Botulinum toxin

1. Botulinum Toxin
Dr. Sanjay Singh
AIIMS, Dermatology

2. Introduction
 Product of clostridium botulinum
 Bacteria and their spores are ubiquitous
 Found in soil and marine segments
 Spores detected in vegetables, fruits and sea foods

3.  Growing bacteria produces neuron toxin, botulinum toxin, the
most poisonous substance
 Toxin inhibits the release of acetylcholine
 Results in flaccid paralysis

4.  Seven serologically distinct types exist
 Type A ( Allergan)
 Type B (Myobloc)
 All seven types are distinct in their molecular weight
 Botax is indicated in wrinkles caused by muscular
contraction and not by solar exposure

6. Indications
 Frown lines between the eyebrows ( glabellar lines)
 Strabismus and blepharospasm associated with dystonia
 Cervical dystonia
 Transverse forehead lines

7.  Lateral canthal wrinkles (crow’s feet)
 Medial and lateral brow lifts
 Wrinkles on the upper lips
 Nasal scrunching and flaring

8.  Marionette lines
 Necklines
 Platysmal bands
 Mental creases and dimpling of chin
 Palmo plantar hyper hidrosis

9. Relevant anatomy
 Vertical rhytides- Corrugator supercilii muscle
 Horizontal rhytides- Procerus muscle
 Horizontal frown lines – Frontal muscle
 Crow’s feet – Orbicularis oculi muscle

10.  Excessive lip pursing – Orbicularis oris and
mentalis muscle
 Platysmal bands- Platysma

11. Dosing of Botox

14. Contraindications
 Wrinkles not caused by muscular contractions
 Neuromuscular disorders
 Hypersensitivity to any ingredient in formulation
 Pregnancy or breast feeding

15.  Unrealistic expectations
 Possible interference with the patients’ work or
daily activities due to changed expressions

16. Workup
 EMG
 Starch iodine test

17. Treatment
 Preoperative details
 Patient counseling
 Pre and post photographs
 Remove makeup's

18.  Patient should lie on back propped up position
 After injection do not massage the injection site
 Avoid exertion on the day of treatment

19. Complications
 Local effects: Drooling, pain, bruising, infection
 Weakness of muscles
 Ptosis
 Delayed eye closure
 Headache