Botox, or botulinum A exotoxin, is a popular aspect of many medical treatments, including facial rejuvenation programs (Khawaja and Hernandez-Perez 311). It has been continuously gaining popularity among women in many parts of the world. The globalization of Botox is rooted mainly on the fact that it has found a “firm place in cosmetic practices for improving wrinkles, frown lines, neckbands, and hyperhidrosis (Pinski and Roenigk, Jr. 198). ” Botox solves common beauty and aging problems such as facial expression lines, specifically, the brow lines, glabellar lines, and crow’s feet (Pinski and Roenigk, Jr.198).
This is by severely weakening or paralyzing the muscles underlying muscles that cause the abovementioned facial expression lines (Pinski and Roenigk, Jr. 198). Botox is also applied in other medical conditions, such as Bell’s palsy, hyperhidrosis, and hemi-facial spasm (Khawaja and Hernandez-Perez 312). Patient satisfaction on Botox treatments is very high, and it is known for causing few side effects (Pinski and Roenigk, Jr. 198). History of the Use of Botox. The history of Botox treatments can be traced as far back as the early 1990s (Pinski and Roenigk, Jr.
198). It was then used by Scott in animal clinical trials to treat strabismus (Pinski and Roenigk, Jr. 198). Later, the same botulinum toxin figured in human clinical trials to treat the same condition (Pinski and Roenigk, Jr. 198). The first reported use of botulinum toxin on humans to treat glabellar furrows involved husband and wife Allastair and Jean Carruthers (Pinski and Roenigk, Jr. 198). The concept of Botox treatments. Botox, when used in dermatological treatments, is contained in a vial with 100 units of toxin, 0. 5 mg of human albumin, and 0.
9 mg of sodium chloride, diluted with 10cm3 of preservative-free saline solution (Khawaja and Hernandez-Perez 311). The toxin contained in the vial is one of the seven types of neurotoxin produced by various strains of the organism, or obligate anaerobic bacterium known as Clostridium botulinum (Khawaja and Hernandez-Perez 311; Pinski and Roenigk, Jr. 198). Botox is injected onto a specific body part of the patient. It works through the binding of the toxin, which is consisted of heat-labile proteins, to motor nerve end-plates (Khawaja and Hernandez-Perez 311).
The toxin is thereby internalized, and within a short period of twenty-four hours, clinical paralysis is effected through the binding of the toxin to the presynaptic neurons. Such binding is irreversible (Khawaja and Hernandez-Perez 311). Clinical paralysis may only be completed after two weeks. In short, Botox is a polypeptide that blocks presynaptic acetylcholine release, which is dependent on the dose administered (Kavanagh, Oh and Shams 1093; Pinski and Roenigk, Jr. 198).
The effect of Botox can last for long periods, although some patients may need repeat injections (Khawaja and Hernandez-Perez 312). Complications and Negative Effects of Botox. Negative effects of Botox treatments can be classified as resistance or complications. Resistance to Botox treatment is possible, especially in case of injection of large amounts of toxin at short intervals (Khawaja and Hernandez-Perez 312). Complications related to Botox injections are neither impossible nor improbable (Khawaja and Hernandez-Perez 312).
Thus, physicians are required to understand relevant factors prior to injection, such as standard electromyography techniques, and alterations to the orbital and neuromuscular anatomy of the patient, which may be caused by prior anatomy (Khawaja and Hernandez-Perez 313). One specific negative effect of Botox is the transient weakness of small hand muscles, observed in some patients (Kavanagh, Oh and Shams 1093). Another common complication of Botox treatments is ecchymosis at the point where the injections were made. Occasional pain and swelling are also common (Pinski and Roenigk, Jr.
198). Another complication is observed to affect few patients (Pinski and Roenigk, Jr. 198). Thus, a small percentage of patients, approximately one to five percent of them, may develop ptosis of the eyebrow or upper eyelid because of the Botox injections (Pinski and Roenigk, Jr. 198). However, this is a minor complication that usually and spontaneously goes away after several weeks, and the patient may ask for two percent zopidine or neosynephrine drops into the affected area in order to speed up recovery (Pinski and Roenigk, Jr.
