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Not just a load of old Botox
Botulinum Toxin ( Botox, Azzalure, Dysport) is most often used for facial anti-ageing. It is however very useful for many other medical reasons. It can be used for muscle spasms in cerebral palsy, strokes and facial spasms and is also used within the NHS for bladder problems, prostate problems and anal fissures to name but a few. At the Stepback clinic we have found an increasing number of people requesting botulinum toxin for underarm sweating and for migraine or chronic tension headache. In excessive sweating the botulinum toxin stops sweating for up to a year by temporarily paralysing the nerves to the sweat glands and in headaches the mechanism of action is a little less clear but it does in part relax the muscles which cause painful spasm. Usually headache sufferers attend for treatment about twice per year. Botulinum toxin MUST be prescribed by a doctor or in a very few cases a specialist nurse prescriber. Please make sure that you ask who is responsible for your prescription and that you are being treated by the person who is prescribing it and that you are not being treated by someone who has procured it from a doctor in another part of the country.
If you are interested in botulinum toxin treatment for anti-ageing, sweat reduction or troublesome headaches which are unresponsive to other treatments then please call the Stepback Clinic for a free initial consultation on 0870 161 0680.
Are you one of those people who suffer from underarm sweating? If so, help is at hand in the form of botulinum toxin injections. Often used for facial anti-ageing purposes or migraine, botulinum toxin is also remarkably efficient at decreasing sweat gland activity. Small and almost pain free injections of the toxin are placed at regular intervals under the arms and can leave the sufferer almost sweat free in these areas for up to a year in some cases.
Botulinum toxin (Botox, Dysport, Azzalure) MUST be prescribed by a doctor or, in a few cases only, a nurse who is a qualified prescriber. You should always ask your therapist to tell you which doctor is responsible for prescribing this for you and refuse administration if you are not happy with the information given. For further information on the use of botulinum toxin for any purpose contact Dr Christopher Davies or Dr Geraldine McKeever of Stepback Cosmetic Medicine on 0870 161 0680.
Stepback clinic information for patients requesting botulinum toxin therapy (botox)
Botulinum toxin (botox) is a medicine produced by the bacteria which very rarely causes botulism food poisoning. Botox blocks the transmission of messages from nerve to muscle in the area where it is injected. Botox is another example of a natural product being used for medicinal purposes e.g. fungi produce penicillin and foxgloves produce a “poison” called Digitalis which many people take for heart disease. With current bioengineering it is common for bacteria to produce the necessary medicine for a specific disease.
Botox was first used medicinally in 1973 for squints. By weakening the eye muscles it provided an alternative to surgery. Botox quickly gained acceptance for other eye problems including spasm of the eye lids. Other specialists use botox also: Neurologists use it for facial or other muscle spasms including those related to strokes. Other indications include migraine and chronic daily headache, speech disorders, Parkinson’s disease and swallowing problems. Urologists use it for disorders of the prostate and it has revolutionised and simplified the treatment of overactive bladders. The list of botulinum toxin applications is growing almost on a daily basis.
While botox is very potent in high concentrations, it is used cosmetically in very small quantities with high margins of safety. After a muscle is injected, its first effects are not seen for 48 hours and the complete effect on the muscle may take 2-3 weeks. As the use of botox increases in many specialties it is becoming more and more obvious just how safe botox is when used properly by experienced doctors.
Background to the cosmetic use of botox
Botox was first discovered to have cosmetic potential in the 1980’s by a consultant eye specialist from Canada. Dr Jean Carruthers noted that when she treated eye problems with botox the wrinkles around the eyes of the treated patients disappeared. The rest is history and botox is one of the most popular cosmetic treatments available today.
Commonly asked questions
How painful are the injections? The smallest needles are used and the medicine itself does not sting as much as a local anaesthetic. Many patients report that they hardly felt a thing.
What should be expected after botox therapy? Botox is a safe therapeutic agent for wrinkles. Complications have been minor and only transient. Bruising may occur at the injection site and a brief pain or headache may follow. Bruising may be greater in patients taking aspirin, anti-inflammatory or blood thinning medication. Anti-inflammatories should be stopped if at all possible for 2 days before treatment although blood thinning tablets should not without consulting your doctor.
How long does botox last? Successful therapy is not immediate but is signalled by muscle weakness beginning several days after injection with a peak at 10 days. The effect of botox lasts between 3 and 6 months for most people.
When should a client return for further therapy? When it is noticed that the wrinkles are returning. Initially this may be every 3-4 months but with subsequent injections the effect seems to last longer, from 4 to 12 months.
