All things are poisons and there is nothing that is harmless, the dose alone decides that something is no poison.
Botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum, and there are botulinum types A – H – the most commonly used types for commercial/medical usage are types A & B [1]. It is in fact, a lethal toxin – but in minute doses, as with certain poisons, can be beneficial in more ways than one.
There are a few approved brands of botulinum toxin only for use in medical clinics in Singapore and by a licensed, trained doctor. At the same time, some brands are non-approved and non-FDA-cleared.
It is important to know what is being used for your face – if you have doubts, enquire with the clinic about the brand of botulinum toxin(s) available prior to the appointment.
A botulinum toxin treatment is a commonly done procedure – an estimated 3 million dollars worth of botulinum toxin procedures or more are done per year, worldwide [2]. Despite that, the knowledge as to how it works isn’t as widely understood as it should be!
As a neurotoxin, botulinum toxin, in layman terms, causes relaxation/temporary paralysis of the muscles. This can be applied in both cosmetic and therapeutic treatment usage, and the effects of botulinum toxin treatments usually last anywhere between 3 – 9 months (depending on the area treated), and may be repeated for maintenance.
Globellar (Between the brows, frown lines)
Overactive bladder
Crow’s feet
Chronic migraines
Forehead lines
Eye muscle issues
Jaw muscle slimming
Cervical dystonia
Excessive underarm sweating
“Botulinum toxin blocks presynaptic acetylcholine release, thus preventing the nerve impulses responsible for muscle contraction, and can be used to treat all wrinkles that are the result of normal facial movement. [3]“
As we read the comments online, we saw this one comment that is a commonly known perception by some members of the public – at what age should one start to consider botulinum treatments?
We age every day.
While aging does play a part in our skin becoming thinner and more prone to wrinkling, these frown/laugh/smile lines are formed due to repeated movements, and botulinum toxin treatments serve to prevent or lessen these movements by relaxing the muscles involved.
A younger person could have the bad habit of unconsciously and excessively frowning and developing these lines earlier in life, too! Botulinum toxin treatments are typically used as a preventive measure to prevent these movement lines from becoming permanent and static. So yes, while botulinum toxin treatments are typically done for adults above a certain age threshold, you do not need to be of a certain age to use it.
Botulinum toxin treatments should not lead to a “frozen look” when the right amount is used – this requires a trained eye and hands – a licensed doctor who is able to gauge the amount needed.
Quoting Dr YZ Tan, “There are no known cases of botulinum toxin deaths directly caused by heart failure. However, an allergic reaction, which is very rare, can result in shock and indirectly result in heart failure when not caught and treated in time.”
“Botulinum toxin procedures, when administered properly, is considered safe.”
Botulinum toxin is generally considered to have a wide safety margin [4]. Side effects from cosmetic use are generally non-fatal and usually result from the unintended paralysis of certain facial muscles. These can include partial face paralysis, muscle weakness, trouble swallowing, headaches, and flu-like symptoms. As the effects of the treatment wear off, one will regain muscle strength and movement, and these symptoms will go away.
However, as with any procedure, there are always risks involved, and while there have been claims of 16 deaths reported to be in relation to receiving botulinum toxin procedures, these cases are extremely rare, and if any, they are typically and possibly due to complication(s) arising from:
“Side effects from therapeutic use can be much more varied depending on the location of treatment and the dose of toxin used. In general, side effects from therapeutic use can be more serious than those that arise during cosmetic use. These can arise from paralysis of critical muscle groups and can include arrhythmia, heart attack, and in some cases seizures, respiratory arrest, and death.” – Wikipedia
“Allergan spokeswoman Caroline Van Hove said children with cerebral palsy receive far larger doses administered into their leg muscles than the doses given adults seeking wrinkle care.” – NBC News. [8]”
Common and negligible side effects of botulinum toxin procedure would include an achey/sore sensation at the site of treatment and possible mild bruising.
However, one should seek medical attention should they experience symptoms such as difficulty in swallowing or breathing, unclear speech, extreme muscle weakness, or difficulty holding up their head.
This article is not meant to be construed as opinion on the recent aesthetic-related death.
The information provided in this blog post is for educational and informational purposes only and should not be considered medical advice. Always consult with a healthcare professional or dermatologist before starting any new skincare routine or treatment, especially if you have existing skin conditions or concerns. Results may vary from person to person, and individual needs may require different approaches.
Dr Tan Ying Zhou, known as Dr YZ Tan, is the founder and Medical Director of Mizu Aesthetic Clinic.
His journey into aesthetics began with a medical degree from St. George’s, University of London, followed by an internship in Dermatology at the National Taiwan University Hospital.
Some of his favourite aesthetic procedures include nose augmentation and anti-ageing solutions, and he also serves as a trainer for emerging aesthetic doctors.
His philosophy revolves around personalised treatments tailored to each individual’s ageing concerns, aiming to transform the ageing process gracefully into a pleasant journey towards confidence and wellness.
