Dr. Edward Buckingham: This evening we're going to talk about neuromuscular blocking agents. Now that's a very big word but basically, what I'm referring to is Botox. And now, relatively newly available on the market is another one called Dysport. And as you go through time, you're going to see other neuromuscular blocking agents come onto the U.S. market. There are others that are available in countries outside of the U.S. So this evening, you can just assume that we're referring to the two that are available in the United States which again, are the most commonly known. One is Botox and the newer one, which is Dysport.

So what are these neuromuscular blocking agents? What they are is Botulinum Toxin Serotype A. Now, botulinum toxin comes from a bacteria, Clostridium botulinum, and it's basically the same toxin that you would have if you're to acquire the disease or the condition botulinum toxin. Now, that scares people but in general, there are lots of things in medicine that have come around from plants and bacteria, fungus. Antibiotics were developed from funguses. And basically, a fungus produces a toxin towards bacteria and has allowed us to produce antibiotics. So basically, again, we're just taking a naturally occurring substance that can be harmful, and we're using it in a helpful way. So, you shouldn't have any fear about botulinum or botulinum toxin as it relates to these neurotoxins. It is merely something that we've discovered in nature that can be used in a beneficial way.

So what botulinum toxin is, is it's a chemical that is, again, produced by a bacteria that when it functions it releases, excuse me, blocks the release of the chemical that causes muscles to contract. The beauty of this particular chemical is that you can inject it precisely into certain muscles and it will basically stay there. It doesn't travel to other parts of your body and affect other muscles such as breathing muscles in the minute quantities that we're talking about. It has a very high affinity to the muscle you inject it into and so, you can be very precise about where you put it in the muscles and how you relax them.

So initially, Botox, since it's the older substance, but neurotoxins were used 50 years ago to help infants who had a neuromuscular condition in the neck called torticollis. And basically, they were able to inject Botox into those muscles and relax them and help those infants out. The uses then progressed toward something called blepharospasm, which is a condition where the eyelid twitches, and they were able to use Botox to relax that muscle and relieve that twitching. Well, when doing that, they also figured out that in the area of the blepharospasm, they were able to reduce wrinkling around the eyes and so, this led to the fortuitous discovery for the company that Botox could reduce facial wrinkling, as well. So that led to the FDA approval of neurotoxins for the use in cosmetics and has now led us to the development of Botox and Dysport.

So Botox and Dysport can be used in regions all over the face, although some regions are better used than others. So the most common areas that we use these neuromuscular blocking agents are to reduce the wrinkles in the frown line, it's called the glabella, commonly referred to as the 11s, the crow's feet or smile lines, and the forehead horizontal lines. So precisely, we can inject these agents into these areas in the clinic in a matter of minutes and get a result that starts about two days later and will last about three months. Now, maximum effect takes about seven days, and there may be some difference between the agents but in general, about two days to onset, three or four months of longevity. Now, these agents are really designed and are beneficial to help with dynamic lines.

So, there are two types of wrinkles in the face, there's dynamic, which are lines that are only there when you're making the face work, and there are static lines, which are the lines that are result of constant activity, and now you have an etched-in line in the skin. Now, these blocking agents may give a little bit of improvement in the static lines but really, once they're etched in, you also have to consider doing other things like fillers or chemical resurfacing, chemical peels, laser resurfacing to help with the static component of these lines. So the most common areas are those to help with those lines. So, what about some of the less common areas? The other uses of these neurotoxins can be used for the brow area. So if you relax a muscle that's pulling the brow down, then you'll get an unopposed action of the muscle that elevates the brow, and you can get a slight degree, one to two millimeters, of brow elevation by relaxing this muscle. So, that's another use of Botox.


Botox and Dysport Neuromuscular Blocking Agents

Dr. Edward Buckingham discusses the neuromuscular blocking agents and how they are used to improve the appearance of wrinkles.