Who should not use botox? It is our policy not to administer botox to pregnant or breast-feeding ladies. Patients with neuromuscular disorders e.g. multiple sclerosis and myasthenia gravis should not be treated. Patients taking the following medicines may notice increased effects from botox: aminoglycoside antibiotics (e.g. streptomycin, tobramycin and garamycin) penicillamine, quinine and calcium channel blockers.
What are the alternatives to botox? Filling agents e.g. fat, collagen and hyaluronic acid can be used. Resurfacing procedures with lasers or peeling agents are popular and face lifting operations may be useful in the more severe cases. Lately dermaroller and skin boosters such as Vital have become popular.
What unexpected benefits have come from botox? Tension headaches and migraine have, for some patients, disappeared due to the relaxation of the forehead muscles and an effect on the blood vessels.
How exactly does botox inactivate the muscle? Botox inhibits a substance called acetylcholine which transmits messages from nerve to muscles to enable them to contract. When acetylcholine is inhibited the muscle will cease to contract.
Does the body make antibodies to the botox protein? Yes if enough toxin is injected often enough. The crucial amount is very much higher than the amount used cosmetically. Also as successive treatments are several months apart, antibodies are less likely. If antibodies form, the strength of the botox is reduced as is its effect on the muscle.
Have there been any reported cases of allergy to BTX? No reported cases of a true allergic reaction have been reported. Patients who are known to be allergic to BTX or albumin should avoid BTX.
Are there any unwanted effects from botox injection for cosmetic purposes? There may be slight bruising or swelling at the injection site. Occasional headache may occur and sometimes a feeling of nausea. Very rare occurrences include tiredness, pains in the limbs, temporary drooping of the eyebrow or upper eyelid, brief visual disturbance, dry eyes/mouth, skin rashes/itching, allergic reaction or muscle atrophy.
Is botox a prescription only medicine? Yes it is and this means that a doctor must take responsibility for prescribing it. There is a system currently being practised in the UK whereby doctors who are not consulting face to face with the patient may issue a prescription for botox to be used by a nurse or less qualified practitioner. The doctor may be many miles away from the venue where the patient is being treated. Currently there are steps being taken to stop this practice which is known as “Directive Prescribing”. It has been condemned by the Nursing and Midwifery Council, by the General Medical Council and lately by the British Association of Cosmetic Doctors. This is a harmful practice and it puts patients at risk. Always ask your practitioner if he or she is licensed to prescribe botulinum toxin in the UK. Remember, if the practitioner can’t prescribe botulinum toxin then he/she can’t prescribe anything else you may need should your procedure go wrong. Stepback Cosmetic Medicine is a “doctor only” clinic and all our doctors are licensed to prescribe and are fully registered with the General Medical Council of the UK. We NEVER use Directive Prescribing.
In recent years some nursing professionals have become specially trained to allow them to prescribe.
Chemical peels have been used to improve the appearance of skin for many years. The Ancient Egyptians used to bathe in sour milk or rub their skins with grape skins little knowing that the lactic acid in the milk and the tartaric acid in the grape skins were hydroxy acids.
These and numerous other hydroxy acids are now used in many beauty products as well as in professional skin peels.
Today, scientists have identified numerous forms of acid which can be used to cause beneficial changes in the skin.
What are chemical peels and how do they work?
Chemical peeling involves the application of a chemical solution to the surface of the skin to produce careful removal of its outer layers. The amount of skin removed depends on the type of chemical used, the strength of the product and how long it is left in contact with the skin.
Chemical peels are usually described according to how deep they work on the skin.
Superficial peels remove the outer layer of skin known as the epidermis.
Medium depth peels remove both the epidermis and the underlying upper dermal layers.
Deep peels remove the lower dermal layers of the skin.
No matter how deep the peel, your skin will re-grow and should heal fully. The deeper the peel, the greater the potential for improvement to the skin.
What skin problems can chemical peels treat?
Chemical peels can be used on most parts of the body, but the commonest use is to improve the skin on the face or the backs of the hands.
They can be used to treat certain age spots, blemishes or lesions e.g. acne and actinic keratosis. Below is a list of the treatments and the type of skin problems which they can reduce.
Superficial peels can lessen rough skin texture, dry or flaking skin, fine lines due to sun damage, mild acne marks, age spots and balance the skins tone.
Medium peels can reduce small wrinkle lines, some acne scarring, and certain pigmentation problems (again evening out the skins tone).
Deep peels can reduce the appearance of deeper lines and wrinkles.