198). In a British experiment of the effect of Botox treatments to palmar hyperhidrosis, transient thumb-index pinch weakness was observed to last for about one to four weeks, although this side effect is seen more frequently where the British version of Botox, Dysport, was used (Moreau, Cauhepe, Mague, and Senard 1044). This version consists of a different formulation from Botox, but uses similar toxins (Moreau, Cauhepe, Mague, and Senard 1044).
These complications and negative effects dictate that extra caution be observed in the administration of Botox to a patient (Khawaja and Hernandez-Perez 315), especially in specific aspects of treatment. In addition to the need for the use of regional anesthesia in the administration of Botox in certain bodily areas such as hands and feet, Botox may be found to be inappropriate to certain classes of patients (Kavanagh, Oh and Shams 1093). For one, since it is not yet known whether Botox injections could cause harm to the fetus of a pregnant woman, physicians should avoid administering it to such patients (Khawaja and Hernandez-Perez 315).
Moreover, there are no findings yet to negate the possibility of the toxin getting excreted in human milk, therefore, Botox injections to lactating women should also be avoided (Khawaja and Hernandez-Perez 315). Botox should also not be administered to children less than twelve years of age (Khawaja and Hernandez-Perez 315). In addition, since a Botox injection consists of human albumin and botulinum toxin, any patient should first be checked for any allergic reactions to these substances, in order to avoid allergic reactions after injection (Khawaja and Hernandez-Perez 315). The Globalizatoin of Botox.
The globalization of Botox is evidenced primarily by the grand developments of the treatment, especially in the field of dermatology. Indeed, the fact that there is a different formulation of Botox, called Dysport (Moreau, Cauhepe, Mague, and Senard 1044), that was formulated in other parts of the world, is a strong indication of the expanding influence of Botox as a cure to many dermatological problems. More importantly, there is a growing number of population that accepts and likes Botox as a solution against aging, skin problems, and hyperhidrosis (Moreau, Cauhepe, Mague, and Senard 1044).
In the 2005 News Release of the American Society for Aesthetic Plastic Surgery, it was reported that about 11. 5 million cosmetic procedures, composed of both surgical and non-surgical procedures, were performed in the United States in 2005, which numbers represent a 1% increase in the number of cosmetic surgeries performed in the country in the previous year (Plastic Surgery Research. info, 2006). Of these numbers, the most prominent and form the biggest bulk are Botox injections (Plastic Surgery Research. info, 2006).
Indeed, in 2005, Botox placed first in the list of top five nonsurgical cosmetic procedures, with 3,294,782 procedures performed, which figures represent a 16 percent increase from 2004’s figures (Plastic Surgery Research. info, 2006). The table below will illustrate just how popular Botox treatments are in 2005. Table. Source: Plastic Surgery Research. info, 2006. The American Society for Aesthetic Plastic Surgery also provides the following table, which illustrates how the demand for Botox treatments has surged over the years. Table. Source: Plastic Surgery Research. info, 2006.
These figures do not reflect the number of women who do go out to have the injections, but the dermatological community does not deny the assumption that most of the patients who demand Botox treatments are women. Nevertheless, a good number of the male population is also enticed into having some injections themselves. This is manifested by the big difference in the number of cosmetic procedures had by women vis-a-vis those of men in 2005, where women had about 10,500,000 of total cosmetic procedures performed in 2005, while men only had about 985,000 procedures (Plastic Surgery Research.
info, 2006). Reduced to percentage, men’s cosmetic procedures only account to approximately 9 percent of the total number of cosmetic procedures performed in the year (Plastic Surgery Research. info, 2006). Botox is often administered to the patient through injection; however, recent developments, studies, and application of Botox has led to the discovery of other alternative drug delivery systems that my have equal or better effect than the traditional injection system (Kavanagh, Oh and Shams 1093).
Such continuous research of better delivery of Botox into the human system is a result of the globalization of Botox, specifically, the increasing the demand for the treatment by a large portion of the world population. One such recently applied alternative drug delivery system is iontophoresis, a “drug delivery system that uses a small external electric current to deliver water-soluble, charged drugs into the skin (Kavanagh, Oh and Shams 1093). ”
While Botox administration through iontophoresis is still not conclusively proven to be effective and safe, initial experiments show positive and promising results (Kavanagh, Oh and Shams 1093). In the study conducted by Kavanagh, Oh and Shams, they hypothesized that Botox can be administered through iontophoresis since the requirements for this system had been met (Kavanagh, Oh and Shams 1093). These requirements include solubility in water, a suitable molecule size, and polarity (Kavanagh, Oh and Shams 1093).
