• Dr. Naureen Akhtar General Practitioner MBBS,MRCGP,DRCOG

Is Age a Factor in the Effectiveness of Botox for Cosmetic Purposes?

uses of BotoxSince its approval by the FDA in 2002, millions of people have already used Botox for a variety of purpose. Majority of patients are between the age of 40 and 50, but the popularity of Botox for cosmetic purposes expanded to include those in their early 20s and those in their 70s. But the question is – does age a major factor into Botox’ effectiveness?

Although there are no age limits to the use of Botox, there are several reasons why patients at the endpoints of the age spectrum may first consider getting this treatment.

Age and Non-Cosmetic Use of Botox

It is worth to note that for non-cosmetic use of Botox, e.g. muscle spasms, hyperhidrosis etc., the age of the patient is generally not considered. Botox has been found to be highly effective in a variety of medical conditions or issues such as eyelid spasms, migraine and excessive sweating. However, there is a minimum age requirement. Botox is only approved to be administered for patients 18 years and above.

Using Botox for Cosmetic Purposes for Patients in their 20s

Botox for Cosmetic PurposesA growing number of women and even men in their 20s that use Botox for aesthetic purposes. Although some young adults may be concerned with a developing fine lines in their forehead or eyes, most patients in their 20s are getting Botox for preventative purposes.

If the facial line is not prominent, then Botox won’t give any noticeable difference. But some medical professionals believe that the use of Botox before a wrinkle form can prevent them from turning prominent and permanent on your face. The most common wrinkle that forms early due to muscle movement is the Glabellar lines on the forehead. It is sometimes called as ’11 Lines’.

Using Botox for Cosmetic Purposes for Patients in their 60s and 70s

Botox for cosmetic purposesAccording to the Botox maker, it is labelled for use in patients below 65 years old. According to the FDA studies, some people beyond the age of 65 have weakened neural junctions. Since Botox works by relaxing the nerve receptors in muscles so they won’t move, the effect of Botox will diminish is the neural functions are weak.

Yet, this is still a case-to-case situation and may be depend on the muscle tone of the patient instead of the age. Although age directly influences muscle tone, it does not mean that when you reach 65, you will no longer enjoy the benefits of Botox.

Although Botox is not labelled for patients beyond 65, it can still be used off-label for wrinkle treatment and other cosmetic reasons. It is best to consider that studies revealed a higher percentage of efficacy among groups below 65 years.

Another issue will be your general health and the medications you are taking. These factors may affect whether it is advised to use Botox. Be sure to discuss with a certified, experienced physician to determine if Botox is still the right anti-aging treatment option for you.

Zinc as Botox Booster?

botox booster

Planning to get Botox? Do you want to extend the duration of Botox effect? You may consider taking a Botox booster.

In a clinical trial conducted by the Department of Plastic Surgery, Baylor College of Medicine, 77 participants received the zinc-phytase supplement, zinc only and lactulose placebo. In the study, researchers used a combination of Zinc citrate and phytase, an enzyme, to increase of the duration and effectiveness of Botulinum toxin injections.
Zinc is believed to be necessary for Botox to work as a neurotoxin. The enzyme phytase can help reduce the time it requires to metabolize the zinc in the body. When combined, the two may ‘boost’ Botox’s effect.

The researchers reported that this Botox booster made clinically significant improvements in some patients, especially those with blepharospasm that did not responded well to other treatments. However, it is still advisable to consult your doctor before using this supplement with Botox.

Results of the study revealed that 84 percent of the participants who received zinc-phytase supplement reported an increase in effect while 92 percent reported an increase in the duration effect. There’s no changes on duration or efficacy reported after receiving either the placebo or zinc supplement.

The researcher even evaluation the effects in the specific subgroups. Researchers discovered that participants 65 years and older reported an improvement in the efficacy of zinc-phytase supplement. The said ‘Botox booster’ increased the treatment efficacy in patients with eyelid spasms (benign essential blepharospasm) which is hard to treat, as well as the treatment duration of patients with hemifacial spasm (muscle spasm on one side of the face.

