Vitals

Sheena in this zoom life, I'm looking at my face a lot and I am definitely getting older.

Alok, me too.

Well, we might not be the only ones.

Some think that all of this screen time has led to a current plastic surgery boom.

Enter botulinum toxin, one of the most poisonous biological substances known to man.

But you may know it as Botox, the youth preserving injection.

And if you're like me, you might be a little curious, but is it safe?

Are there any downsides?

And do you really need to start getting it in your twenties to prevent wrinkles?

Well, you've got questions.

You might have wrinkles.

We've got answers.

Botox is the most popular cosmetic treatment in the U.S., totaling 4.4 million procedures.

Even at the height of the pandemic when we were supposed to be staying in the house.

And the use of these injections is exploding.

Botox is even prescribed for non-cosmetic reasons.

And people of all ages are pursuing treatment.

So while middle aged patients are the ones who are most likely to get jabbed, the clientele is moving younger.

With people in the thirties making up 20% of the market.

And you may have heard the buzz about "Baby Botox", an experimental treatment that supposedly prevents wrinkles before they even start.

Sheena, why don't you start us off?

What exactly is botulinum toxin?

Alright, Alok, I got this.

It's actually a neurotoxin defined as a substance that alters or damages the nervous system.

The toxin is naturally occurring, commonly found on plants in soil, water and the intestinal tracts of animals.

And it's produced by the bacterium Clostridium botulinum.

The discovery actually goes all the way back to 1820 when this toxin producing bacteria was first described.

Thanks to our pile of rotten sausages and the curiosity of a German physician, Justinus Kerner, he was the first person to describe the medical condition botulism, which he linked to spoiled food.

Untreated, botulism can weaken your muscles and slowly cause paralysis.

But don't sweat it too much.

Botulism used to be more common, but today the CDC reports an average of about 110 foodborne cases a year.

Okay, hold on.

So we conquered this public health food poisoning threat, but then decided to inject this stuff into our faces.

When did this all start to happen?

Well, the clinical use of botulinum toxin began in 1977 when it was tested as a treatment for strabismus or cross eyes.

The logic was simple inject the toxin at a low dose and weaken the muscles in the eye that cause misalignment.

It worked, and it's been FDA approved since 1989.

But it really took off when doctors figured out that injecting Botox could temporarily reduce the appearance of wrinkles.

And then the FDA gave Botox the green light in 2002.

When injected into the body.

Botulinum toxin paralyzes muscles or inhibits their contraction by blocking the release of the neurotransmitter acetylcholine.

This means that signals from your motor nerves don't reach your muscles.

Now, to explain more about when and why and who should be using Botox, we've got board certified dermatologist Dr. Angelo Landriscina and Dr. Alexis Stephens in the house.

To start, we need to understand how the skin ages.

When we're thinking about the first wrinkles that appear on the face.

They're known as hyperdynamic expression lines and they come from repeated movements of our facial muscles to make facial expressions like smiling, frowning, raising our eyebrows and the like.

There are other static wrinkles that do come up just from skin laxity, loss of collagen and environmental factors like sun, exposure too.

But those tend to show up a bit later.

So what does a neurotoxin have to do with wrinkles?

It's simple.

By temporarily weakening the muscles in the face that cause wrinkles to form.

When facial muscles can't contract, the fine lines, wrinkles and crow's feet that sit above them are less visible.

So the primary type of wrinkles that we're trying to treat with Botox injection are hyperdynamic wrinkles a crow's feet from smiling, the horizontal for headlines, for lifting the eyebrows, or what some people know as their elevens between their eyebrows.

We see the effect kind of waning at two and a half to three months post injection.

Once the muscle is no longer paralyzed, you can do motions like this and that, and you'll start to see those fine lines creep back in.

But there's a new claim about Botox swirling on social media, and it's feeding an off label or non-FDA approved use of the drug.

It's called preventative Botox, and it holds that long term regular use of Botox can prevent wrinkles before they even form and even improve the skin's overall quality.

And treatment starts younger than before.

That's because dermatologists attempt to freeze the dynamic or expressive lines in the face before they settle into static lines or the wrinkles visible at rest.

In fact, the American Academy of Facial, Plastic and Reconstructive Surgery reports that 74% of their members have seen a significant increase in patients under the age of 30 requesting Botox or similar procedures.

But where is the scientific support?

It's primarily anecdotal.

By logic, it makes sense.

Repetitive use of these facial muscles creates the lines.

So if you're preventing that long term, the lines should never appear.

Right.

Interestingly, there's not a lot of research about it.

Some of the best data that we have is actually at the lowest level that can be published.

So it's something called case reports or case series.

There's an interesting one that came out in 2006, a dermatologist compared to identical twins, one of which had Botox consistently about twice a year for several years.

And another of which had the procedure about twice.

And if you look at the photos of them, there really is a striking difference between the two with the one who got Botox regularly having less lines.

The reason that this is not a perfect piece of data to point to is that, you know, even though these are identical twins, they did live very different lives.

They lived in different countries.

So there could be other factors that could be confounding the findings here.

So freezing the face is wrinkle causing muscles might slow down the aging process but won't stop it.

As for Botox as ability to improve overall skin quality.

One study found that Botox enhances the skin's ability to stretch, pliability, and recoil, elasticity, making the skin appear younger.

This gave rise to the theory that botulinum toxin stimulates dermal remodeling or the reorganization of the dermis dense, fibrous network of collagen.

Now collagen is the most abundant protein in your skin, its tissue strengthening networks become disorganized in aged skin making it appear looser and more wrinkled.

Well, let's get back to what she mentioned when she said: "in theory".

That's right.

We don't know if Botox is actually improving the skin through dermal remodeling.

And that's because there's barely any high quality, long term clinical research on preventative Botox.