All of these requirements are met by Botox (Kavanagh, Oh and Shams 1093). Applying iontophoresis to a 22-year old female subject who has had severe palmar hyperhidrosis since puberty, Kavanagh, Oh and Shams found that there was a significant reduction in the sweating of her treated palm and fingers after only 48 hours (Kavanagh, Oh and Shams 1095). Sustained treatment for three months using the proposed procedure led to a finding tat the results are “70% as good as the injections (Kavanagh, Oh and Shams 1095). “
Despite these positive results, Kavanagh, Oh and Shams still think that more study and experiments are needed, in order to consider several other relevant factors, such as water solubility and molecular polarity or size (Kavanagh, Oh and Shams 1095). Nevertheless, their findings provide a good start towards the improvement of Botox delivery to patients (Kavanagh, Oh and Shams 1095). Another trend that is caused by the globalization of Botox is the development of neutralizing antibodies (Pinski and Roenigk, Jr. 198).
However, this development only concerns patients who receive at least 200 units in one session (Pinski and Roenigk, Jr. 198). Botox has been so globalized that it is even being studied and tested as a possible solution and treatment to other medical problems aside form dermatological dilemmas (Conway, Delplanche, Crowder and Rothrock 355). For example, Botox is also tested as a cure to chronic migraine (Conway, Delplanche, Crowder and Rothrock 355). In this study, patients with diagnosed chronic migraine received a single set of injections of Botox (Conway, Delplanche, Crowder and Rothrock 355).
These patients were asked to keep a headache diary for a month, where records of the days of occurrence of headache, their intensity, and the abortive therapy used were kept (Conway, Delplanche, Crowder and Rothrock 355). Forty one percent of the subjects reported a positive treatment outcome, which means that there was a fifty percent reduction in the days where these patients experienced their headaches per month (Conway, Delplanche, Crowder and Rothrock 356).
Subjective responses such as “much better” or “somewhat better” experiences of headache during the testing period were also reported (Conway, Delplanche, Crowder and Rothrock 356). Moreover, there was an observed decrease in the number of days where abortive therapy was used by the subjects (Conway, Delplanche, Crowder and Rothrock 356). The globalization of Botox is also illustrated by the growing number of studies that attempts to compare it with a different formulation, Dysport (Brisinda et al. 695).
One such study, which illustrates the growing use of Botox and its counterpart, Dysport, was conducted in 2004 by Brisinda, et al. They conducted a study to compare the difference as to efficacy and tolerability of Botox and Dysport, two various formulations of type A botulinum toxin, when applied to patients with idiopathic fissure (Brisinda et al. 695). The said study concluded that both formulations of the toxin have positive effects on the subjects, and the results are indistinguishable (Brisinda et al. 695).
Works Cited Brisinda, G. Albanese, A. Cadeddu, F., Bentivoglio, A. R. , Mabisombi, A. , Marniga, G. , and Maria, G. “Botulinum neurotoxin to treat chronic anal fissure: results of a randomized ‘Botox vs. Dysport’ controlled trial. Aliment Pharmacol Ther 19 (2004): 695-701. Conway, Stafford, Delplanche, Curtis, Crowder, Jessica and John Rothrock. “Botox Therapy for Refractory Chronic Migraine. ” Headache 45 (2005): 355-357. Kavanagh, G. M. , Oh, C. and K. Shams. Botox delivery by iontophoresis. British Journal of Dermatology 151 (2004): 1093-1095. Khawaja, Hassan Abbas and Enrique Hernandez-Perez. “Botox in dermatology.
” International Journal of Dermatology 40 (2001): 311-317. Moreau, M. Simonetta, Cauhepe, C. , Magues, J. P. and J. M. Senard. “A double-blind, randomized, comparative study of Dysport vs. Botox in primary palmar hyperhidroses. ” British Journal of Dermatology 149 (2003): 1041-1045. Pinski, J. B. and Henry H. Roenigk, Jr. “Botox: clinical aspects. ” Dermatologic Therapy 13 (2000): 198-200. Plastic Surgery Research. info. (2006). American Society for Aesthetic Plastic Surgery Reports 1 Percent Increase in Surgical Procedures. Retrieved November 20, 2007, from http://www. cosmeticplasticsurgerystatistic