Botox - what is it and what is the drug capable of?

On the path to restoring their former beauty and youth, women encounter many procedures and medications. Thus, one of the most popular procedures - the injection of Botox - leaves many patients confused: what is the difference in the use of Botox, Dysport, Xeomin and others? Which one is better/worse, more expensive or cheaper? Let's try to deal with these issues once and for all.

Botulinum toxin type A has been used in cosmetology for several decades. Its task is to eliminate facial wrinkles due to muscle fiber relaxation, as well as correct hyperhidrosis. The toxin blocks neuromuscular transmission, thereby relaxing the muscle.

The most well-known drugs today are the following: Botox, Dysport, Xeomin, Lantox, Relatox. These products are certified and approved for use in the Russian Federation.

We will analyze and compare the composition of the most common botulinum toxins type A, and also try to compare them based on the analysis of this data.

Composition of drugs

Both drugs contain water-soluble protein Albumin (Albuminum humanum) and sodium chloride.

Difference between Botox and Botulax:

• production technology;
• cleaning level;
• auxiliary components;
• dosage;
• price.

Let's look at each tool in more detail.

…

Botox

A classic anti-aging product with botulinum toxin, it has long been successfully used in cosmetology and medicine. Produced by the American company Allergan. World famous, well studied. The effect lasts up to 6-8 months.

Compound:

• purified class A botulinum toxin to suppress muscle impulses and relax muscles;
• Albumin is a protein for tissue repair;
• sodium chloride is a solvent for the ingredients of the drug.

Storage method: at temperatures from -3o to -17o.

…

Botulax

Manufactured by the South Korean company Hugel Inc. The effect lasts up to 4-6 months.

A relaxing antipsychotic with a good effect on facial muscles. The basis of the composition is highly concentrated protein botulinum toxin A. For stabilization, auxiliary ingredients are present. Injections are carried out slowly - foaming may occur if injected quickly.

Compound:

• Category A protein neurotoxin;
• simple water-soluble proteins in whey;
• sodium chloride 0.9%.

The prepared solution is stored for no more than a day at temperatures up to +7o.

Table of the number of units of Botox, Dysport, Botulax, Relatox for treated areas

Indications for use

Korean and American drugs are used in cosmetology for people aged 20 to 65 years, the target audience is 30-45 years. The effect lasts until the botulinum toxin is completely removed from the body, after which the procedure is repeated.

The drugs showed especially good results when correcting facial asymmetry, modeling oval shapes, and eyebrow lines.

For deep wrinkles and folds, self-injections will not be effective, but can be effectively used in combination with other anti-aging procedures.

Indications for Botox and Botulax injections:

• smoothing facial wrinkles;
• restoration of facial proportions, elimination of asymmetry;
• raising drooping eyelids;
• rejuvenation of the neck area;
• fight against blepharospasms;
• prevention of static wrinkles.

Correct dosage

Wherever toxin injections , it is important to correctly calculate the dose of the drug to achieve optimal effect. There is no need to do the calculations yourself - this is the task of an experienced cosmetologist in the clinic. The doctor will be able to determine the required amount of botulinum toxin only after an in-person examination and assessment of the patient’s skin condition.

The calculation takes into account:

• Age;
• Skin condition;
• Depth of wrinkles;
• Muscle activity;
• Condition of muscle tissue;
• Processing area;
• Number of injections.

However, there are average values ​​for the required amount of botulinum toxin for different areas. The drug is measured in units. Knowing these values, you can very roughly calculate the cost of the procedure before visiting the clinic in order to have an idea of ​​what to prepare for. Let's consider how many units may be required for different zones.

Which drug is more effective?

Let's compare the effectiveness of Botox and its analogue from South Korea.

Botox:

• Easily tolerated, complications are rare.
• Low effectiveness in eliminating deep wrinkles.
• The effect increases gradually from 2-3 days. Maximum result at the end of the second week.
• Frequent repeated injections form an addiction to the drug and reduce its effectiveness.
• The result lasts 6-8 months.
• Good lifting effect: the corners of the lips and brow ridges are raised.
• High price due to the popularity of the brand.

