Therapeutic Botulinum Toxin Injections
Botulinum toxin injections are often used as anti-wrinkle treatments, but they can also be used to help treat a range of conditions including:
- Hyperhidrosis (Excessive Sweating)
- Bell’s Palsy
- Teeth Grinding (Bruxism)
- Non-Surgical Jaw Reduction
Our Consultant Surgeons have a background in head, neck and face reconstructive surgery, plastic surgery and maxillofacial surgery. Our Principal Consultant Surgeon Mr Ashok Songra is also on the Anti-Wrinkle Validator panel of experts for the UK.
Hyperhidrosis (Excessive Sweating) Treatment at Cosmetech. Helping Hyperhidrosis sufferers get the answers they need.
What is Botulinum toxin type A?
Botulinum toxin type A is a treatment given by injection into the skin. When not used for cosmetic reasons it is often referred to as ‘Therapeutic’.
It is licensed in the UK for treating localised hyperhidrosis of the armpits (axillae). This drug has been used for many years to treat muscle spasms affecting the face, eyes and neck. It is used to treat foot problems in children with cerebral palsy. It is also widely used for cosmetic purposes.
Therapeutic botulinum toxin is a preparation of protein. When small doses are injected into the skin, it blocks the nerves that supply the eccrine glands. This prevents the glands from producing sweat.
The treatment is not a cure for hyperhidrosis. It only provides temporary relief. It needs to be repeated every three to six months for maximum effect.
Therapeutic botulinum toxin injections are not licensed in the UK for palmar (hands) or plantar (feet) hyperhidrosis. It can however be performed at some private hospitals. The skin in these areas is sensitive, and the treatment can therefore be painful unless an anaesthetic is applied. It would need repeating on average every 4 months, and so a general anaesthetic each time is not generally recommended. A local anaesthetic can be given.
When is it used?
It is usually considered when topical treatments such as antiperspirants, iontophoresis and medications have been unsuccessful. Therapeutic botulinum toxin is only effective in treating small areas. It is therefore not a viable option for treating generalised hyperhidrosis.
How does it work?
Sweat glands are actually in the skin, not underneath it. When you sweat, a chemical messenger is sent to the sympathetic nerves that meet your sweat glands, turning the sweat ‘on’.
When therapeutic botulinum toxin is injected, the toxin blocks the chemical messenger sent to your sympathetic nerves and so it does not reach the sweat glands. Without the chemical message, the glands cannot turn on the sweating. Therapeutic botulinum toxin permanently blocks the nerve endings and so sweat cannot be produced. Within 6-12 weeks, your body starts to produce new nerve endings. These new endings can receive the message to turn those particular sweat glands on, so mild sweating returns. Within 4-12 months, all of the new nerve endings have been produced. This means the full chemical message can be received, turning all of the sweat glands on again. Sweating returns to normal and the treatment has finished.
The physician will have a consultation with you before the treatment. This helps to determine where sweating occurs at its worst and to ensure that you have no health problems that Therapeutic botulinum toxin may interfere with or worsen. You will then be told the possible side effects of the procedure to forewarn you of any unwanted symptoms. It is important to note that you will be awake during the procedure and this is perfectly normal and is common practice.
Firstly, the site of injection will be cleaned to avoid infection. Secondly, any anaesthetic that is required will be administered, but this is generally not necessary in the axillae. Thirdly, you will be injected with a very fine needle which will introduce the botulinum toxin.
Therapeutic botulinum toxin is used most frequently with sweating under the arms (axillae), with each armpit administered around fifteen injections which are completed relatively quickly.Treatment for the hands and feet is a bit different in that injections can be rather painful and the treatment will take longer.
Most Therapeutic botulinum toxin procedures are over within 15-45 minutes, depending on the site of injection.
Aftercare and possible side effects
It can take up to a week for the Therapeutic botulinum toxin to start working properly. It is important not to expect a miraculous disappearance right away. Your physician may ask you to avoid massaging the area or putting pressure on the injection site for a few days, and to avoid strenuous activity. The site may be a little painful and small bruises can form, but these symptoms go away within a day or two.
Many patients experience muscle weakness when they have had Therapeutic botulinum toxin injections, but this does wear off eventually. Some patients have experienced an increase in sweating in another part of the body.
The Therapeutic botulinum toxin treatment can often cause tiredness and blurred vision, flu-like symptoms and possibly arm and neck ache for those who have injections in their armpits. These are all temporary symptoms and should disappear in a few days, and not everyone experiences them. There are no severely uncomfortable sensations or effects which should affect your daily life and there are rarely any complications.
Therapeutic botulinum toxin was licensed for the treatment of chronic migraine in July 2010 by the Medicines and Healthcare products Regulatory Agency (MHRA). Chronic migraine is defined as headaches occurring on 15 or more days each month, at least half of which have migrainous features. Therapeutic botulinum toxin has not been shown to be effective for any other headache type (e.g. episodic migraine, tension-type headache, cluster headache) as yet.
Studies in the treatment of migraine have shown a decrease in the incidence and severity of headaches for a period of 3 to 4 months along with a reduction in the use of painkillers. Some people respond well after only a single treatment session. Others improve after repeated injections.
The current standard is injections every 12 weeks however it is not unusual to vary the duration between treatments in some patients. It is generally worthwhile having at least two treatment sessions to assess treatment response. If individuals have not responded by two to three treatment sessions it is generally considered that the individual is a non-responder.
Therapeutic botulinum toxin has been a mainstay treatment for patients with synkinesis, partial facial paralysis and Bell’s Palsy for the past two decades. Therapeutic botulinum toxin injections relax unwanted muscle movements on the normal side of the face and reduces tension in areas of the face that are hyperactive due to synkinesis.
At Cosmetech, Therapeutic botulinum toxin is utilized to address asymmetric facial movement in a novel manner. To create a more symmetrical facial movement and reduce the signs of facial paralysis and synkinesis. Therapeutic botulinum toxin is most commonly utilised with neuromuscular retraining. This will be performed by a Consultant Maxillofacial Surgeon.
Teeth Grinding (Bruxism)
Teeth Grinding is the unconscious grinding and clenching of the teeth that mostly takes place while we are asleep.
It affects about one in four adults, with symptoms that can include:
- aching jaw
- gum problems
- tooth enamel being eroded
The pressure experienced during teeth grinding can be 20 times greater than the force used in normal chewing and biting. As a result, the incisors can end up shorter with sharp edges and tiny chip marks, and the canines can be covered in notches. Teeth can also work loose and fillings be gouged out.
Until recently treatment for teeth grinding has been basic, with sufferers usually having to wear a mouth guard. Therapeutic botulinum toxin injections, more commonly associated with cosmetic procedures, are now being used as a way of keeping it under control.
The effect of the treatment lasts for around four months.
Botulinum Toxin Injections for Non-Surgical Jaw Reduction
Non-surgical jaw reduction can be achieved using botulinum toxin. Injections into the jaw muscle (Massester muscle) can help both with excessive teeth grinding (Bruxism) and also with reducing the size of the muscle and thereby reducing the size of the jaw. This treatment can transform the jaw from a square shape to a more feminine ‘V’ shape. The injections do this by weakening the jaw muscle over time.
Not everyone is suitable for non-surgical jaw reduction and a Cosmetech Consultant will evaluate patients before deciding to provide treatment. How suitable a patient is will depend on the size of their jaw muscle.
Depending on muscle size, patients may need up to 3 treatments to obtain maximum effect.
This is a relatively painless procedure with no downtime and little swelling or bruising.
It can take up to 6 weeks for the effects of the procedure to become visible and results can last from 6 to 12 months.
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