And there are a few more caveats to know before you rush to go see your dermatologist.

While Botox is generally well tolerated, it lasts for months.

So little can be done if you're unsatisfied with the results.

At too high a dose, those facial muscles will be real stiff, potentially making you look expressionless or mask like.

Worse still, and imprecise injection may lead to paralysis of other musculature in the face, though uncommon ptosis or drooping of the lower eyelid and brow is not ideal.

And again, there are no long term studies testing the effects of preventative Botox.

So patients should still be mindful.

This brings us to another note.

Repeated Botox injections is going to cost you in 2020, the average surgical fee was $466 per procedure.

That cost is leading some to attempt dangerous at home Botox and facial filler kits.

Please do not do this.

Botox is meant to be performed by a trained specialist and that is not you at home on your couch.

So let's ask our experts another question.

What is the consensus on baby Botox?

I let patients know that logically the idea makes sense, but that there isn't a ton of research behind it, and I let them make their own decision.

Usually if people come to me and, you know, they're starting to develop lines, then, you know, they're they're a great candidate.

I always start with education in my office because that's just what I believe.

We definitely need more literature out there, but there are a few small articles and case studies.

Now, we've been talking about Botox as a strictly cosmetic procedure.

But fighting wrinkles isn't the only thing Botox is good for.

There's more.

The FDA's approved Botox for 11 therapeutic indications.

And the pharmaceutical company Allergan has 800 patents for even more uses.

Botox is used in urology, otolaryngology, ophthalmology, gynecology, general surgery and neurology.

Here's one popular application for a condition affecting millions of Americans chronic migraines.

So I have really chronic migraines.

I've had them since I was a teenager.

And it reached a point where it was I was having upwards of 14 migraines a month.

It was really impossible to kind of live and work as I would want to normally.

And so I was just really desperate for anything that would work and any medication that might have any impact on it.

That's where botulinum toxin intervenes.

During a migraine, the body releases neurotransmitters and other molecules that signal pain.

Botox taken up by the nerves in the head, neck and face muscles is thought to interfere with these substances transmission.

I did not immediately notice a difference.

It takes a little bit of time for the Botox to work.

After like a week, I noticed that I couldn't move my forehead in the way that I normally can.

I think in so much of a market for me is like the tension or like the feeling, like your muscles are working really hard to do something that's actually causing you pain.

But definitely notice a reduction in migraine days.

And also just in the severity of the migraines I was getting.

Now, a key study from 2010 that led to Botox is approval as a chronic migraine treatment found a reduction in nine headache days per month in treated patients.

But here's the thing.

In the untreated group, the number of headaches also drops not quite as much, but still reduced by nearly seven days per month.

So some research is suspect that the placebo effect might play an outsized part in this.

I'm reluctant to say that it wouldn't matter at all if it were a placebo.

But also, honestly, I just felt and feel really desperate to be in a body that's not making me chronically in pain.

It also does genuinely feel like the tension that makes things unbearable was reduced.

If you're curious about those other conditions that Botox has used for, some of them are excessive sweating, overact like bladder and cervical dystonia or painful muscle spasms in the neck.

And there are other uses still under study.

Like treating depression.

All right.

Hang with us for a minute.

It's an unusual theory, but some clinicians believe that by blocking the negative feedback that frowning sets to your brain, Botox can actually relieve depression.

And all it takes is popping some Botox unsettles frown lines.

Okay, well, a meta analysis of five randomized controlled trials found that patients treated with Botox showed a more intense improvement of depressive symptoms in comparison to subjects that received placebo injections.

Phew.

Well, we've covered a lot of ground, but before we go, there are a few more notes to add.

First, while new trending drug uses are exciting, always talk to your doctor before pursuing any new treatment.

110%, Sheena.

A health care professional, can help you decide which treatment is potentially right for you and when you should start it.

Nobody wants you to attempt to inject your own face at home.

There are also cost effective, scientifically proven alternatives for slowing skin aging.

The UV exposure from the sun is the primary preventable factor when it comes to skin aging.

We can even see the effects of it under the microscope.

So if you take a biopsy of sun exposed skin, what you'll often find is a finding called solar elastosis.

So that's when the collagen and fibers that give our skin its elasticity are replaced by very disorganized, elastic fibers.

So that leads to skin sagging.

It could potentially lead to the development of wrinkles, too.

Usually I tell people to go for an SPF of at least 30 for their daily sunscreen.

Take it up to 50 if you can.

Smoking is one of the number one culprits for premature signs of aging.

It will accelerate whether or not your collagen is actually being broken down fast or not.

So I would highly advise you try your best to decrease or stop smoking altogether.

I would also throw in lastly is the use of retinoids.

So those are derivatives of vitamin A. Vitamin A is known as retinol.

So you may have seen that and a lot of over-the-counter products that you can get out there.

But the prescription retinoids, such as Tretinoin and Tazarotene, have shown to reverse some of the signs of aging in clinical trials.

And when they're not coming from excessive sun damage, wrinkles are your friends people.

They're all a part of the beautiful natural process that is aging.

My three year old has some wrinkles when she's laughing or smile lines when she's laughing, that's normal.

So you don't ever want to completely take away your ability to express yourself?

I couldn't agree more.

Aging.

It's natural.

It's beautiful.

We all go through it now.

Botulinum toxin injections are generally safe, but they're not medically vital.

But they are really popular.

So as research on Botox advances, you are bound to hear more about all the exciting applications of the so-called miracle toxin.

Well, that's it for us on this episode of Vitals.

Are you considering or have you tried botulinum toxin injections?

Let us know in the comments.

We're always down for chat about health and wellness.

And be sure to subscribe, like and share this video.

We will see all of you and your beautiful youthful faces next time.