Botulax:

• Affordable price. Competitor in price even for domestic products.
• Peculiarities. The drug's production technology and components are similar to Botox.
• The duration of the effect is 4-6 months.

The general features of the drugs are targeted effects, preservation of natural facial expressions and gestures. The effect of the drugs does not extend to nearby tissues.

Number of units of Botox for the treatment of hyperhidrosis

To get rid of excessive sweating, you will need quite a lot of Botox, but the result will be impressive.

On average, it takes about 50-100 units 50-70 units per palm . For one foot from 50-100 units . The effect of the procedure lasts for 1 year.

Description of the procedure

Stages of botulinum therapy:

1. Before injections, the face is thoroughly cleansed of dirt, sebum, and makeup.
2. Application of anesthetic gel to relieve pain.
3. The drug is prepared in accordance with the intended dosage regimen. The required number of units is calculated depending on the segment of the face in which the injection is given.
4. Administration of injections according to the scheme.
5. Compress for the prevention of edema and hematomas.
6. Recommendations for skin care.

The procedure takes 20-45 minutes, upon completion the client quickly returns to normal life. After 3-5 hours, visible results are already visible. All that remains is to observe the changes and follow all the specialist’s recommendations.

pharmachologic effect

Muscle relaxant. The botulinum toxin type A molecule consists of two chains: a heavy chain (with a molecular weight of 100,000 Daltons) and a light chain (with a molecular weight of 50,000 Daltons), connected by a disulfide bond.

The heavy chain has a high affinity for specific receptors localized on the surface of target neurons. The light chain is characterized by Zn2+-dependent protease activity. It is specific for the cytoplasmic regions of the synaptosomal associated protein with a molecular weight of 25,000 Daltons (SNAP-25), which is involved in the processes of exocytosis.

First stage

The action of botulinum toxin type A is the specific binding of the molecule to the presynaptic membrane.

Second stage

— penetration of the bound toxin into the cytoplasm of neurons by endocytosis.
Inside the cell, the light chain exhibits Zn2+-dependent protease activity, selectively destroying SNAP-25, which in the third stage
leads to blockade of acetylcholine release from the presynaptic terminals of cholinergic neurons.

The end result

is prolonged chemodenervation.

Clinically, there is a pronounced relaxation of the muscles into which the injection was made. In denervated muscles, the process of reinnervation occurs due to the formation of lateral processes of nerve endings 12 weeks after injection, which leads to the restoration of muscle contractions. However, the processes are partially effective and subsequently regress while primary neuromuscular transmission is activated.

Rehabilitation

Unpleasant sensations are possible during the first three days: redness, swelling, bruising, soreness of the injection points, headaches. Symptoms usually go away without treatment, but if they worsen, seek medical help.

Basic recommendations for successful recovery:

• do not take a horizontal position or bend over for 6-8 hours;
• on the first day, do not touch your face, do not wash your face, do not apply makeup;
• cancel any physical activity for a week;
• do not consume spicy foods, coffee and strong tea;
• exclude visits to baths, saunas, solariums, beaches, swimming pools, water parks for 2 weeks;
• exclude the use of antibiotics, hormone-containing drugs and medications that alter blood clotting;
• give up alcoholic drinks.

A healthy lifestyle is not only beneficial for the body, but also for the injection area – it preserves botulinum toxin and, therefore, the effect of injections.

Side effects

As a rule, adverse reactions appear during the first days after injection and are transient. In rare cases, the duration of adverse reactions may be several months or more.

Local muscle weakness reflects the expected pharmacological effect of botulinum toxin on the muscle. However, large doses may cause weakness in muscles other than those directly at the injection site.

Dysphagia following injections in areas other than the neck muscles has been reported. If there is a problem with swallowing, speech or breathing, the patient should immediately consult a doctor.

