What is Botox? How Does Botox Work?
Even though the name Botox is all over the media, internet and gossip channels many people still do not know what it actually is. It is not uncommon for people to ask me, “What is Botox?”
Well, for one Botox is a band name of a product developed by Allergan Inc. It is a medication that is derived from a protein produced by natural bacteria, Clostridium botulinum. This bacteria is all around us and is natural to the environment however it is often dormant and often causes no trouble to us humans. However, the bacteria can cause “botulism” if people eat things such as preserved meats or home canned products that were not performed prepared. But, this is not Botox, this is botulinum toxin.
Botox is a much more purified form of this toxin and of course available in a controlled amount.
So, how does Botox work? Well, this is a complex physiological process but I will summarize some of the key aspects of this so people can understand how it works.
To understand how Botox works, you first need to understand the basics of neuromuscular physiology, or how a nerve makes a muscle move. When you try to move, your brain sends a signal down a nerve to your spinal cord (or brainstem). At this point, another nerve leaves your spinal cord and targets a specific muscle. At the end of the nerve, there are attachments to the muscle fibers. The nerve releases a chemical called “acetylcholine” that causes the muscle to contract. This all happens VERY quickly.
When you inject Botox into a muscle, you “modulate” this response, hence the term neuromodulator. The Botox actually finds its way into the end of the nerve fiber (this nerve that was attached to the muscle). Once in there, it breaks apart a little protein that is responsible for allowing the acetylcholine to be released from the nerve onto the muscle. So, now when the brain tries to send a signal to have the acetylcholine released, nothing happens and the muscle does not move. This is how Botox results in muscles not moving.
So, why is Botox only temporary? This is the key to the question “How long does Botox last?”
Your body will now try to repair itself and allow the muscle to start working again. At the end of the nerve that is affected by Botox, new “sprouts” start to form. This means, the nerve sends out NEW little attachments to the muscle that are not affected by the Botox. Once this contacts the muscle, the muscle can now move again. This allows time for the original nerve attachment to repair its self. Once this happens, the sprouts disappear and there nerve is back to normal. At this time, there is no known long term nerve Damage associated with Botox.
All of the different types of botulinum toxin have a similar mechanism as Botox. In fact, there are actually three formulations of botulinum toxin, onabotulinum toxin A (Botox), incobotulinum toxin A (Xeomin) and abobotulinum toxin A (Dysport). When you look at these names, first off they are all “botulinum toxin.” However, they each have subtle differences in their structure and function.
Each formulation is purported to have unique benefits over the other however it is unclear if these differences are clinically significant. Producers of each formulation often highlight a number of factors distinguishing their product from their competitors.
Dr James P. Bonaparte, MD, MSc, FRCSC
Otolaryngology – head and Neck Surgery
Cosmetic and Reconstructive Surgery
Ottawa, Ontario, Canada