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Folders  |  Botox®: how it works - myth and reality
Botox®: how it works - myth and reality
Dr. Miguel Trincheiras - Tel 213714116
Botox®: how it works - myth and reality

Botulinum toxin, myth and reality

Commonly known as Botox®, the application of this molecule has become more and more popular in the field of aesthetics. Dermatologist Miguel Trincheiras explains here what it is and how it works.

The botulinum toxin is a molecule produced by a bacteria - its existence was already known in the 18th century, but it was identified only in 1944. Its therapeutic use started in the 70’s, for treating strabismus in ophthalmology;  in the late 80’s, it was used on a much larger scale, in the field of aesthetic dermatology.

Today it is the most frequently applied cosmetic procedure in the world, with over 4 million annual applications in the USA alone. In our country we have witnessed an ever-increasing growth in the demand, although there is still some mistrust from the majority of the population because it is a “toxin”. Equally, a large part of the medical products used in clinical practice can be toxic, and even potentially fatal, if used in quantities or concentrations superior to those recognised as guaranteeing the desired biological effect.

Botox®, the name by which it is best known, is the pharmaceutical speciality most divulged, and is used in more than 90 per cent of cases.

How does Botox® work?

This molecule is a protein of a specific configuration that connects to the nervous terminations of a overactive muscular zone;  it inhibits the release of acetylcholine (neuromediator) and, as a consequence, prevents the muscle from contracting and produces its relaxation (to a greater or lesser extent, depending on the dosage), which is progressively reversible after a few months.

In what situations can it be used?

It is used frequently at a local level, in small quantities and on restricted areas of certain superficial muscles that cause the wrinkles of facial expression (so called “frown lines”), resulting therefore in the smoothness of the skin situated immediately above. Initially, it was used almost exclusively on frown lines of the upper 1/3 of the face (forehead, between the eyebrows and crow´s feet) but today it is used more widely over the whole face, neck and cleavage. Its application was recently approved in severe cases of hand and feet sweating, an aspect that is beyond the scope of this article.

How long does it take to act, and how long does it last?

The effect of skin smoothness (described above) starts to show in from 48 to 72 hours, and reaches its maximum effect after approximately a week. The results remain satisfactory during six to 10 months, as a progressive muscular contraction begins to occur from the third to fifth month after treatment.

Is the application painful?

The application is made by direct infiltration of the superficial muscular areas where mobility is sought to be reduced or annulled, through a very fine (30G) needle, so it is almost painless. It is an ambulatory technique, so anyone submitting to it has no restrictions to her daily life, the only limitation being not to do any physical workout in the two hours immediately following the infiltration.

Are there limits to the number of applications?

There are no known risks associated to multiple applications, and possible side effects that may occur are rare. These however are reversible and, quite frankly, hardly ever happen in experienced hands: the most frequent side effect is a slight temporary and parcial eyelid droop (ptosis), that could occur if minimum infiltration distances at the forehead level are not respected.
For what has been described above, it is usually necessary to renew applications after six to 10 months or more, there being no maximum limit of total applications recognised up till now.

What does the treatment cost?

The cost of each session may vary between 200 to 550 euros, depending on the areas treated and quantity of product-units used.


Summarising the aforementioned, this is not a technique of filling in wrinkles, as was commonly thought to be the case, but rather an “erasing” of wrinkles by diminishing the contraction of the muscles causing them. Naturally there may be other types of wrinkles or accompanying skin relaxation that do not benefit from the application of Botox®, in which case mixed techniques such as peelings, use of lasers, filling-in materials or other, usually have to be resorted to, in order to obtain a more harmonious and natural effect of the facial skin texture and expression.

Dr. Miguel Trincheiras

Before and after application

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