Botox in Singapore – The Botulinum Toxin Bible

by | Feb 24, 2022 | Aesthetics, Botox, Medical Aesthetics | 0 comments

Botox In Singapore is one of the cosmetic procedures that both men and women choose to get for clear and wrinkle-free skin. About millions of people get Botox, making it the most performed aesthetic procedure worldwide, as stated by the American Board of Cosmetic Surgery. Over 7 million people got Botox injections in 2018. 1
Botox is taken from botulinum toxin, created by a bacterium known as Clostridium botulinum. Botulinum toxin can cause muscles to become weak or paralyzed, leading to severe complications. However, Botox can be an effective drug that can help reduce wrinkles and treat certain health conditions when taken in small doses.
Primarily, the main reason behind the cosmetic Botox treatment is the presence of wrinkles on the face. However, it is also used to slim jaws and add a smooth appearance to the neck.
You can expect to see the difference in the Botox before and after photographs when a few weeks have passed, but these desirable effects do not seem to last long. They wear off after 3 to 12 months, and this duration depends on the kind of treatment you have gotten.

You can get Botox in Singapore if: 

  •  There are wrinkles in the area between your eyebrows. These wrinkles are glabellar lines, frown lines, or elevens. 
  • You notice horizontal creases on your forehead. 
  • Lines have formed at the corners of your mouth. 
  • Your chin has developed a ‘cobblestone’ skin 
  • You have wrinkled skin around the corner of your eyes. These wrinkles are termed crow’s feet. 2

History of Botox

Emile Pierre van Ermengem, a Belgian scientist, discovered Clostridium botulinum after an outbreak of botulism in Belgium. The University of California, located in San Francisco, had scientists who attempted to cause isolation of botulinum toxin for the first time in the 1920s. However, Dr Edward Schantz was the one who successfully isolated the botulinum toxin in the form of crystals after 20 years.

By the 1970s, scientists began treating strabismus, an eye condition in which eyes become crossed, with the botulinum toxin. While they were using the toxin on monkeys to see if the treatment worked, researchers observed a reduction of wrinkles in the area between eyebrows.

After the botulinum toxin was found effective in treating strabismus, Allegan, a pharmaceutical company, licensed the treatment and gave botulinum toxin a brand name, Botox. 3

Afterwards, Botox was approved by the FDA to treat various medical problems and cosmetic purposes.

Below are the dates on which FDA approved 4 the botulinum toxin for different purposes: 

  • Blepharospasm and strabismus in the year 1989 
  • Cervical dystonia in the year 2000 
  • Glabellar lines in the year 2002 
  • Axillary hyperhidrosis in the year 2004 
  • Spasticity in the upper lip and chronic migraines in the year 2010
  • Urinary incontinence in the year 2011
  • Crow’s feet (lines present in the corner of the eyes) in the year 2013 

Medical uses of Botox Singapore

Along with multiple cosmetic uses, Botox is used by healthcare professionals worldwide to treat a spectrum of medical conditions. 

Botox serves as an acetylcholine release inhibitor and helps in blocking neuromuscular junction stimulation. The FDA indicates Botox Singapore in the following medical conditions:

1. Overactive bladder 5 is mainly associated with a neuronal injury or condition. These can include a spinal cord injury or multiple sclerosis with insufficient response to anticholinergic medications.

2. Upper limb spasticity in adults (safety of Botox is not established in younger patients).

3. As prophylaxis in patients of chronic migraine (migraine that occurs for 15 days or more in a month, which includes headaches that last for 4 hours or more per day).

4. Cervical dystonia; is a neurological condition that results in abnormal head and neck position, which induces pain. 

5. Hyperhidrosis in the axillary region is increased sweating localized to armpits only. The effectiveness of Botox in cases of increased sweating in other regions of the body is not yet established.

6. Strabismus, crossing the eyes, results in blurred vision and diplopia. Only patients over 12 years of age can be treated with Botox in such cases.

