Most people in America have now heard of Botox and if they haven’t, they surely will in the immediate future with its TV advertising campaign. The commonality of Botox has not only generated lots of interest but with that level of curiousity comes misconceptions and wife’s tales. Let me cover some basic concepts of this miracle drug….some of which you may know and others of which you may find surprising.
Allergan, the manufacturer of BOTOX™ or botulinum toxin, was an original dermatology/opthalmology product company. It began developmemt of Botox as an experimental drug over three decades ago in the 1970s. It’s opthalmological researchers tried it on monkeys with strabismus (eye muscle disorder known as cross-eyed or wall-eyed) with surprising curative results. Since then, they have sought and expanded its uses to include cosmetic facial applications which was granted in 2002. It is this cosmetic application that has exploded Botox unto the American and worldwide scene.
The manufacturing of Botox is an interesting story. In the beginning, it was made under the strict supervision of the U.S. Military as it was a poisonous drug. Since then it is manufactured in a secret location in the U.S. and then shipped for bottling in Ireland. Whether this story is actually true, I do not know but it certainly adds to the drug’s mystique. It certainly is the most expensive drug in the world if you break down its price structure . At 5 nanograms of volume placed in each bottle which sells for nearly $500 per bottle to providers, that makes its value over 1 trillion dollars per pound!
Botulinum Toxin or BOTOX™, is produced from anaerobic (lacking oxygen) bacterial cultures creating a toxin. The toxin is composed of seven strands named A, B, C, D, E, F, G. Each strand can block the release of the neurotransmitter, acetylcholine, from the nerve synapse resulting in temporary muscle paralysis. (no power to the muscle so to speak) The different serotypes have different durations of action before it wears off. Serotype A lasts around three to four months while Serotype F lasts just a few weeks. This is why you see on the Botox bottle and in its advertisements, botulinum toxin A, as this one serotype lasts the longest.
The actual Botox toxin is put into small vials of 100 units as a desiccated (dry) powder. But what does the 100 units mean? It means how many units are required to kill 100 mice. Each vial then contains one hundred mice units or 100 units for short. Initially, Allergan used 25 nanograms of the toxin to kill 100 mice. But it has been learned with improved technology and manufacturing that less is needed to do the same job and the amount per bottle is now reduced to 5 nanograms. This has great relevance since Botox is a drug that requires repeated injections over time to maintain its effects. Using repeated lower doses will reduce the likelihood that patients may develop resistance or immunity. And despite what is often touted, some few select people do have a natural immunity to Botox and others do develop some resistance to its effects over time.
As a cosmetic treatment, Botox is what I call a ‘northern’ treatment’. It is superb at controlling undesired expressions around the eyes and forehead. This northern area of the face probably accounts for the vast majority of its cosmetic use as it creates results that sometimes actual surgery can not rival. It can also be used on the southern part of the face around the mouth. But its effectiveness in this area is diminished as surgical treatments are usually more effective and Botox plays more of an ancillary role to complement other types of treatments.
Dr. Barry Eppley