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Botox: A friend told me that her friend, who is not a doctor, applies botox and very cheaply...

Let's Analyze the Risks

by Doctor Luis Carlos Moreno A.

Plastic surgeon, aesthetic and reconstructive

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Given the growing number of false aesthetic clinics closed by the authorities, and given the notable rise in cases of malpractice, it is important to raise awareness

Botox (onabotulinumtoxinA), which is how the treatment is popularly known, is really a commercial brand.  of botulinum toxin that was the pioneer company in the production of botulinum toxin type A, for cosmetic uses. The real name of the treatment is application  Botulinum toxin.  

But what really is botox?  

It is a neurotoxic protein (which damages the nerves of the muscles) that is produced by the bacteria known as Clostridium botulinum, a bacterium that causes the disease known as botulism.

This toxin is processed, purified and prepared for use for cosmetic purposes, an application that has been approved since 2002, to reduce wrinkles in the forehead, peri-ocular, crow's feet, chin and neck wrinkles. Since 2004 it has been approved for the treatment of axillary and hand hyperhidrosis, which is excessive sweating that occurs in some people.

Aplicación del Botox, Asociación Panameña de Cirugía Plástica

Once applied, the toxin blocks nerve transmission to the muscle, producing flaccidity or paralysis of the muscle.  By paralyzing the muscle or reducing its strength, the wrinkles that these muscles can produce in the skin are softened or disappear.


The muscles of facial mimicry can have effects of raising the eyebrows or depression of the eyebrows, so controlling these muscles can raise the eyebrows in patients who have sagging due to aging. The effect of the botulinum toxin is reversible since over the months the nerve recovers and the innervation of the muscle is restored, recovering all its function.

Aplicación del Botox, Asociación Panameña de Cirugía Plástica

For the effect of the application of botulinum toxin type A to be adequate, the strength of the muscle and its effect on facial wrinkles must be assessed.  The effect of the toxin on the muscle is dose dependent, that is, not all muscles require the same dose of toxin to have a good and lasting effect, and not all patients require the same dose of application in each muscle.  


This dose is determined by the doctor when evaluating the different muscles of the patient.

Another factor that influences the result is the degree of dispersion of the toxin at the time of its application.  

Dispersion is the movement of the toxin from the site of application to another neighboring muscle.  

The dispersion has been determined to depend on several factors:  the type of botulinum toxin used, the dilution and the volume applied. Botulinum toxin type A is sold in crystallized form and stored at temperatures of at least -5 degrees Celsius or lower. 

Aplicación del Botox, Asociación Panameña de Cirugía Plástica

The toxin is thermolabile, that is, it is affected by an inadequate temperature.  

Storage of the toxin at temperatures above -5 degrees centigrade produces inactivation and therefore poorer and shorter-lasting results.  


The dose that is applied also affects the result and duration of the effect. A low dose for what the patient needs will give a poor and short-lived result. Before the application of the toxin, it must be reconstituted with normal saline solution that does not contain preservatives. Dilution is always recommended by the manufacturer.  


Altering this dilution will produce less strong effects, of short duration and may induce a greater dispersion of the toxin, affecting neighboring muscles that we do not want to be affected.

Aplicación del Botox, Asociación Panameña de Cirugía Plástica

But the most important thing is that if, due to ignorance, the botulinum toxin is applied in a blood vessel, be it arterial or venous, the effects of the toxin will be produced in distant muscles, which can even compromise the life of the patient. How can a person who is not a doctor know the location, depth, effect of a certain muscle to be treated? ignorance of anatomy  by the person who applies the botulinum toxin is a serious factor and highly irresponsible  for the harm it can cause to the patient. Even a doctor who is not trained or qualified to apply cosmetic treatments is also risky and can produce unwanted complications of the treatment.


The treatment with botulinum toxin A produces excellent results, which rejuvenate the patient's skin, although in a transitory way, the application every six months, maintains the results in a prolonged way. But for this to happen, the application must be carried out by qualified medical personnel trained in these techniques. Therefore, the application of botulinum toxin,  It is the most performed non-surgical cosmetic procedure worldwide.

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