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Botox is short for “Botulinium Toxin”- is a medication derived from purified neurotoxin produced by the bacteria Cloistridium Botulinum. First developed by Allergan, Botox (onabotulinumtoxinA) was US FDA approved for cosmetic use in 2002. Since then, other brands of botulinium neurotoxin have been developed and approved for cosmetic and medical use, including Dysp0rt (abobotuliniumtoxinA- Ippsen Pharma) and Xe0min (incobotuliniumtoxinA- Merz Pharma).
Botulinium neurotoxins (“Botox” for short) works by blocking signals between nerves and muscles, thereby relaxing the target muscle. Dynamic wrinkles on the face form due to overactive muscles of facial expression- treatment with botox would improve the appearance by reducing dynamic wrinkles and fine lines. Static wrinkles form due to repeated facial expression eventually causing permanent creasing of the skin- these do not respond well to botox treatments and require other treatments such as laser resurfacing.
The most common misconception about Botox is that it will result in a “frozen” look. Current injection techniques and treatment dosages are aimed at a “natural” and “softer” look, with the client appearing less angry or stressed. This is achieved by using lower treatment dosages and performing the treatment in 2 stages, with a conservative initial dose and a subsequent touch up dose 2 weeks later.
Apart from cosmetic use on the face to treat dynamic wrinkles from overactive muscles of facial expression, Botox is also used to slim the face by reducing the size of the jaw muscle (masseter). Botox can also be injected into the shoulder muscle (trapezius) for a slimmer neckline, and into the calf muscle (gastrocnemius) for a slimmer calf. Medical uses of Botox include: treatment for teeth grinding and temporomandibular joint disorders, treatment for migraines and excessive sweating (hyperhidrosis)
Figure 1- Treatment areas for Botox
Figure 2- Mechanism of action for Botulinum neurotoxin
Figure 3- Forehead lines, crows feet and frown lines are examples of dynamic wrinkles that form due to overactive facial muscles. Dynamic wrinkles resolve at rest, static wrinkles do not. Dynamic wrinkles can be effectively treated with Botox alone, static wrinkles require botox in combination with laser resurfacing or radiofrequency microneedling
Figure 4: Botox injection into the jaw muscle (masseter) is a medical treatment for temporomandibular joint disorders, teeth grinding (bruxism) and has the cosmetic effect of slimming the face.
Figure 5- Botox is a medical treatment for excessive sweating (hyperhidrosis)
Figure 6- Botox can be used to reduce the size of the calf muscles
Botox is the one of the most common nonsurgical cosmetic procedure worldwide- In 2022, plastic surgery practices performed over 3.9 million cosmetic procedures involving neurotoxins (such as Botox) in the United States alone! Botox delays the signs of ageing on the face by relaxing overactive facial muscles, eliminating dynamic wrinkles and softening existing lines. This makes an individual look less angry, stressed and tired- helping to maintain a natural and refreshed appearance. With a youthful appearance restored, self confidence is boosted.
In the famous “Botox Twins Study” (William J. Binder.Long-Term Effects of Botulinum Toxin Type A (Botox) on Facial Lines. Archives of Facial Plastic Surgery.Nov 2006.426-431)- the photographs of two identical twins were compared. One twin underwent regular Botox treatment of her forehead, glabellar and crows feet (2-3 times a year for 13 years), while the other twin did not. Apart from Botox and skincare, both twins did not go for any other medical aesthetic treatments. Not surprisingly, the twin who received regular botox appeared to have aged more gracefully, with smoother skin and less wrinkles.
Botox treatments can be performed together with other in clinic treatments for added effect- common treatments paired with Botox include Hydrafacial, BBL HERO, PicoSure, skinboosters or fillers.
Figure 7- The famous “Botox Twin study” comparing two twins- one who went for regular Botox treatment over 13 years and another who only had it done once. Who aged better?
Source: William J. Binder.Long-Term Effects of Botulinum Toxin Type A (Botox) on Facial Lines. Archives of Facial Plastic Surgery.Nov 2006.426-431.
When is the right age to start doing Botox? Is there an age limit on Botox? This is a question that is often asked. This depends on various factors, such as the reason for doing Botox and the expectation of the client. Generally, the typical Botox patient starts in his or her late 20s when dynamic wrinkles develop. Above the age of 50, skin laxity develops and Botox treatments need to be calibrated accordingly to avoid getting droopy eyebrows and eyelids.
Botox is generally safe, but there are some risks that need to be considered. When treating the upper face, especially in older individuals with pre-existing skin laxity, Botox may result in assymmetry or drooping of the eyebrows and/or eyelids. Often- the eyebrow or eyelid droop was pre-existing and was compensated by overactivity of the facial muscles. Resistance to Botox is caused by formation of antibodies that neutralise the effect of Botox- this is rarely seen with Aesthetic treatments due to the low dosages being used and usually occurs when Botox is used for medical purposes such as the treatment of neurological diseases such as spasticity (requiring higher dosages).
Due to the potential risks of Botox, it can only be administered by a qualified medical professional who has underwent further postgraduate training (MBBS with Certificate of Competency, Dermatologist or Plastic Surgeon).
Beyond credentials, it is also important to find a provider who has a sense of beauty, who listens and respects the goals of the client- the right chemistry between client and provider is essential and it is important to work with a provider you feel comfortable with.
The 3 locally approved brands of botulinum toxin- Botox (“Allergan Botox”), Dysp0rt and Xe0min are generally regarded by doctors to be interchangeable. There are differences in their characteristics such as rate of onset, rate of diffusion and duration of action- which is why most experienced providers will stock all 3 brands.
Most clinics charge Botox per unit used, with prices depending on clinic location, provider experience etc
Botox price per unit $15-20
Xe0min price per unit $15-20
Dysp0rt price per unit $8-10 (note- 1 unit of Dysport has the approximate effect of 0.5 units of botox, hence the price)
Another common practice is to charge a flat fee per area of treatment, with common treatments being the forehead, glabellar, crows feet
Different areas of treatment may be charged at different prices to reflect the anticipated units of Botox required
At the 2 week mark, the full effect of the Botox treatment is seen and it is common to require additional units of Botox to “touch up” any wrinkles not addressed by the initial treatment. Most clinics charge for the touch up treatment.
Be skeptical of establishments offering Botox at unbelievably cheap prices! There has been a surge of illegal beauticians offering such illicit services in spas or rented apartments. Often the product used is not original but an unlicensed neurotoxin from dubious sources.
Botox is one of the top treatments at Bay Aesthetics Clinic for several reasons- the convenient location in the CBD (a short walk from Downtown and Raffles Place MRT) allows office workers to pop in during their lunch hour for a quick fix! To provide clients with choice, all 3 brands are available (Allergan Botox, Dysport and Xeomin). Pricing is competitive and includes free touch up for wrinkles within 2 weeks.
Botox price at Bay Aesthetics Clinic:
Botox forehead/glabellar/chin
$180 for 1 session
$500 for 3 session package
Botox eye (right and left side- 2 areas)
$360 for 1 session
$1000 for 3 session
Botox jaw muscle (masseter)
$580 for 1 session
$1600 for 3 session
Botox one vial (100 units)- $1200
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