Botulinum toxin is the most poisonous substance known. It works by paralysing muscles and breathing in only a small amount can be fatal. It is a neurotoxin (or nerve toxin), produced by a bacterium called Clostridium botulinum, known to grow in anaerobic environments (those lacking in oxygen). The toxin not uncommonly causes food poisoning and was initially called the “sausage poison” when it was first discovered (in 1870) from the Latin word botulus, which means sausage.
The toxin is heat sensitive and usually denatured (made non-toxic) by cooking. But when foods tainted with the toxin are eaten, it is absorbed and spread by the blood where it then works on the muscles. Sporadic outbreaks of botulism occur after ingestion of home-canned foods, meat products and preserved fish. The incubation period is 18-36 hours.
But the muscle paralysing feature of botulinum toxin, when used beneficially, has proven to be useful in more than 50 conditions, including cosmetic applications, as well as in muscle spasm, cerebral palsy, excessive sweating and bladder hyperactivity.
How it works
Botulinum toxin attacks a neurotransmitter (called acetylcholine), present in the nerve cells, and blocks it from working locally. At first, it binds to the nerve and then it enters the nerve. Then, the toxin is broken down in the nerve cells, and the by-products of the toxin then interferes with the normal process of nerve activation. This results in the blocking of the neurotransmitter which further leads to muscle relaxation.
The toxin usually requires 1-3 days to show its effect, this is the time duration necessary to disrupt the nerve activation process. The effect lasts for about 8-12 weeks, and at the 10-week mark, patients begin to note a gradual reversal.
History of its discovery and use
These bacteria were first discovered in 1897 and was later purified into a crystalline form in 1940. In the late 1970s, trials in patients with strabismus (“lazy eye” or “cross-eyed”) were successfully performed and then in the mid-1980s, the first individual was treated with botulinum toxin for cosmetic reasons. In 1989 the US Food and Drug Administration approved it for treating various indications, including but not limited to crossed eye, involuntary spasms of eye muscles, involuntary twitching of facial muscles, involuntary contraction of neck muscles, excessive sweating, migraine, urinary incontinence and also for cosmetic use. There are approximately 30 or more conditions in which the botulinum toxin has been reported as useful.
Most common clinical uses
Today, botulinum neurotoxin injection is the most commonly performed cosmetic procedure in the world. It is frequently used in the management of ‘hyper-functional’ lines, most commonly lateral canthal lines (or crow’s feet), glabellar lines (in between the eyebrows) and forehead areas. These lines can cause dismay to those affected, as they often cause patients to be misread as angry, anxious, fearful, or fatigued.
In the past, facial plastic surgeons only had surgical options, such as the surgical removal of muscle or nerve, fat grafting, filler, or fat implants that plump up the facial lines temporarily. However, these options often provided minimal improvement and were associated with side effects e.g. allergy to collagen, skin tissue death due to reduced or no blood flow, and damage to eye and vision.
Therefore, the current treatment of choice for the hyper-functional lines is botulinum toxin (type A) injection into the muscle, as it has proved less painful, and more effective and convenient with minimal side effects.
Formation of facial lines depends on both the skin and muscle around the area. The factors related to skin includes continuous dehydration of the skin, loss of elasticity or turgor, pigmentation and reduction of collagen (protein that increases the skin firmness) in tissues. The muscle factors include repeated contraction of the muscle mostly focused around the area related to emotional expression such as areas around the eyes, forehead, glabella, mouth and nose.
Lateral canthal lines or crow’s feet
Lateral canthal lines are formed over time when the muscle around the eyes contract repeatedly. These can also be seen in subjects in between 20-30 years of age, if there is a lot of movement around the eyes especially when smiling. These facial lines might not be apparent at rest and only seen with facial expressions.
Moderate Lateral Canthal Lines
Severe Lateral Canthal Lines
These lines are one of the most demanding indications of Botulinum toxin products. These lines occur due to regular and repeated contractions of the muscle which controls the movement between the eyebrows. These repeated movements in turn causes a loss of skin elasticity, resulting in formation of deep wrinkles which can even be seen when the muscle is relaxed. These hyperactive lines can cause distress as it can be misinterpreted as signs of aging, tiredness and fear, etc.
Moderate Glabellar Lines
Severe Glabellar Lines
There are many ways to improve facial lines or wrinkles. Some but not all include facial lifts, laser treatments, skin peeling, fat implants and fillers etc. However, these treatments do not control the muscle contraction and therefore are unable to achieve the desired results. Instead, botulinum treatment has proved to show better results. It relaxes the muscle by blocking the chemical message from the nerve cell to the muscle which causes the muscle to contract. The botulinum treatment makes the subjects look younger and helps in building up self-confidence.
AusTrials is conducting a phase 2 clinical study to treat subjects with moderate to severe glabellar lines (in between the eyebrows) or canthal lines (crow’s feet, next to the eyes) to observe its safety and tolerability.
We are looking for participants 18-65 years old with bilateral and symmetrical, moderate to severe facial lines in between the eyebrows or around the eyes and who have not had any facial aesthetic treatments in the past 12 months.
If you think you qualify for the above criteria and would like take advantage of receiving this therapy for free, then please contact us on 07 3278 5255, by email to firstname.lastname@example.org by clicking on the ‘Studies’ page of our website
Other therapeutic uses of the Botulinum toxin
Therapeutic uses of botulinum toxin injection are extensive:
- Focal dystonias – Involuntary,
sustained, or spasmodic patterned muscle activity
- Cervical dystonia (spasmodic torticollis)
- Blepharospasm (eyelid closure)
- Laryngeal dystonia (spasmodic dysphonia)
- Limb dystonia (writer’s cramp)
- Oromandibular dystonia
- Orolingual dystonia
- Truncal dystonia
- Spasticity – Velocity-dependent
increase in muscle tone
- Traumatic brain injury
- Cerebral palsy
- Non-dystonic disorders of
involuntary muscle activity
- Hemifacial spasm
- Myokymia and synkinesis
- Tinnitus (due to myoclonus of stapedius muscle & tensor veli palatini muscle)
- Hereditary muscle cramps
- Nocturnal bruxism
- Strabismus (disorder of conjugate eye movement) and nystagmus
- Chronic pain and disorders of
localized muscle spasms
- Chronic low back pain
- Myofascial pain syndrome
- Tension headache
- Chronic migraine headache
- Medication overuse headache
- Lateral epicondylitis
- Knee pain
- Shoulder pain
- Neuropathic pain
- Smooth muscle hyperactive
- Neurogenic bladder – Detrusor hyperreflexia
- Detrusor-sphincter dyssynergia
- Benign prostatic hypertrophy
- Achalasia cardia
- Sphincter of Oddi dysfunction
- Chronic anal fissures
- Raynaud’s Phenomenon
- Sweating, salivary, and allergy
- Axillary and palmar hyperhidrosis
- Frey syndrome, also known as auriculotemporal syndrome (gustatory sweating of the cheek after parotid surgery)
- Drooling in cerebral palsy and other neurological disorders
- Nasal allergy and allergic rhinitis