Overview of BotulinumTreatment

What is Botulinum Toxin?

Botulinum toxin A was first used in the treatment of neurological diseases, it is now more commonly used for wrinkle smoothing.

Botulinum is an agent that reduces or completely suppresses the activity of muscles and can be used for aesthetic reasons and for medical indications, for example, migraine and muscle cramps in spasticity.

In the aesthetic field, it is used to treat wrinkles and helps specifically against the formation of wrinkles in the upper half of the face: frown lines, forehead wrinkles and wrinkles around the eyes.

What does Botulinum do?

Botulinum reduces or blocks the activity of muscles, this is done by inhibiting the transmission of excitation from nerve to muscle: The nerve no longer stimulates the muscle, it no longer contracts, relaxes.

Botulinum was originally used for purely medical reasons, especially in patients with spasticity: their overactive muscles that cause the limbs to cramp up are damped, arms and legs become normally mobile. Other medical applications included migraine and hyperhidrosis (excessive sweating). It was later discovered that the drug also helps in the aesthetic area, namely for wrinkle reduction.

Aim of Botulinum Treatment

The aim of this wrinkle treatment is to reduce or even remove facial wrinkles gently and without surgical intervention. This is only possible if the wrinkles have not yet dug deeply into the skin.

Effects of Botulinum Injections

Usually the effect of the treatment occurs after 48 to 72 hours with the maximum effect being achieved after 1 to 2 weeks, though in individual cases, this might take longer.

What Types of Wrinkles can be Reduced with a Botulinum Injection?

In order to use Botulinum correctly, it is important to know that there are three types of wrinkles on the face: the dynamic wrinkle, resting wrinkles and those caused by loss of volume.

Dynamic wrinkles are caused by facial muscles working, i.e. contracting and taking away the overlying skin, the wrinkle then develops. When the muscle relaxes, it smooths out, for this Botulinum is the right treatment.
Resting wrinkles and wrinkles due to volume loss are caused by another mechanism: the sinking / regression of the tissue, are treated with hyaluronic acid or own fat and discussed below. Botulinum and hyaluronic acid are different substance classes and have completely different areas of application.

The following symptoms are optimally suited for treatment:

• Worry lines: Horizontal forehead wrinkles, also called worry lines
• Frown lines
• Eye wrinkles: Crow’s Feet
• Mouth wrinkles: Wrinkles in the initial stage in the lip area
• Neck and chin wrinkles: When they appear on facial expressions.

As described, Botulinum reduces or blocks muscle activity, dynamic wrinkles disappear, when the skin is contracted by the muscles many times, the collagen of the skin suffers over the years: its structure changes, it breaks, permanent wrinkles appear. These permanent wrinkles, once formed, are not affected by Botulinum, this would require alternate arrangements.

Can a Botulinum Injection be Topped up as often as I want?

Botulinum works at the transmission point between nerve and muscle and sets a blockade, the effect usually lasts between 4 and 6 months. After this time, the substance is broken down and the relaxing and wrinkle-smoothing effect subsides.

In people with highly active metabolism it lasts for a shorter period of time, observations show that even a longer period of effect is possible with regular treatment with Botulinum.

In principle, it is possible to undergo a top up treatment at our clinic in Berlin.

The aftercare:

A treatment with Botulinum has many advantages, one major advantage is that aftercare is not necessary. Just a few years ago, people were cautious and advised against all kinds of activities after a Botulinum injection, it has been shown that this is not necessary.

How does Botulinum Therapy Work?

Our patients come to us and tell us what their treatment aim are, which wrinkle treatment they want and we make a suggestion. If Botulinum is the right solution, the treatment can begin immediately.

We first inject a medium dose, then we ask you to observe the effect, because everyone reacts a little differently to the remedy. If (too many) wrinkles are still visible after two weeks, we will give the patient another injection, treatment usually takes 5 to 10 minutes.

Side Effects of Botulinum

Even with a professionally conducted procedure, slight swelling and minor bruising around the puncture sites may occur but these can be easily cooled and disappear again quickly. The active ingredient gradually decomposes in the body, so all possible side effects of botulinum are temporary and reversible.

Systemic side effects that affect the whole body can be virtually ruled out, the same with allergic reactions which are rare.

Certain Diseases & Medication

Like an allergy to the carrier substance albumin, these can be a contraindication for Botulinum therapy. In this case, Botulinum should not be used, along with;

• Myasthenia gravis,
• Myopathy,
• Lambert-Eaton-Rooke-Sydrome or severe coagulation disorders

Botulinum During Pregnancy & Skin Diseases

During pregnancy and the subsequent breastfeeding period, Botulinum injections are not recommended. If there are inflammations or skin diseases in the area to be treated, it is also not recommended to go ahead with Botulinum injections.

Possible Risks/Complications of Botulinum Therapy

If botulinum is used correctly, complications are extremely rare or almost impossible:

• Infection of the puncture sites is possible but thanks to thorough disinfection and careful hygiene, it does not normally occur in the practice.
• Too low a dose: A re-injection is possible without any problems after two weeks.
• Wrong injection point: classic example of this: Injecting too close to the eyebrows. The eyebrows temporarily drop.
• Little or no effect: Causes may be a hyperactive metabolism or in individual cases antibody formation.
• Further possible side effects with aesthetic application: Dry mouth, difficulty swallowing, dry eye, strabismus, headaches. In our clinic in Berlin such symptoms could not be observed. Possible systemic effects have not been proven by serious studies.

Selecting a Clinic for Botulinum Treatment

Although the procedures for Botulinum injections are very gentle and safe for the patients if the correct dosage and choice of injection points are used, it is important to choose the right clinic.

The Experience of the Therapist

The experience and qualifications of the doctor play a decisive role in the success of treatment. They are able to individually select the correct quantity of injections and the correct injection points for each patient. This enables them to achieve the desired result and avoid complications, for example, possible overdosing.

Caution with Botulinum treatments in the Beauty Salon

Botulinum (botulinum toxin) or hyaluronic acid injections are a medical practice requiring a permit, it requires medical expertise and it is essential that the treating personnel have exact knowledge of the structure of the skin, the course of nerve tracts and blood vessels, as well as of muscle strands and the special anatomy of the face.

On 17.02.2012, the OLG Karlsruhe made an important decision: It prohibits cosmeticians from injecting filler or Botulinum to combat wrinkles. Botulinum toxin is now a prescription drug, therefore, it is reserved for licensed physicians only.

How Expensive is a Botulinum Injection?

For aesthetic applications, the costs are between 150 and 450 €, depending on the amount required and the quality of the product used in the treatment. We only use the original product Botulinum.

Is Botulinum treatment covered by health insurance?

The costs for aesthetic treatments are to be paid by the patient.

If there is a medical indication, for example for the treatment of neurological movement disorders or hyperhidrosis, an application for cost coverage can be made to the statutory health insurance company. Whether the costs are ultimately covered is down to the insurance companies but a number of conditions must be met.