Botox is temporary. It is possible that there are differences between individuals and the rate of nerve regeneration varies, which causes differences in the effectiveness and duration of maintenance for different individuals. The average duration of effectiveness is 3.4 months, while the efficacy may increase appropriately after several injections, but generally none exceeds one year. Another point that must be made is that there is no difference between domestic and imported drugs in terms of efficacy. There is only one truly imported botulinum toxin, and that is BOTOX from Allergan, a GlaxoSmithKline agent. The price of playing cheap is the same as the expensive one. Botox prices are very confusing, with a few hundred dollars for a single Botox injection, and several thousand dollars or even over ten thousand. So how to see this difference? Because Botox is a toxic drug management, the state strictly controls it. Up to now, there are two legal Botox manufacturers in China, Lanzhou Hengli and American BOTOX. Botox is a prescription drug both at home and abroad, so the injectable drug must have a State Drug Administration-issued National Drug Certificate number. The beauty salon is not a medical beauty institution and cannot buy this drug at all. Even if the beauty salon bought the real drug, it is illegal to use, because it is not qualified to practice medicine. In the current market, many unqualified beauty institutions have botulinum toxin purchased from unscrupulous dealers. These botulinum toxin not only does not have an approval number, did not indicate the expiration date, and the amount of medicine is also inaccurate. Once there is a problem, the consequences are unthinkable. After injecting Botox, facial aging problems will be improved According to a Botox expert, 50% of the Botox preparations on the Chinese market are “1 product split into 2 or even 3 for sale” Some profit-seeking unscrupulous traders, which is how to dilute the potency of Botox, profiteering from it. The market also has a package of 30 units of Botox, and the world’s three major manufacturers, including the Lanzhou Institute of Biological Products, have not produced this specification of Botox. The price of this botulinum toxin is very low, some only a few tens of dollars a piece, while the price of botulinum toxin from regular manufacturers is higher. Due to the drive of interest, unscrupulous organizations purchase inexpensive Botox and sell it at high prices to make huge profits. For the sake of your health, you should go to a regular medical institution for injections. And the cost must be within a certain range, between 1,000 and 3,000 yuan is reasonable, too high price is also unreasonable. Any fat face is effective. Now the word “slimming needle” often appears in newspapers and magazines, in fact, refers to Botox injections, and Botox for wrinkle removal is the same drug, the difference is the difference in the muscle injected. The difference is that the muscle injected is different. The wrinkle removal injection is the expression muscle, while the face slimming injection is the hypertrophic bite muscle. The principle of botulinum toxin face slimming is simply this: the drug can block the nerve impulses of nerves and muscles, paralyze the overdeveloped bite muscle to relax, lose the function of chewing force, gradually atrophy, the volume becomes smaller, also to achieve the effect of slimming the face. So, if you really have a fat face caused by an enlarged bite muscle, Botox injections are effective! But not that any fat face can be made thin by injecting Botox, for those fat faces with more subcutaneous fat, facial liposuction or removal of cheek fat pad is needed to solve the problem; and for square faces with large jaw angle bones, bone grinding surgery is needed to do so. It will be permanently fixed by playing 3 times. Now there is this saying that after 3 consecutive Botox injections, it will be permanently effective and there is no need to do it again. This is actually a false statement. In principle the effects of Botox injections appear slowly, starting to appear about two weeks to a month or so after the injection. Usually, after three to six months, the effect of the treatment will slowly disappear, at which point you will have to receive another injection if you want to obtain the original effect. Even after 3 or more injections, the results are not permanent and will recover after a period of time. Furthermore, Botox injections can lead to the production of neutralizing antibodies under certain conditions, so if you use Botox type A again to remove wrinkles, you must switch to Botox type B and F. The way to prevent the emergence of antibodies is: the amount of each injection is less than 100 units; the interval between two injections is more than 1 month. Is it easy to get an injection? Nowadays, most of the medical beauty institutions in China are doing Botox injections, and even life beauty salons are not lagging behind, and they are getting into the business of injecting wrinkle removal, as if it is a very simple medical business. But many beauty salons do this procedure without formal training, injecting this “botulinum toxin” is extremely vulnerable to danger. This is because the botulinum toxin type A injected into the muscle is easy to spread, if the amount of liquid is large, or once the injection site beyond the area, spread to other muscles that do not need paralysis will occur some complications, is likely to cause disfiguring events such as lowered eyebrows, eyelid drooping, eye bags turned out, serious symptoms such as diplopia, swallowing difficulties, inhalation difficulties, and even life-threatening. Although this injection process is simple, it requires the injector to be familiar with the anatomy of facial nerves and muscles and the structure of the orbital region, and has very strict requirements on the dilution level of Botox, injection site, injection timing and the interval between each injection, so the injector must be a specialist with certain training. At the same time, we caution all beauty lovers who choose Botox treatment: choose a qualified doctor or medical institution. Can Botox solve all aging problems? Botox wrinkle removal is only one of many wrinkle removal procedures and is not 100% effective for anyone. Wrinkle removal with Botox can generally remove crow’s feet, forehead lines, inner nasolabial lines and neck wrinkles, but it is best used for early, less visible wrinkles and where the skin is not very saggy. If there is significant sagging of the skin, surgical wrinkle removal is required. Is Botox safe? Botulinum toxin type A is a toxin that was first discovered when people mistakenly ate spoiled sausage and died due to ingesting large amounts of botulinum toxin. The current projected limit for the use of Botulinum toxin type A is an LD50 of approximately 40 units/kg, or 2,400 units for a 60 kg person. However, the amount currently used in clinical applications is very small, less than 200 units each time, and is therefore safe. However, there are side effects of Botox injections, but of course these side effects will be reduced over time until they disappear. Some are possible results of Botox injections, commonly localized swelling, petechiae, numbness at the injection site, headache, tightness in the forehead, unnatural expression, photophobia and tearing, mild lower lid ectropion, and blurred vision. These reactions often occur 3 to 5 days after treatment and usually subside gradually in 2 to 4 weeks. Some side effects related to injections, such as deepening of wrinkles in adjacent areas, change in eyebrow shape, ptosis, drooping eyebrows, and unnatural expressions around the mouth caused by injection of the bite muscle, can be avoided or reduced by appropriate injection techniques. Inject the needle into the injection site quickly and precisely; pay attention to the distance of at least 1 cm from the bony structures of the orbit; inject slowly; apply ice to the area after injection; apply gentle local pressure rather than massage after injection, and do not massage the area for 2 to 3 hours after injection; it is best to keep the head upright for 3 to 4 hours after injection; the injected muscle should be contracted continuously for 2 to 3 hours after injection, because the toxin selectively binds to the moving muscles.