Joseph R. Anticaglia, MD
Medical Advisory Board
At times, medical breakthroughs happen by sheer accident, and keen observation. Such accidental discoveries have changed the course of medicine. Consider the accidental discovery of penicillin. “In 1928 Dr. Alexander Fleming returned from a holiday to find mold growing on a Petri dish of Staphylococcus bacteria. He noticed the mold seemed to be preventing the bacteria around it from growing. He named the chemical that could kill bacteria, Penicillin. Before antibiotics, Science Museum continues, “Everything from paper cuts to childbirth had the potential to kill through bacterial infection.”
While not as impactful as the “wonder drug” penicillin and other antibiotics, Botox has a serendipitous, and influential history. In 1987, Canadian husband and wife doctors accidentally discovered Botox’s cosmetic potential. Ophthalmologist Dr. Jean Carruthers, while treating a patient diagnosed with spasmodic winking [a spasm of the eyelid muscles that causes the eyes to close tightly — blepharospasm] observed that the patient’s forehead lines disappeared. She and her Dermatologist husband published a study in 1992 suggesting that Botox (C. Botulinum-A) could be used for cosmetic purposes.
What Is Botox?
Botox is an injectable drug that’s used in cosmetic and medical procedures to temporarily relax the targeted muscle. Cosmetically, it’s used to smooth lines and wrinkles; in certain medical conditions, such as blepharospasm, it’s used to relieve spasticity.
Botox is a brand name of the purified botulinum toxin, a neurotoxin protein that can paralyze specific nerves. It comes from the bacterium, Clostridium botulinum. This pathogen causes botulism, a life-threatening type of food poisoning.
The Belgium bacteriologist Emile Pierre vân Emergem in 1897 described the toxic pathogen Clostridium botulinum after 34 musicians suffered food poisoning, and reported three of the musicians died within a few days. Botox is also known as botulinum toxin type A.
Cosmetic Uses
Cosmetic Botox injections work by temporarily preventing the movement of facial muscles by blocking the transmission of nerve signals reaching the targeted muscle. The neurotransmitter acetylcholine is a signal transmitter, a bridge between a nerve and muscle activity. Botox injections inactivates and blocks acetylcholine relay signals, causing facial muscles to relax and by doing so reduce the appearance of wrinkles.
In other words, the brain wants a certain muscle to contract. It sends a signal to the nerve instructing it to release; for example, the neurotransmitter acetylcholine into the muscle. The nerve carries out the instruction, and the muscle contracts. Botox blocks the transmission of acetylcholine into the muscle. As a result of the blockage, the muscle relaxes, the wrinkles become smooth.
Rule of 3s
Typically, you see the results of a Botox injection by day three, the maximum effect in three weeks, and the effect lasts approximately 3 months. Three months after the Botox injection, the communication between nerve and muscle is reestablished and the function of the neurotransmitter acetylcholine is restored.
Look of 3
On December 10, 2002, the FDA approved Botox treatment to improve the look in three facial areas:
- Forehead lines, also called worry lines, appear due to facial expressions such as raising the eyebrows, squinting, and frowning.
- Frown lines are vertical lines that appear between the eyebrows, also called glabellar lines.
- Crowe’s feet are lines that appear along the outer eye areas.
Medical Uses
Botox is used to treat a number of medical conditions including:
- Voice and speech disorders: Botox, for example, has been injected into the muscle of the larynx (voice box) to treat benign essential tremor, a hiccupping, staccato sound to the voice due to the tremor.
- Migraines: People experiencing migraine headaches have been helped with Botox injections.
- Eye problems: Botox can help people with strabismus (crossed eyes) and blepharospasm (spasmodic winking).
- Cervical dystonia: It has been used to treat involuntary neck and shoulder muscle contractions.
In addition to the above, Botox has been used to treat severe underarm sweating, and overactive bladder.
Side Effects
Generally, Botox injections are safe with minimal side effects when administered properly, and by experienced doctors. Most side effect are minor and resolve within a few days. After laryngeal Botox injections, people may experience breathiness, and a weak quality to their voice. Some individuals might complain of coughing, and liquids “going down the wrong pipe.”
Side effects other than those that involve the larynx include irritation at the injection site, headache, flu-like symptoms, drooping eyelids, eye redness, and neck pain.
Botulinum toxin is considered one of the most deadly naturally occurring substances known to man. Credit man’s ingenuity in transforming a lethal poison into procedures to smooth wrinkles, and to treat medical conditions! Botox is a temporary fix. It’s not a cure. To maintain desired results, repeated treatments are recommended by qualified, experience professionals.
Glossary
Botox is indicated to teat dynamic wrinkles which appear as you move your face such as forehead lines.
Cervical dystonia — neck and shoulder muscle contractions
Hyperhidrosis — severe underarm sweating, and overactive bladder.
Action potential happens when the brain sends electrochemical signals to motor neurons in the spinal cord to initiate muscle contractions. The motor neurons send signals to the muscle fibers to contract.
References
- Carruthers and Carruthers; Treatment of Glabellar Lines with C. Botulinum-A Exotoxin; The Journal of Dermatologic Surgery and Oncology, January 1992
- Science Museum; How Was Penicillin Developed? February 23, 2021
- DermMedica; The History and Uses of Botox Cosmetic;
- Frank J Erbguth; Historical notes on botulism, Clostridium botulinum, botulinum toxin, and the idea of the therapeutic use of the toxin; Mov Discord, March 2004
- Christopher P. Smith et al; Botulinum Toxin: Poisoning the Spastic Bladder and Urethra; Rev Urol, Spring, 2002.
- FDA; Botulinum Toxin Type A — Product Approval Information; April 11, 2002
- Andrew Biello; et al; Laryngeal Botulinum Toxin Injection; Europepmc. org, April 17, 2023
- Angelica Balingit, MD; Botox Injections: A Guide to Cosmetic and Medical Botox; Healthgrades, Nov 22, 2022
- Frank J Erbguth; Historical notes on botulism, Clostridium botulinum, botulinum toxin, and the idea of the therapeutic use of the toxin; Mov Discord, March 20042004
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.