As with any injection, local soreness and/or bruising may occur at the injection site. An increase in temperature and the occurrence of a flu-like syndrome have been described.

What procedures should be used to supplement botulinum therapy?

“Beauty injections” correct facial contours, make facial wrinkles less noticeable, but have almost no effect on the condition of the skin. For better results, it is worth adding a set of anti-aging procedures.

What can be combined with Botulax?

• Mesotherapy and biorevitalization - injections of cocktails based on hyaluronic acid with the addition of antioxidants and vitamins, promote the production of collagen and elastin.
• Chemical and hardware peelings will renew the surface of the skin and eliminate pigmentation.
• Fillers smooth out deep folds and create the correct relief.

After the age of fifty, combined methods work much more effectively than any monotherapy.

How many units of botulinum toxin are needed to smooth out wrinkles on the forehead?

Expression wrinkles on the forehead are a common problem. Often such folds appear at a young age and quickly deepen, forcing their owners to hide their faces under their bangs.

Treating wrinkles usually requires multiple treatments. The earlier therapy is started, the more effective it is. 10-15 units of Botox are used for the forehead area . The amount of Dysport is calculated in a ratio to Botox of one to three, or one to four.

During the preliminary consultation, the doctor will ask you to frown to determine the exact location of wrinkles and evaluate facial expressions. After this, the doctor will determine the required amount of the drug and the exact injection sites.

Contraindications

Botulax is a new drug on the Russian market and has passed the necessary studies.

Main contraindications for injections:

• individual intolerance;
• diseases: diabetes, oncology, tuberculosis, infections, endocrine and cardiovascular, chronic pathologies;
• pregnancy and breastfeeding;
• problems with blood clotting;
• menstrual period;
• hernia of the eyelids;
• chronic muscle fatigue.

The choice of anti-aging injections will be made by a cosmetologist taking into account the condition of the skin, rejuvenation area, and age. It is difficult for a non-professional to make the right decision; choosing a drug is the task of a specialist.

Using Botox to remove wrinkles around the eyes

One of the first noticeable signs of aging is wrinkles in the corners of the eyes, the so-called “crow's feet”. The procedure will smooth out this area and erase such signs of age. To treat one zone, 5 to 15 units of product are required.

Injections into the area under the eyes will help smooth out fine wrinkles on the lower eyelid, as well as make the look more expressive, removing signs of fatigue.

Botox lyophilisate for preparing a solution for intramuscular administration 100 units fl

Active substance

botulinum toxin type a

pharmachologic effect

Muscle relaxant. The botulinum toxin type A molecule consists of two chains: a heavy chain (with a molecular weight of 100,000 Daltons) and a light chain (with a molecular weight of 50,000 Daltons), connected by a disulfide bond.

The heavy chain has a high affinity for specific receptors localized on the surface of target neurons. The light chain is characterized by Zn2+-dependent protease activity. It is specific for the cytoplasmic regions of the synaptosomal associated protein with a molecular weight of 25,000 Daltons (SNAP-25), which is involved in the processes of exocytosis.

The first stage of action of botulinum toxin type A is the specific binding of the molecule to the presynaptic membrane.

The second stage is the penetration of the bound toxin into the cytoplasm of neurons through endocytosis. Inside the cell, the light chain exhibits Zn2+-dependent protease activity, selectively destroying SNAP-25, which in the third stage leads to blockade of acetylcholine release from the presynaptic terminals of cholinergic neurons.

The end result is prolonged chemodenervation.

Clinically, there is a pronounced relaxation of the muscles into which the injection was made. In denervated muscles, the process of reinnervation occurs due to the formation of lateral processes of nerve endings 12 weeks after injection, which leads to the restoration of muscle contractions. However, the processes are partially effective and subsequently regress while primary neuromuscular transmission is activated.

Indications for Botox

• blepharospasm;
• hemifacial spasm;
• cervical dystonia (spasmodic torticollis);
• focal spasticity of the wrist and hand in patients who have had a stroke;
• paralytic strabismus (strabismus);
• local muscle spasm in cerebral palsy in children aged 2 years and older;
• correction of facial wrinkles.

