Rus Articles Journal

Botulotoksin in cosmetology - poison or medicine?

botulinum toxin Preparations (mainly, Botox) gained popularity as means for smoothing of mimic wrinkles, that is the wrinkles caused by excessive activity of hypodermic muscles in recent years. For example, in 2006 in the USA 11,5 million procedures of injections of Botox were made. Advertizing claims that smoothing of wrinkles by means of this poison - fast, safe procedure with low risk of side effects. Sometimes authors of advertizing articles come so far that represent Botox as the certain nontoxical form of botulinum toxin having nothing in common with deadly poison. However since recent time messages on the become frequent cases of serious side effects and on the lethal outcomes connected with application of this preparation began to appear. Whether Botox is so dangerous and that in general we know about it?

the Tamed poison

B 70 - x years of the last century the American ophthalmologist Alan Scott began to test

on the patients suffering blefarospazmy (an involuntary zazhmurivaniye of eyes), the unusual medicine prepared on the basis of a botulotoksin, the most powerful natural poison which causes a deadly form of food poisoning - botulism.

For the first time symptoms of botulism were described by

in the 19th century. The main feature of this disease - the progressing paralysis which in most cases leads to death as a result of respiratory standstill. As poisoning happened in the past at consumption of the sausages infected with the bacterium producing this toxin it more often and called, botulinum toxin, that is sausage poison (botulus in translation from Latin “sausage“ means), and poisoning - botulism.


Though botulotoksin, certainly, it is dangerous, in Scott`s ideas there was nothing unexpected as in 1950 - x years scientists established that the purified and strongly diluted toxin it is possible, though carefully, to use in the medical purposes for relaxation of spasms of muscles. Soon, seeing high percent of treatment, also other doctors followed Scott`s example, gradually expanding toxin scopes. In particular, botulotoksin began to apply to treatment of squint and a gemispazm (a spasm of one half of the face). Already then some doctors treating patients botulotoksiny noticed an interesting side effect. In areas of injections on a face there was a wonderful disappearance of wrinkles, for example mezhbrovny folds on a forehead or folds in mouth corners. The patient, thus, not only got rid of a tiresome spasm, but also found the young-looking, weakened and friendly look. Soon in accident wards of doctors - neuropathologists the thin streamlet of unusual patients - wealthy ladies aged for 50 which were ready to risk everything at least for a while to become more young stretched.

several types of botulinum toxin which differ on immunological and chemical properties Exist. Botox was the first commercial preparation containing botulinum toxin. Producers of a preparation chose botulotoksin type A (all types of toxin designate Latin letters), which long time remained the only type of a botulotoksin applied in medicine. Recently there were preparations containing toxin of type B. Other types of toxin in medicine are not applied.

B 1989 of FDA (the American Management on foodstuff and drugs) was officially approved by use of Botox for treatment of a number of the diseases connected with involuntary reductions of muscles. And though wrinkles in the list of indications to application of this preparation did not appear yet, more and more doctors began to apply this medicine as speak in America, “off label“, that is not for the intended purpose.

Only in 2002 FDA at last approved use of Botox (Botox Cosmetic) in the cosmetic purposes - for elimination of mimic wrinkles on a forehead and around eyes. From this point triumphal ascension of Botox on success top began. Reached that in the USA this procedure became so popular that it is offered nearly continually - in beauty shops and even in sports clubs. In Europe and Russia along with Botox apply a preparation disport (Dysport).

Such different wrinkles

we Will talk now about that from where wrinkles undertake and why they disappear after botulism toxin injections.

of the Wrinkle which so afflict women not only look differently, but have the different reasons of emergence. Truly age wrinkles arise from - for the changes happening in the skin. Everything that you heard about destruction of collagen and about accumulation of damages under the influence of UF - radiation and other harmful factors, belongs to this type of wrinkles. But there are also other wrinkles which are just the skin folds which are formed on the place of a habitual spasm of hypodermic muscles. At reduction the muscle is shortened and wrinkles skin, and at relaxation comes back to a starting position and “pulls“ it for itself back. Young women have an elastic skin, it quickly reacts to such movements of muscles and is restored, but with age similar exercises are given it already heavier.

Such wrinkles are usually formed by

where our mimicry - around eyes, most actively “works“ at a nose bridge, at a forehead. Therefore they are called mimic wrinkles. If to force a muscle to relax completely, then the wrinkle is as if by magic smoothed. The effect, as a rule, remains 3 - 4 months then activity of muscles is restored, and the fold comes back to the former place. Therefore injections of Botox or disport need to be repeated from time to time. Sometimes, for not quite clear reasons, the effect of injections keeps very little - no more than 6 weeks.

