Botox, or botulinum toxin, is a purified product of the Clostridium botulinum bacteria which reduces muscle movement. When placed accurately it prevents the muscles from crinkling the skin which is what creates wrinkles over time. When the muscle is relaxed the skin can relax which reduces the wrinkles and, with a series of treatments, can make them effectively disappear. As it is a drug, botox requires a prescription and so must only be used by qualified, trained practitioners. Beyond this, the use of botox is an art and with my experience and advanced training, I can smooth out wrinkles, reduce tired, worried or angry appearances and subtly contour the face.
Men can be treated too, although the aesthetics of the male face is different from that of the female face and this must be carefully planned out. Men also normally require slightly more botox as the muscles are larger.
Wrinkles normally start to show in the late twenties and early thirties and become more ‘etched’ into the skin in the mid to late thirties, so botox can be used preventively in the mid to late twenties. The most common age range is in the thirties, forties and fifties. I have treated patients in their sixties and seventies and botox can provide the best result but fillers, peels and other forms of treatment are generally more appropriate at this age.
A further area for treatment is for jaw joint pain from habitual clenching or grinding of the teeth. Other treatments are available, eg bite guards, but some people find them ineffective or uncomfortable to wear and could benefit from botox at the corners of the jaw. Please see the link for a more complete description of this therapy, as well as a series of research papers.
Botox Treatment Areas
Informational Botox Brochure – download here (1.6 mb, pdf)
Botulinum toxin for TMJ symptoms - click to read
Botulinum toxin is becoming increasingly widely used for medical and dental treatments as well as for aesthetics. Targeting the masseter and temporalis muscles has been popular in Asia for over a decade and is becoming increasingly commonplace in the United States and Europe, in particular for TMJ symptoms which have responded poorly to conventional splint and exercise therapies. Treatment can remove the excessive occlusal forces with normal functional forces left. This can be particularly useful for those patients who cannot tolerate an occlusal splint or only require short term therapy eg examinations stress. Botulinum toxin can work as an adjunct to splint therapy as well. Grinding symptoms and signs can be controlled and other issues, such as nocturnal grinding annoying partners can be aided. There is a list of studies below that go back over more than 20 years and demonstrate the efficacy of the treatment.
A diagnosis of the signs and symptoms will be evident to a dentist so a recommendation of treatment can be made without a further full assessment being required normally. Treatment time is 5-10 minutes with no local anaesthetic normally required but ice is a useful adjunct for comfort. Normally the masseters are injected as they are the main source of the symptoms, but the temporalis muscles may be injected as well. The effects are felt after a few days with the full effect felt after 2-4 weeks. During this time accommodation to the weakened muscle is required with chewy or tough foods requiring care, although the treatment reduces the forces from an excessive loading to a normal, functional loading. Review is carried out after a month and a top-up may be required (this is included in the original cost). The duration of effect is 3-6 months but intervals between treatments can be up to a year after several courses of treatment. Hopefully the habit of clenching and/or grinding can be broken, with the occasional use of a splint the only long-term maintenance treatment required. A further effect with long-term treatment is a slight narrowing of the face at the mandibular angles which occurs after approximately 2 months and is becoming a popular aesthetic treatment to reshape a square-jaw appearance and make the cheekbones more noticeable. The effect of muscle bulk reduction lasts approximately 6 months but requires a higher dose of botulinum toxin.
Locations – an assessment appointment or referral can be made via the AG Aesthetics Belfast website or Facebook page. Alternatively the treatment can be carried out at the dental practice normally attended if a suitable appointment time can be provided (currently Wednesday mornings only).
Cost – the cost of the treatment including any top-up required at the review appointment is £250.
Studies - click to read
J Jankovic – Botulinum toxin treatment of cranial-cervical dystonia, spasmodic dysphonia other focal dystonias and hemifacial spasms (1990). Short, medium and long-term improvements in 73% of cases.
M Schwartz – Treatment of temporomandibular disorders with botulinum toxin paper (2002). Botulinum toxin emerging as a very potent and valuable clinical tool for the diagnosis and therapeutic care of TMD.
M Ziegle – Treatment of recurrent temporomandibular joint dislocation with intramuscular botulinum toxin injection (2003). Over a 3 year period only 2 of 21 patients suffered dislocations.
R Aoki – Evidence for antinociceptive activity of botulinum toxin type A in pain management (2003). Botulinum toxin exhibits anti-inflammatory effects within muscle.
J Jens – Type A botulinum toxin in the treatment of chronic facial pain associated with masticatory hyperactivity (2003). 91% of patients demonstrated an improvement in symptoms.
M Castro – Treatment of myofascial pain syndrome with botulinum toxin type A (2006). All cases showed a reduction in symptoms of at least 50%.
L Guarda-Nadini – Efficacy of botulinum toxin in treating myofascial pain in bruxers (2008). Results supported the efficacy of botulinum toxin A to reduce myofascial pain in bruxers.
A Flores – Botulinum toxin in temporomandibular joint muscular dystonia (2008). Focal and controlled muscle weakening for masseter and temporalis with relief of dystonias and pain by 45%.
C Kurtoglu – Effect of botulinum toxin A in myofascial pain patients with or without functional disc displacement (2008). Improvement in pain symptoms and psychological state with botulinum toxin treatment.
F Arrellano – Botulinum toxin in muscle dystonia of the temporomandibular joint (2008). Visual Analogue Scale of pain (0-10) improvement from 8.15 to 3.7.
T Huerta – Botulinum toxin type A in the management of chronic myofascial pain syndrome patients (2010). Botulinum toxin effective in reducing pain intensity and improving function.
E Del Solar – Theraputic effect of botulinum toxin A in the treatment of masticatory myofascial pain syndrome (2011). Visual Analogue Scale of pain (0-10) improvement from 6.36 to 0.57.