CHEMICAL PEELS CANNOT change your pore size, improve loose skin or deal with deep scarring. They will produce better results if combined with homecare products available from your practitioner.
Two terms it is important to be familiar with are HYPERPIGMENTATION where the skin contains too much pigment e.g. brown spots or blotches, and HYPOPIGMENTATION where the skin can look bleached or white.
SUPERFICIAL PEELS are the commonest used and these produce a mild “sandpapering” of the skin. They most often contain some form of hydroxy acid. The Stepback clinc uses a beta hydroxy acid called salicylic acid. This gives the skin a healthy glow and is useful before a special occasion. Salicylic acid is also useful in oily skin and in acne treatment.
MEDIUM DEPTH peels use stronger peeling solutions. The Stepback clinic uses trichloracetic acid under the brand name of “easypeel”.
DEEP PEELS may require some sedation and carry a higher risk of side effects and the Stepback clinic do not offer these.
THINGS TO AVOID BEFORE A PEEL
Avoid any changes in your normal skincare routine for 1-2 weeks before the treatment. Other things to avoid include electrolysis, exfoliating facials, sunbathing and tanning beds.
WHAT HAPPENS DURING A PEEL?
The skin is initially cleansed after which the peel is painted on and left for a variable amount of time until the practitioner sees a whitish colour called “frosting”. The face may feel hot and a fan may be used for your comfort.
Superficial peels may be repeated every 4-6 weeks for optimum results and medium peels may be repeated 6-12 months after the initial peel or peel package.
Recovery time is very individual depending on how well you heal and any post-treatment complications.
COMPLICATIONS WHICH MAY OCCUR
Include hyperpigmentation and thus a high factor sunscreen should be worn after one of our peels before going outdoors.
WHAT HAPPENS AFTER A PEEL?
With superficial peels the skin is often pink after the solution is removed. There may be a whitish appearance or a blotchiness within a couple of hours. Some people will experience a peeling of the skin whilst others won’t but the treatment will still have a beneficial effect.
With medium peels the face may swell shortly after the solution has been applied and turn pink and stinging of the skin may last for 30 minutes to one hour. The skin will peel over a five to six day period approximately and may be quite itchy during the peeling process. After peeling the face may be bright red which should settle down over the next week to six weeks approximately. In some patients redness may last longer than 2-3 months. Very rarely some patients experience scarring after these peels.
WHAT TO DO AFTER A PEEL PROCEDURE:
- Cleanse the face gently with a soap-free cleanser, pat dry and moisturise twice daily.
- Do not pick off any dead or peeling skin as this may cause bleeding and discoloration or even mild scarring.
- Do not expose yourself to the sun without a sunscreen for at least 6 weeks after treatment to reduce the risk of hyperpigmentation.
- Contact your practitioner if you notice any signs of infection or pigment changes.
- Use mild painkillers e.g. paracetamol if necessary.
- Gently splash the skin with warm water and pat dry.
- If infection occurs apply a thin layer of antibiotic cream several times daily.
- If itching is severe antihistamines may be used.
- Sleeping on your back with your head propped up may reduce swelling.
- Avoid strenuous exercise for a couple of weeks to allow healing to happen without sudden jarring of the face.
- Avoid scratching or picking at the skin to reduce the risk of scarring.
- Start using a sunscreen after the skin has healed and avoid sun exposure for 6 weeks.
Contact your practitioner if you notice signs of infection, scarring or pigment changes.
WHO SHOULD NOT HAVE A PEEL?
- Those with a history of keloid scarring.
- Have abnormal skin pigment/ colour.
- Have facial warts or any type of active skin infection.
- Have used the anti-acne drug Roaccutane within the last 12 months.
- Have darkly pigmented skin or red hair with freckles as these people may experience pigment changes.
Important considerations when choosing a cosmetic practitioner
One of the most important considerations when choosing a cosmetic practitioner to perform your facial aesthetics is whether or not he/she is qualified both to prescribe and administer the products they advertise.
Dr Geraldine McKeever from Stepback Cosmetic Medicine says: “Good facial aesthetics mixes the skill and delicacy of a surgeon with the keen eye of an artist. Make sure you find a doctor or a nurse with specialist aesthetic training. Many people don’t realise that botox is a prescription only mediciation and that they should be assessed by the prescribing doctor prior to receiving it. Botox is currently being administered without the recipient even meeting the doctor who proscribes it. The Nursing and Midwifery Council has published it’s disapproval of such practice.”
Dr Christopher Davies and Dr Geraldine McKeever of Stepback are both qualified GPs and have advanced training in cosmetic procedures