Zinc and Phytase Enzyme – the Botox Booster: How It Works

Botox is a popular treatment for various muscular disorders, sweating and facial wrinkles, however, the result is not permanent. Its effect eventually wear off. For some patients who depend on it or choose to get it on a regular basis, the longer the effect, the better.

Dr. Charles Soparkar, one of the authors of the study, noticed that some of his patients were not as receptive to Botox as others and he started to investigate. He thought that there may be a link between Zinc and Botox.

Botox booster

Soparkar told that all Botulinum toxins rely on zinc – metalloprotease, which means they need zinc to properly work. Up to 50 percent of the people are zinc deficient and so Dr. Soparkar started recommending zinc supplement combined with phytase enzyme, in the form of Zytaze, the drug. Sopakar prescribes it four to five days prior to the treatment.

Conclusion

The result of this study still need to be confirmed. Further studies will be necessary to find out the optimum dose and combination. However, it is possible to achieve similar effect by increasing the body’s level of zinc through your diet before having Botox therapy. Foods rich in zinc include beef, spinach, flax seed, shrimp, oysters and pumpkin seeds.

The Benefits of Botox for Overactive Bladder

Botox for overactive bladder

Botox is not only for wrinkles and facial lines. In 2013, the FDA extended the indication of Botox to include overactive bladder (OAB).

About Overactive Bladder

Botox for overactive bladder

Overactive bladder is not a disease. It’s a collection of symptoms associated to the function of the bladder.

Sudden urge to urinate. A person with OAB experience an urgent, overwhelming, intense need to urinate. It is so sudden that you have trouble reaching the toilet in time.

Urinary frequency. Within 24 hours, you don’t have to pee for more than eight times. If you keep on going to the bathroom, you may have OAB.

Disturbed sleep. Overactive bladder may disturb your sleep, making you wake up two or more times every night to pee. This symptom is called nocturia.

Urine leakage. Leaking urine is a sure sign that there’s something wrong. Leakage can be minimal like a few drops or they can be more serious.

Botox for Overactive Bladder

Botox has been approved to address OAB symptoms such as leakage, frequency and urgency in adults when medications such as anticholinergic doesn’t work well or can’t be taken.

Botox for overactive bladder is a unique approach that target the root cause of OAB – the bladder muscle itself. If you are diagnosed with OAB, Botox can greatly help your OAB symptoms.

Botox for overactive bladder targets the bladder muscle and nerves by blocking the signals that cause OAB. Specific body chemicals travel from your nerves to your muscle cells to trigger contraction of your bladder so you can urinate. But with OAB, your bladder muscles contract uncontrollably so you frequently feel like you need to urinate.

Botox can help calm the nerves that cause OAB, helping you reduce leakage episodes, lessen the frequency of your urination and resolve the intense need to empty the bladder right away.

Based on clinical trials, patients noticed that at week 12, their daily leakage episodes reduced by 50 percent or more after the Botox for overactive bladder treatment. About 1 in 4 patients reported they were no leakage episodes anymore. In this trial, the Botox treatment offered improvement of symptoms for up to 6 months.

The Positive Impact of Botox for Overactive Bladder

By significantly lessening leakage, Botox treatment can provide positive impact on your life.

First, there is no need for overplanning every single detail of your activity beforehand. Having an overactive bladder often cause avoidance and limiting behaviour because of worrying on the bathroom location or limiting how much liquid to drink.

Second, a person may feel worried or embarrassed that the symptoms such as leakage might be noticed by other people. Thanks to Botox, you’ll feel confident to go out without worries.

Lastly, having an OAB makes you frustrated or preoccupied with how your condition affects your daily decisions like what to wear, where to go and how you feel on your general wellbeing.

Botox for Chronic Refractory Low Back Pain

Botox for chronic refractory low back pain

Low back pain is one of the leading causes of physician’s visit in the UK, next to respiratory tract infection. It is a major health issue that challenges many physician, particularly since the withdrawal on a number of Cox 2 inhibitors from the market because of intolerable side effects.

