A-Z of Cosmetic Surgery (Part 3)
Botulinum Toxin Type A (BOTOX®)
By Dr Ophelia E. Dadzie

What is BOTOX®?
It is a purified neurotoxin complex, produced from fermentation of a strain of Clostridium botulinum type A (a type of bacteria). Each vial of BOTOX® contains 100 Units of Clostridium botulinum type A neurotoxin complex, 0.5 milligrams of Albumin (Human), and 0.9 milligrams of sodium chloride in a sterile, vacuum-dried form. Prior to injection, the vacuum-dried BOTOX® is reconstituted with sterile normal saline without a preservative. It is important to note that there are other formulations of Botulinum toxin such as, Botulinum toxin-A Dysport and Botulinum toxin-B, MyoBloc.

How does BOTOX® work?
BOTOX® blocks the communication between nerves and muscle at a site called the ‘neuromuscular junction’. When injected into muscles (e.g. facial muscles) it leads to reversible reduction in the muscle activity. On the other hand, injecting it into a part of the skin, called the dermis, results in a reduction of sweating locally.

What can BOTOX® be used for?
Here is a list of some of the licensed and un-licensed/‘off’ label uses for BOTOX®.

• Treatment of cervical dystonia (abnormal contraction of the neck muscles leading to an abnormal head position and pain).
• Treatment and reduction of facial wrinkles and lines.
• Treatment of severe primary axillary and palmar hyperhidrosis (excessive sweating in the armpit and palms) that is inadequately managed with topical agents.

It is important that medical causes (such as thyroid disorders) for the excessive sweating are excluded.

Contraindications and adverse effects
Broadly speaking, the safety of Botolinum toxin for dermatologic use is extremely good. Most adverse effects are related to injection technique rather than the unexpected action of the toxin itself. Hence, a significant amount of observed complications following a BOTOX® procedure can be avoided with careful and informed practice. Nonetheless, the rare occurrence of anaphylaxis has been reported during a botulinum toxin procedure. However, BOTOX® is contraindicated in the presence of infection at the injection site. Furthermore, known hypersensitivity to any of the components of the formulation is also a contra-indication to its use. The use of BOTOX® in individuals with certain disorders of nerves and muscles (e.g. myasthenia gravis) should only be undertaken with caution.

Can a pregnant woman have BOTOX®?
There are no adequate and well-controlled studies of BOTOX® in pregnant women. There have been studies in animals, however since these animal reproductive studies are not always predictive of human response, the manufacturer of BOTOX® states in their data sheet that ‘it should be administered during pregnancy only if the potential benefit justifies the potential risk to the fetus. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential risks, including abortion or fetal malformations which have been observed in rabbits’.

As a breastfeeding mum, can I have BOTOX®?
The manufacturer states that ‘it is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when BOTOX® is administered to a nursing woman’.

Can black people have BOTOX® injections?
The simple answer to this question is yes. In fact, black men and women are now choosing to have BOTOX® to help reduce their facial lines e.g. the reduction of lines around their mouth. None-the-less, I would still recommend that you discuss this issue and any other concerns with your dermatologist before you have your BOTOX® injection.

Final point
BOTOX® is a popular procedure for reducing facial lines and wrinkles. Broadly speaking, it is generally safe, with the vast majority of side effects being related to the injection technique. If you are considering this procedure, ensure that you choose a dermatologist who is experienced in this field and in managing ‘skin of colour’.

References
Stephen E Wolverton. Comprehensive dermatologic drug therapy.

Disclaimer:
Medicine is a science and an art form, which is constantly evolving and changing because of ongoing research. Nonetheless, the author of this article and Black Health Matters have provided to their best ability an overview of the topic discussed, based on a review of the scientific literature. However, neither the author or Black Health Matters warrants that the information provided in this article is complete or accurate, nor are they responsible for any omissions or errors in this article. We advice all readers to confirm the information in this article from other sources prior to use. For more information, please see the full terms and conditions for use of this website.