As Botulotoksin acts botulotoksin


is a protein which is capable to break transfer of an impulse from the nervous termination on a muscle, causing thereby muscle paralysis. By normal transfer of an impulse in the field of connection of the nervous termination with a muscle (synapse) there is a release of a neuromediator of acetylcholine which causes reduction of a muscle. It is quite difficult process. At first the bubbles containing acetylcholine approach a membrane (an external cover) of the nervous termination. That acetylcholine was released, bubbles have to merge with a membrane that is impossible without a special “complex of the merge“ consisting of several proteins (SNARE - a complex). Botulinum toxin passes through a membrane of the nervous termination inside, and then “cuts off“ certain proteins from a merge complex. Each type of toxin of botulism has the favourite target. For example, botulinum toxin of type A which is a part of Botox attacks SNAP protein - 25. Without full-fledged SNARE bubbles with acetylcholine cannot merge with a membrane any more and remain in the nervous termination. As a result, in spite of the fact that nervous fiber continues to send teams, reduction of a muscle does not happen any more.

And all - is poison

of the Dose of a botulotoksin, entered into time of cosmetic procedures, are very small (several times less applied in medicine one hundred times less lethal dose). All this amount of toxin is enough for, - to relax the muscles lying near the place of an injection. And still the fact that stick in skin deadly poison, cannot but disturb. And if toxin spreads in some way further, than it is necessary to it? May it cause some serious side effects?

according to FDA, from 1989 for 2003 injections of Botox led to death of patients in 28 cases. In 2008 FDA released caution that use of Botox can cause violation of breath and other serious problems with health. To calm a little clients of beauty shops, we will note - practically in all cases the described side effects arose at medical use of Botox, mainly at treatment of spastic paralysis at children till 16 years. FDA notes that in the USA use of Botox against children`s spastic paralysis is made by “off label“, that is informally, so, the doctor selects doses at own risk, proceeding from the published data, the experience and experience of colleagues. Unlike cosmetic procedures at treatment of spastic paralysis considerable doses as it is necessary to eliminate a spasm in large muscles are required. Nevertheless from - for the fact that all is - about fatal cases FDA began investigation of all preparations of botulinum toxin which are applied in the USA.

And still risk to ache with botulism and furthermore to die after a cosmetic injection of Botox it is insignificant. However botulinum toxin can really spread out of limits of an injection and cause a number of troubles. The matter is that toxin is not programmed on fight against wrinkles, and just blindly affects all muscles which can “reach“. If poison filters there where it was not planned to be entered, the effect can be tragicomic. For example, after the injection made to the area of eyebrows, poison can get into muscles of an upper eyelid which for the next 2 - 3 months will remain half-closed - it will be impossible neither to open an eye, nor to close completely. It will result in dryness of an eye, dacryagogue and the general discomfort. Other complication is omission of a corner of lips that leads to effect of “the Greek tragic mask“ and a salivation. Are possible also asymmetry of the person from - for uneven relaxations of muscles on the right and left side (wry smile), difficulties with swallowing and hoarseness of a voice (partial paralysis of muscles of a throat).

All these side effects are listed to

in the summary to a preparation where recommendations about their prevention are also made. In particular, the drug is recommended to inject gradually, small doses, watching reaction. Explain to the patient that the place of injections cannot be combed not to disperse toxin on surrounding fabrics. However sometimes there are also unexpected side effects. For example, the small part of patients after injections of a botulotoksin has severe headaches reminding migraine. And sometimes happens and vice versa - the headaches tormenting the person for years after such injections suddenly wonderfully pass. One of patients (the case is described in the medical magazine) after procedure with Botox gained resistant metal smack in a mouth which “pleased“ her exactly so much, how many and the smoothed wrinkles. The mechanism of these side effects is still unknown, so, further researches still can give surprises.

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Desire of people to rejuvenate and get prettier by all means and their readiness to pay for it big money led

to the fact that in modern cosmetology very risky methods are quite often applied. It is well known that such procedures as a liposuction (surgical removal of excess fat), the phenolic peeling and a mesotherapy can end for the patient it is deplorable, and seldom or never even to lead to a lethal outcome (at a liposuction sometimes there is severe bleeding, phenol has toxic effect on heart, and after mesotherapy injections in isolated cases the infection of connecting fabric eating a body“ develops difficult curable “).

On this background use of deadly poison for smoothing of wrinkles does not look something outstanding. Most of experts consider that at a right choice of a dose and a method of introduction of a preparation, and also at observance by the patient of all recommendations of the expert the risk of side effects is small. And all - the fact that botulinum toxin is poison which easily gets into nervous tissue and selectively strikes the molecular structures responsible for transfer of a nervous impulse, forces to belong to this preparation carefully. Also it is worth reflecting whether it is reasonable to subject the nerves (and it is possible, and brain cages) to attack of sausage poison only for 3 - 4 months to erase from the face mimic wrinkles - traces of thoughts and smiles?