Studies continue to prove the benefits of Botox treatment for muscle pain issues. Recently, it has been shown to provide a continuous reduction in refractory low back pain in more than 50 percent of patients.

Analgesic Functions of Botox

Numerous studies of human subjects had revealed that treating neck muscles with Botox can significantly decrease neck pain. Based on the data, here are the analgesic effects of Botox:

1. Reduce muscle spasm by blocking the release of acetylcholine from pre-synaptic vesicles.
2. Decrease release of pain neurotransmitter such as bradykinin and substance P from the dorsal root ganglia
3. Decrease release of sympathetic neurons or interrupt the action of sympathetic nervous system in maintaining chronic pain
4. Reduce muscle spindle discharge, which results to reduced central sensitization.

Studies on Botox for Chronic Refractory Low Back Pain

The following studies discuss the experience using Botox for chronic refractory low back pain. The two studies indicate pain relief in about 50 percent of patients who undergone treatment with this protocol.

A randomized, double blind, placebo-controlled study was conducted between 1998 and 2000 among 31 adult patients diagnosed with chronic, unilateral low back pain. Prior to the treatment, each patient was assessed for level of pain and the effect of activities of daily living on their pain using Visual Analog Scale (VAS) and Oswestry Low Back Pain Questionnaire (OLBPQ).

Result of the study indicate that at two months, 60 percent of the patients in the Botox group experience significant reduction of pain intensity compared to 18.8 percent in the placebo (saline) group. Activities of daily living also improved – 66 percent for the Botox group and 18.8 percent for the placebo. No side effects were reported.

The second study started in 2002. Seventy-five patients were assessed for chronic low back pain. After one month, 39 of the 75 patients had a significant response. Of the 39 who responded, 33 completed the 1 year follow up.

Conclusion

Treatment with Botox for chronic refractory low back pain has been shown to relieve in about half of the subjects. The side effects reported, which is flu-like symptom for 2 to 5 days, are mild and transient. The success of the two studies may be entirely due to effective methodology, covering the entire low back area and the use of adequate dose for each site to ensure maximal effect.

Currently, Botox for chronic refractory low back pain is off-label and is not approved by FDA. Because of the high cost of Botox, the approach should only be reserved for patients with refractory pain and must only be done by physicians with substantial experience and skin in using Botox for pain syndromes.

Botox for Knee Pain – An Effective Treatment for Injured Athletes

botox for knee pain

British researchers have discovered a new way to use Botox. People diagnosed with Lateral Patellofemoral Overload Syndrome (LPOS), a condition that affects the muscles of the knee and thigh. It commonly affects cyclists, runners and other athletes. Also called patellofemoral pain sydrome, it is often categorized as an overuse injury. But the more appropriate term is ‘overload’ since the condition can also affect inactive individuals.

Hills, steps and uneven terrain tend to aggravate patellofemoral pain. When LPOS develops, even prolonged sitting can already be painful due to the increase in pressure between the femur and patella during knee flexing.

Symptoms of LPOS include a sharp localized pain and inflammation, which prevents runners, cyclists and athlete from continuing as it takes several day to recover. Experts estimate that one in eight active men and one in five active women have the symptoms of LPOS in varying degree.

Current treatment methods include the use of anti-inflammatory drugs, physiotherapy, steroid injections and if all else fails, surgery. Still, despite all these treatment options, most patients reported reduced activity levels and persistent pain.

Knee pain can wreck even the most dedicated cyclist, making pedalling too painful especially on rough terrains or steep slopes. Although there are many holistic ways to alleviate knee pain, from getting a correct bike fit to stretching, medical treatment is still necessary.

Botox for Knee Pain

That is where Botox for knee pain comes in. Based on a recent study published by the American Journal of Sports Medicine, 45 patients with classified LPOS who failed to recover from conventional therapy were administered with Dysport, a type of Botulinum toxin injection, along with physiotherapy. The researchers noted that the patients had overused tensor fascia muscle in the hips rather than the gluteal muscles at the buttocks.