Dosage regimen

Rules for the preparation and storage of solution for injection

The preparation of the solution for injection and the collection of the solution into the syringe should be carried out on a work surface covered with a paper towel on a polyethylene lining, which makes it possible to quickly remove the spilled drug. Botox restoration is carried out only with 0.9% sodium chloride solution for injection. The injection solution is prepared by piercing the stopper with a sterile needle and introducing the required amount of solvent into the vial. If the solvent is not drawn into the vial under vacuum, the vial is destroyed. Before puncturing, the central part of the rubber stopper must be treated with alcohol. To pierce the cork, use a sterile 23-25 ​​G needle.

The solvent should be carefully introduced into the bottle (see table above), mixing the powder with the solvent with light rotational movements of the bottle. Vigorous shaking of the vial and the formation of foam can lead to denaturation of the drug. The finished solution is a clear, colorless or slightly yellowish liquid without foreign inclusions; slight opalescence may be observed.

Reconstituted Botox® can be stored in the refrigerator at a temperature of 2°-8°C for 24 hours. The prepared solution is administered using an insulin syringe with a non-removable needle. Once reconstituted, the product must be used within 24 hours if stored correctly. Unused solution must be discarded.

The units of action of botulinum toxin in different preparations are not interchangeable. Recommended doses expressed in units of action for Botox differ from those for other botulinum toxin preparations.

No adequate dosing studies have been conducted in elderly patients. The same doses are used as in adults, but the use of the minimum effective dose is recommended.

Botox injections must be performed by a qualified physician who has undergone special training and received permission from the manufacturer. Injections can be performed on an outpatient basis in a treatment room.

The Botox dose and injection points are determined individually for each patient in accordance with the severity and location of muscle hyperactivity. In some cases, electromyography (EMG) is used to more accurately determine the localization of the pathological process.

Treatment of blepharospasm and hemifacial spasm

The Botox solution is injected with a needle measuring 27-30G/0.4-0.3 mm. To treat bilateral blepharospasm, the drug is injected superficially into the upper eyelid into the medial and lateral sections of the orbicularis oculi muscle and into the lower eyelid into the lateral section of the orbicularis oculi muscle. Other points for injection: the pretarsal part of the orbicularis oculi muscle, the eyebrow area and the forehead area (if the spasm that occurs in it affects vision). To prevent the occurrence of ptosis, as a complication of the procedure, it is necessary to avoid administering the drug near the muscle that lifts the upper eyelid. To prevent diplopia, as a complication of the procedure, it is necessary to avoid injecting the drug into the medial part of the lower eyelid.

The initial dose is 1.25-2.5 units of the drug at each injection point. The total initial dose should not exceed 25 units on each side. The effect of the drug appears during the first three days after the procedure and reaches its maximum severity 1-2 weeks after it. The duration of the effect of the drug reaches 3 months, after which the procedure can be repeated.

If the effect of the initial treatment is regarded as insufficient, when the drug is re-administered, the dose can be increased by no more than twice. However, the introduction of more than 5 units of the drug at each injection point is not accompanied by a significant improvement in the clinical effect.

When treating blepharospasm, the total dose of Botox over 12 weeks should not exceed 100 units.

Treatment of patients with hemifacial spasm is carried out in the same way as with unilateral blepharospasm; if necessary, injections of the drug are also carried out into other affected facial muscles. The total dose of Botox for the treatment of hemifacial spasm should be the same as for blepharospasm.

The safety and effectiveness of Botox in the treatment of blepharospasm and hemifacial spasm in children under 12 years of age have not been demonstrated.

Treatment of cervical dystonia (spasmodic torticollis)

The Botox solution is injected with a needle measuring 25-30G/0.5-0.3 mm.

When treating spastic torticollis, the drug solution is injected into the most tense muscles of the neck in a dose of no more than 50 units at each point.

