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Botox® is the trade name for Botulinum Toxin, a neurotoxin in the form of a purified protein. The mechanism of action for Botox is quite simple; it is injected into facial muscles but doesn't affect the muscle at all. Botox works by blocking the transmitters between the motor nerves that innervate the muscle.
The areas typically treated with Botox are the forehead, between the eyes (glabellar region), around the corners of the eyes (crow's feet), and around the lips (smoker's lines or gummy smile). Botox can also be used to reduce muscle tension in the masseters (jaw line). There is no loss of sensory feeling in the muscles. Once the motor nerve endings are interrupted, the muscle cannot contract, causing wrinkles in the skin to smooth.
Botox has important clinical uses as an adjunct in facial pain and bruxism cases for patients with chronic Temporal Mandibular Joint Syndrome (TMJ) and orofacial pain. Botox is also used to complement esthetic dentistry as a minimally invasive alternative to surgery to treat conditions related to the TMJ. It may also help prevent nighttime teeth grinding, patients that clench, and relieve chronic migraines. Botox takes between 2-10 days from injection to exert its clinical effect.
Retreatment with Botox is typically between 3-4 months, with a small percentage of patients going considerably longer. The cumulative effect of long-term, regular use of botulinum toxin obtains the best results, and often patients will note longer duration of action due to mild atrophy of the hyper-dynamic muscles and skin regeneration. As the effects wear off, strength gradually returns (along with the wrinkles caused by movement), but wrinkles are not any worse than baseline.
The most common side effects of Botulinum Toxin injections are bruising, redness, and swelling. To reduce the possibility of these side effects, it is recommended to avoid alcohol for at least 24 hours before the procedure. Aspirin and anti-inflammatory medications should also be avoided for a period of two weeks prior to the procedure. As always, consult your physician before stopping any medications.
Other rare side effects are possible and will be reviewed by the treating doctor. To avoid adverse reactions and results, it is recommended not to manipulate the treated area for 2 hours after injections. Additionally, maintaining an upright position for at least 4 hours can further reduce the risk of adverse effects.
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