Researchers found out the reason why physiotherapy was not effective in the past – when the patients were performing exercises intended to ease the pain by strengthening the glutes, the tensor fascia lata muscle was still compensating, which concludes that the exercises have minimal effect.

Subjects first done physiotherapy alone but failed. Next, researchers used Dysport in the hip muscle to relax the tensor fascia lata to push the glute muscles to work harder. The Dysport treatment was followed up with physiotherapy to further strengthen the butt muscles.

Most athletes who participated in the study had exhausted all treatment options and Botox for knee pain was their last resort. Of the patients treated, almost 70 percent remained free of pain for five years after the experiment.
Although the research is an exciting new development for riders suffering from knee pain, it is worth to note that getting proper bike fit, appropriate muscle balance and sufficient recovery time can help your knee pain in control before considering Botox for knee pain.

The Benefits of Botox on Groin Area

Botox on groin

Most people knew Botox as a drug that can eliminate wrinkles and facial lines to bring back youthful appearance. However, Botox can also help those suffering from excessive sweating, a condition known as hyperhidrosis.

Today, more and more people are getting Botox to control excessive sweating. Common areas include armpits, the palm of the hands, sole of the feet and even the scalp. And now, people are also getting Botox injections in their groin area too.

The groin area – the trough running from the hips where the genitals is situated, has folds that trap the belly skin and leg skin. This is the area where people, especially those obese, tend to trap a lot of moisture. The maker of Botox, Allergan, claims the toxin injection can block the nerve signals that stimulate sweat glands.

Excessive sweating in the groin area can cause problems, particularly if you are obese or overweight. People who are obese or overweight often have an overhang on the lower abdomen. For thin individuals, it is not an issue of concern since they would have less overhang of lower belly that can trap moisture or sweat.

Botox on Groin Area

Botox injections done for hyperhidrosis of the armpits is usually done between 4 to 6 months since that is how long Botox lasts. As for Botox on groin area, the coverage is about the same as the armpits. Discomfort that can experienced is minimal. In fact, it is more painful in the face than in groin area as the nerve density in the groin is less than on the face.

The injections of Botox on groin aren’t really big but they spread in multiple tiny injections. The reason for doing this is to fully cover the groin area. If you only inject one or two areas, it will be hard to disperse the medication.

As for the risks, the injections of Botox on groin area is very superficial. There should not be any risk as long as the person performing the procedure knows what he/she is doing. Also, the muscles in the groin area are huge, major muscles so the small amount of Botox administered in this area isn’t going to cause any harm.

One of the biggest benefits of Botox on groin area is that it can reduce the risk of developing fungal or yeast infections. Of course, Botox won’t prevent these infections because what it does is only reduce the wetness or moisture in that area. However, by reducing the moisture of the area and keeping the area drier, there is less chance yeast or fungi develop in the groin area.

What Happens To Your Face as You Age – Facial Aging in Your 20s, 30s and 40s

facial aging

As you age, your skin begins to look and feel different. Apart from that, the actual shape of your face also changes. Find out more about facial aging changes in your 20s, 30s and 40s and what you can do to keep your skin healthy and radiant-looking.

Facial Aging Begins in Your 20s

When you head from being a teenager into young adulthood, you start to lose baby fat. Though the changes are subtle, you start to look more like a woman and less like a girl. You may not believe it but facial aging starts at this phase.

This is the time when very early signs of so-called motor wrinkles – the creases and facial lines related to movement – first appear. Also, if you spend most of your time squinting in front of a computer screen, you may also start to see ‘crow’s feet’ or the tiny lines around the eyes.

Young women should also watch for melasma – a brown hyperpigmentation that appears on the forehead and cheeks, caused by a combination of hormones, sun exposure and pregnancy.

What to Do?

To maintain your youthful glow, avoid the sun if possible and always use sunscreen when you’re outside. How you look in your 40s and beyond will reflect on what you do in your 20s. Applying sunscreen is key.