No more than 100 units of the drug is injected into the sternocleidomastoid muscle.

The total dose of the drug during the first procedure should not exceed 200 units.

When treating spastic torticollis, the drug is injected into the sternocleidomastoid muscle on the side opposite to rotation, and into the splenius muscle on the side of rotation.

In cases accompanied by shoulder elevation, the drug should be additionally injected into the trapezius muscle and the levator scapulae muscle on the affected side.

When tilting the head back, the drug is injected into the splenius and trapezius muscles on both sides.

When the head is tilted forward, the drug is injected into the sternocleidomastoid muscles on both sides.

With subsequent administration, the dose of the drug may be adjusted depending on the previous clinical result and observed side effects.

Clinical improvement appears within the first two weeks after injection of the drug. The most pronounced clinical effect is achieved approximately 6 weeks after injection. The duration of the clinical effect reaches an average of 12 weeks, after which, if necessary, treatment can be repeated. Intervals between therapy sessions of less than 10 weeks are not recommended.

In case of complex forms of torticollis or weak effect of treatment, EMG of the neck muscles should be performed to more accurately determine the localization of tense muscles.

The safety and effectiveness of Botox in the treatment of spasmodic torticollis in children under 12 years of age have not been demonstrated.

Treatment of local muscle spasm in cerebral palsy

The Botox solution is injected with a needle measuring 23-26G/0.6-0.45 mm.

When treating spasticity and equinovarus deformity of the foot in children with cerebral palsy, the drug solution is injected into 2 points of each head of the gastrocnemius muscle (medial and lateral). In case of hemiplegia, the drug can be injected into the flexor muscles of the forearm, and when crossing the hips - additionally into the adductor muscles of the thigh. The total dose of the drug for one procedure is determined at the rate of 4-6 units/kg body weight and is distributed evenly between all muscles into which injections are performed. The total dose should not exceed 200 units.

Clinical improvement is evident in the first 7-14 days after injection. The drug is re-administered when the severity of the clinical effect is reduced by half, but not earlier than 3 months after the previous procedure. The dose of the drug is selected in such a way as to achieve at least a 6-month interval between procedures. Orthopedic correction, muscle stretching, and physical therapy can help improve the clinical effect of Botox injections.

Treatment of focal spasticity of the wrist and hand in stroke patients

The Botox solution is injected with a 25G, 27G, or 30G needle into the superficial muscles and a longer needle into the deep muscles.

To establish the localization of the muscles involved in the pathological process, EMG control or nerve fiber stimulation methods can be used. Injecting Botox into several points can help distribute it more evenly in the muscle, which is especially justified when injecting the drug into large muscles.

Selection of the exact dose of the drug and the number of injection points must be carried out individually in accordance with the size, number and location of the muscles involved in the pathological process, the severity of spasticity, the presence of local muscle weakness and the nature of the patient’s response to previous treatment.

Positive changes in muscle tone were noted within 2 weeks after injection, the maximum clinical effect was observed, as a rule, no later than 4-6 weeks.

In cases where the attending physician considers it necessary to re-administer the drug, it can be done after the effect of the drug on muscle tone has decreased. The interval between injections should be at least 12 weeks. Changing the degree and nature of muscle spasticity before re-introducing the drug may require adjusting the Botox dose and identifying new injection points. The minimum effective dose must be used.

In patients with focal spasticity, Botox® is used in combination with a standard treatment regimen. The drug is not intended to be used as a replacement for these treatments.

Treatment of paralytic strabismus (strabismus)

The Botox solution is injected with a 27G needle.

Botox is injected into the muscles of the eyeball under EMG control. To prepare the eye for a Botox injection, it is recommended to instill several drops of a local anesthetic and decongestant into the conjunctival sac a few minutes before the procedure.

For minor deviations of the eyeball, minimal doses of the drug are used; when treating more pronounced deviations, the dose is increased.

