It is a recurring question in aesthetic medicine consultations, and a visit to the discipline's forums on the Internet shows that doctors and patients have been asking it for years: Is it true that the effects of Botox, the commercial brand that makes two decades ended up becoming the generic and popular name for botulinum toxin?
The answer to this question goes far beyond the doubts one may have in front of the mirror. First, because of the economic repercussions. Botulinum toxin is the most used treatment in aesthetic medicine: last year 332,000 vials of this medication were sold in Spain for aesthetic purposes for 79.3 million euros, according to data from the specialized consulting firm Iqvia. And second, because the debate has become scientific, with dozens of articles published in medical journals and many hours of interpellations at industry conferences.
“It is true that the effects of the toxin sometimes last less than expected. But the causes, in general, do not have to be sought so much in the substance itself, but in the characteristics of the patient or in inadequate administration,” says Fernando García Monforte, a doctor specialized in the discipline and co-author of a study recently published in the journal scientific Aesthetic Medicine with the title Botulinum toxin. Why does it last less? A review from our experience.
This substance is a protein that is produced in nature by bacteria of the species Clostridium botulinum. Due to its powerful neurotoxic effect, it poses a risk in the food sector, where it can cause serious poisoning in the form of botulism when these microorganisms contaminate foodstuffs such as preserves. “It causes muscle paralysis by inhibiting the release of acetylcholine, which is the transmitter used by neurons to communicate with each other. In practice, this causes the nerve endings to stop giving orders to the muscles,” explains Francisco Zaragoza, professor of Pharmacology at the University of Alcalá de Henares (Madrid).
The same effect that makes it dangerous—someone intoxicated will drown when the breathing muscles stop working—gives the toxin enormous potential in the medical field if applied locally in tiny doses. In aesthetic medicine, it is widely used to “eliminate or reduce facial wrinkles such as those on the forehead, between the eyebrows and around the eyes,” he explains. Juan Antonio López Pitalúa, president of the SEME. In other areas of medicine, the toxin is used in various muscle ailments—dystonia, spasticity…—and some cases of migraine, among others.
García Monforte's article raises the problem from the first paragraph: “Complaints about the shorter duration of the toxin's effect in patients are a cause of concern among doctors,” since “it is common to hear that, when performing a new treatment with the same brand of toxin as the previous time, this time the duration of the effect has been shorter.”
In responses to EL PAÍS, the author reveals numerous explanations that shed some light on this apparent mystery. “Some of them have to do with the way the toxin is administered, which is a protein that can degrade if it is not handled correctly, which will reduce its effectiveness and, therefore, the duration of its effects. I usually say that the toxin lasts less in some hands…”, he states. Shaking it, for example, should be avoided in all cases. You must also follow the manufacturer's instructions in detail when reconstituting the toxin, which is sold in vials with a powder that must be diluted in physiological saline and then kept at a low temperature.
“If it is used too frequently, the body will develop antibodies that also shorten the effects,” adds García Monforte. To avoid this, injections must be spaced out for aesthetic purposes, but also keep in mind that the toxin is also used in the healthcare system for various neurological, muscular or pain ailments. “The person often does not relate that the medication they are injected with in the hospital is the same or very similar to the one we use. That is why all information, including the brand, should always be requested. Not all toxins are the same and we can achieve better results if we take all this into account,” explains this doctor.
Finally, experienced professionals know that there are other factors that can play a role. “The effects of the toxin last less in summer, for example. It is because of the heat and the sun that warm the skin and contribute to degrading the toxin. People who go through a time of stress also tend to have less lasting effects. In general, anything that involves more activity, tension or movement can shorten them,” continues García Monforte.
With so many questions on the table, it is “normal that there is some disparity in the results obtained” concludes the author of the study, who maintains that “although it is said that the toxin lasts up to six months, in reality we have to think that it lasts three and, From there, consider it as a gift that can be obtained with precise use.”
The president of the SEME explains it in other words. “The use of this drug must be evaluated within six months. In the first two, the paralysis is complete. In the next two, the muscle recovers mobility. And in the last two, although it has recovered almost completely, the wrinkles tend to be less marked due to the time that the muscle has been relaxed,” López Pitalúa describes.
Patient preferences are not always the same either. “There are some who like better the results obtained in the first weeks. Others, however, look better a month and a half or two months after the puncture. It depends on each person's taste, there is a lot of variability,” he adds.
According to the article published by García Monforte, “those responsible for the manufacture and distribution of the toxin deny that there is a cause dependent on the manufacturer in relation to the shortening of the effectiveness of the toxins.” This newspaper has asked two of the largest manufacturers of the drug presentations used in aesthetic medicine, Merz and Allergan, for their version, but both have declined to answer.
The experts consulted admit that it will be very difficult to close the debate, partly because of the large number of influencing factors and partly because it has an important subjective component that makes “each person and each treatment unique.”
#effects #Botox #mystery #worries #aesthetic #medicine