Start using moisturizers on a regular basis. Dermatologists recommend using retinol-based skin care products.

Facial Aging in Your 30s

This is the decade when you’ll notice your skin is less radiant and appears ‘tired’. You will start to notice deep crow’s feet including past sun damage that may aggravate the appearance of small brown spots. Be prepared for the dreaded 11’s – the parallel lines that emerge between your brows.

Both the 11’s and the nasolabial lines around your mouth will appear during this decade.

What to Do?

Experts suggest to increase usage of retinol products to three to four times a week. Also, this is the time you have to use moisturizers and sunscreens. Chemical peels can eliminate minor imperfections and maintain that ‘youthful glow’. To add, this is the decade to go after those wrinkles with Botox and dermal fillers such as Juvederm and Restylane.

Keep in mind that the best way to make the most of the results and ensure safety is to look for a board-certified plastic surgeon or dermatologist.

Facial Aging in Your 40s

When you reach 40, the facial lines and wrinkles become deeper. Lines around your upper lip – called the purse string muscle – start to appear. Since this area is prominent, it is highly prone to sun damage. If you skipped sunscreen on this area, you will see the aging lines here first.

Be prepared to see more lines and creases on your forehead, eyes plus a more noticeable smile lines.

What to Do?

Consider Botox and dermal fillers at this point if you haven’t tried it on your 30s. You also have to use stronger moisturizers and a night cream. Experts believe that when you sleep, your skin undergoes a natural healing process so skincare products intended for night use are absorbed better and may provide better results.

Recent Study: Stomach Botox for Weight Loss

botox for weight loss

A new use of Botox is now being considered by many doctors – the injectable toxin may help overweight and obese people shed weight, based on early research.

Botox treatment is believed to work by blocking a crucial nerve in the stomach that regulates feeling of satiety and hunger. In a small study in Norway, researchers injected Botox into the stomach of 20 obese individuals, with body mass indexes ranging from 35 to 44. The study utilized an endoscope, a medical instrument to look inside the stomach and administer Botox for weight loss into the lower part of the organ. Participants received Botox at the beginning of the study and then another one every six months.

After a year (patients had received two injections) results revealed that 70 percent of the group had lost weight, with an average weight loss of 17 percent out of their excess weight body. After 18 months (patients got three injections), 75 percent of the patients lost weight, with an average weight loss of 28 percent of their excess body weight.

Researchers emphasized that despite the small size of the study and the need for more research in order to confirm, if future studies validate the findings, then this procedure may become ‘the latest method in treating obesity.
A number of past studies have also tested Botox for weight loss, but majority of the studies found that Botox did not help the subjects lose weight. The difference between this study and those in the past is that earlier studies followed patients for just a few months after a single shot of Botox, whereas this new study followed the patients for over a year with repeated injections of Botox.

Furthermore, researchers in the earlier studies thought that Botox would only help people lose weight since it could slow down the rate of stomach emptying. However, the researchers in the new study had a different theory – Botox can block the vagus nerve – a nerve connecting the stomach and the brain, controlling feeling of satiety and hunger.

The researchers first tested their theory in animals, targeting the vagus nerve with Botox injection in mice and discovered that the rats lost weight by eating less. But in experiments where the vagus nerve had been cut, they did not lost weight even with Botox injections. This experiment suggested that Botox acted through the vagus nerve, inducing weight loss. This made the researchers target vagus nerve with Botox.

Botox for weight loss is relatively safe and patients didn’t experience any serious side effects. Also, the procedure is quick, which only takes about 15 minutes. Still, Botox can cause serious side effects such as trouble breathing, muscle weakness and double vision, in rare cases.

The study was funded by the European Commission and The Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology.

Getting Botox for Career – How Cosmetic Injections Help More Men Compete Against Younger Men

Botox for career

Today, more and more men are jumping on the Botox bandwagon – and they are giving all different reasons to give wrinkle injection a try. According to a recent survey done by the American Society for Aesthetic Plastic Surgery (ASAPS), there is a significant increase in the number of total procedures (9.9 per cent) for both men and women, with more than 400,000 male patients who got Botox injections last year.