Initial doses:

when injected into the muscles that carry out vertical movements of the eyeball (superior and inferior rectus muscles) and with horizontal strabismus, less than 20 prismatic diopters: from 1.25 to 2.5 units for any muscle;

for horizontal strabismus from 20 to 50 prismatic diopters: from 2.5 to 5 units for any muscle;

with abducens nerve (VI nerve) palsy that persists for 1 month or more: from 1.25 to 2.5 units in the medial rectus muscle.

The initial effect is observed 1-2 days after the procedure, increases during the first week, persists for 2-6 weeks and gradually decreases over the same time period. Rare cases of persistence of the effect for more than 6 months have been described.

Approximately half of the patients after the first injection of the drug require repeated administration due to an inadequate clinical response of the muscles to the first procedure or due to mechanical factors: significant deviation or limitation of the mobility of the eyeballs, as well as the inability to stabilize the position of the eyes due to the motor component of binocular fusion (fusion) . It is recommended to examine patients 7-14 days after each injection to assess the effect of the procedure. In patients with incomplete relaxation of the target muscle during subsequent administration, the dose of the drug can be doubled.

Repeated administration of the drug should be carried out only after the clinical effect from the previous procedure has decreased, which is expressed in a stable restoration of the function of the injected and adjacent muscles.

The maximum recommended dose for a single injection into any muscle for the treatment of strabismus is 25 units.

Correction of facial wrinkles

It is not recommended to use Botox for the correction of vertical facial wrinkles between the eyebrows in patients under 18 and over 65 years of age.

Botox solution (100 units/2.5 ml) is injected with a 30G needle.

4 units are injected into 5 injection points: into the musculus corrugator - 2 points on each side, into the musculus procerus - 1 point. The total dose is 20 units.

Before administering the injection, it is necessary to press the thumb and forefinger firmly against the skin below the edge of the orbit to prevent the drug from spreading below this level. When performing an injection, the needle should be directed upward and medially. To reduce the risk of developing ptosis, it is necessary to avoid administering the drug near the levator palpebrae superioris muscle, especially in patients with well-defined levator palpebrae superioris muscle. When injecting the drug into the corrugator musculus, the injection must be made into the central part of the muscle, retreating at least 1 cm above the arch of the eyebrow.

Smoothing of vertical facial wrinkles between the eyebrows occurs, as a rule, within a week after the procedure. The effect lasts up to 4 months.

The interval between procedures should be at least 3 months. If there is no effect from the administration of the drug or a decrease in its severity after repeated injections, other treatment methods should be recommended.

For all indications for use

If the first procedure is ineffective, i.e. In the absence of significant clinical improvement compared to the initial state, 1 month after administration of the drug, it is necessary:

clinical confirmation of the effect of the toxin on the injected muscle(s), which may include an EMG study performed by an experienced specialist in a specialized department;

analysis of the reasons for the ineffectiveness of the procedure, for example, inadequate selection of injection points, insufficient dose, incorrect injection technique, signs of fixed contracture, weakness of antagonist muscles, formation of toxin-neutralizing antibodies;

re-evaluation of the appropriateness of treatment with botulinum toxin type A;

in the absence of any undesirable effects associated with the first administration of the drug, the following conditions must be met during the repeated procedure: dose adjustment taking into account the analysis of the reasons for the ineffectiveness of the previous procedure; EMG control; the interval between procedures should be at least 3 months.

If there is no effect from the administration of the drug or a decrease in its severity after repeated injections, other treatment methods should be recommended.

Before use, consultation with a specialist is required.

The method of administration and dosage regimen of a particular drug depend on its release form and other factors. The optimal dosage regimen is determined by the doctor.

Storage mode, interactions and side effects are indicated in the instructions.

Contraindications for use

Are common

• proven hypersensitivity to any component of the drug;
• inflammatory process at the site of the proposed injection(s);
• acute phase of infectious diseases;
• pregnancy;
• lactation.

For blepharospasm and correction of facial muscles

• pronounced gravitational ptosis of facial tissues;
• pronounced “hernias” in the area of ​​the upper and lower eyelids.