Plastic surgeons are not surprised to see more men in their practices. The main motivation of men to get Botox injection is to appear youthful, particularly at work where they’re more likely to face age discrimination. Many men view the procedure as a way to defy aging effectively and freeze time.

The pressure to look young and feel more youthful are not exclusive to women; men too feel pressured. This is according to most physicians who told patients age 35 to 65 years were interested in getting the injection.
The president of the ASAPS Dr. Daniel Mills said, “’They’re simply having more procedures done because they want to maintain the competitiveness in an increasingly ageist workplace”. Nowadays, the younger you look, the better chance you have in competing and staying in market. The most common areas injected with Botox for career are around the eyes and eyebrows.

In addition, spouses and significant others play a part in convincing their partner to go inside their doctor’s office. Some patients feel more comfortable having the procedure after finding out that a loved one or a friend have it, while others just reported that their partner demanded they get Botox.

After seeing more and more men considering this cosmetic procedure, doctors are beginning to pay more attention to men’s aesthetics, as this trend may continue and even perpetuate. In the past, a man checking a plastic surgery website may see procedures often aimed at women. But now, more and more websites are dedicated to cater men.
Another reason to the rise on the number of men getting Botox is social media and the desire to look great on their dating profile. This inspired more and more men to try the Botox.

Most men who likely get Botox for career have higher incomes and a lot of them work in fashion, art, corporate world and law. There’s also no specific ethnicity – Asian, White, African-American.

Studies Suggest – Botox for Arthritis Pain

Botox for arthritis pain

Popularly used to smoothen fine lines and reduce the appearance of wrinkles, experts are exploring the potential of Botox for arthritis pain, specifically rotator cuff arthropathy. Rotator cuff consists of four tendons and four muscles that surround the joints and provide important function. It makes sure the end of the humerus stays within the socket of the shoulder.

Rotator cuff tears are more common among the elderly. This is often caused by wear and tear in the joints and affects up to one in four people. Along with reduced blood supply, tendons in the area become weaker with age. Shoulder blade rubs against these tendons, causing tears in the tissue and impairing movement. Some elderly people experience difficulty in raising their arm above their head due to rotator cuff arthropathy.

Benefits of Botox for Arthritis Pain

In the past, treatment options for arthritis pain include heat or ice packs, anti-inflammatory medications and physiotherapy, and sometimes, for severe cases, surgery. Administration of Botox in the affected muscles bypasses such measures because Botox relaxes the tissue by blocking signals that prompt the muscle to tighten.

Another reason is that Botox for arthritis pain can paralyze the nerves. Similar to injecting wrinkles, it could have similar effect on the muscles that is transmitting pain. The toxin may eventually be used for treating osteoarthritis patients and those with rotator cuff arthropathy, whose pain isn’t adequately controlled by traditional medicines such as analgesics or NSAIDS.

Botox Blocks Pain Signals

Like how Botox flattens wrinkles, the substance can block neuromuscular junction, so the nerve cannot transmit signals, preventing muscle contraction.

In a study published by the Journal of Rheumatology, 54 patients with chronic knee pain were grouped into two – one group were injected with Botox while the other were given placebo. Result of the study showed 71 percent of those administered with Botox achieved significant reduction in pain, with measurable improvement in the joint function compared to 35 percent of those who got placebo.

Botox as a Possible Treatment for Inflammation

Another study has further raised interest by telling that Botox might be used someday for treating inflammation. Published in the Biochemistry Journal in 2011, it cited a future use of Botox – treating chronic inflammation and not only temporarily relieving pain.

The study led by Felix Yeh, PhD said the focus of the study is to learn how the toxin get into the neurons, something he names ‘the Trojan horse strategy’. With the use of Botulinum toxin Type B, a relatively new product, Yeh revealed that the neurotoxin can be used to inhibit the release of tumor necrosis factor alpha, a type of cytokine that possibly causes inflammation in autoimmune diseases such as rheumatoid arthritis.