7. Blepharospasm 6; is the spasm of eyelids.

8. Achalasia; difficulty swallowing through the oesophagus (food pipe). 

9. Anal fissure; a tear in the inner mucosal lining of your anus which may result in bleeding and pain.

10. Biliary dyskinesia; is a digestive tract dysfunction that disrupts normal digestion. For example, bile is a mixture produced by your gallbladder that helps digest fats.

Some of the off-label uses of Botox in Singapore are: 

1. Sialorrhea 7; excessive production of saliva

2. Inverse Psoriasis; is a skin condition that involves skin folds

3. Post-herpetic neuralgia; pain that lasts even after herpes infection has resolved 

4. Anismus; Anal muscle dysfunction

5. Eczema (dyshidrotic eczema); involves palms and soles

6. Vulvodynia; is a pain in the vagina that has no definite cause

Micro-Botox

Multiple microdroplets of botulinum toxin are injected into the dermis or between the dermic and muscular layers. These diluted microdroplets injected into the face are called micro-Botox or meso-Botox. Micro-Botox includes diluted microdroplets injected in the dermal or subdermal space in different face and neck regions. This method, which has recently been developed, helps improve different ageing aspects of facial skin and smoothen skin texture. 8

The mixture used in Micro-Botox includes a small volume of lidocaine and a calculated dose of botulinum toxin A, which is mixed with 2.5 ml normal saline. Every millilitre of this solution contains 20-28 units of Botox A and is then used to administrate around 100 to 120 injections. These tiny injections help tighten skin. Treatment effects last for about 3-4 months and may last up to 6 months 9. Micro-Botox is used in various conditions, and the intention mainly revolves around the cosmetic rejuvenating of the lower face. 

Uses of micro-Botox include the following:

1. Sweat and Sebaceous gland atrophy. Diluted injections are introduced into the subdermal space to decrease sebaceous gland activity and sweat by causing the atrophy of these glands. 

2. Improves skin texture and smoothens horizontal creases. Botox A tightens skin and smoothens skin texture when injected in diluted quantities.

3. Reducing fine lines and wrinkles. By weakening facial muscles attached to the skin, micro-Botox reduces the pull and tension of these muscles, affecting their tendency to form wrinkles.

4. Reducing the size of facial pores. Micro-Botox helps improve skin texture by reducing visible skin pores. 

5. Treatment of accordion facies 10. Accordion facies refer to facial skin with an extensive wrinkle network that runs from orbits to the neck and temples. Superficial diluted injections in such cases show quite an improvement.

6. Decreasing vertical banding. In addition to facial improvements, Micro-Botox helps decrease vertical banding in the neck region, better jawline position, and contouring. 

7. Correct jowl formation. Jowl formation is the descent of cheeks below the jawline. Again, botox injections can help correct this.

8. Correction of Platysma banding. The platysma is a muscle present in the most superficial part of your neck. Contraction of this muscle causes band formation vertically running both sides of your neck. Botox might help treat this condition.

9. Prevention of frozen appearance. Microdroplets prevent frozen appearance as there is less chance of diffusion into the deeper muscles of the face.

Slimming of jaws with Botox 

Besides removing wrinkles from your face, Botox Singapore can also help in slimming and contouring your face. The masseter muscles present at the back of your jaw are targeted in the jaw slimming procedure, known as masseter reduction. These muscles are the bulky muscles that you use for chewing food. 

Sometimes, your face becomes square-shaped or round due to the increased size of masseter muscles. In addition, excessive grinding of teeth involuntarily, also termed bruxism, can lead to the growth of masseter muscles, resulting in your jaw acquiring a squared shape. 

Botox in Singapore can be an effective treatment for causing the shrinkage of the squared jawline. Masseters are injected with Botox on both sides of the face. 

As of now, the FDA has not given the nod on Botox usage for jaw slimming. However, according to a clinical study 11, the masseter reduction process is considered a safe cosmetic procedure that is quite effective in treating the squared jaw appearance of the face. 

Botox Singapore typically requires 2 to 5 days to begin making changes in the facial appearance and a few weeks to notice proper changes in your jaw. The slim jaw does not last for long, though, and remains only 3 to 4 months after treatment. So if you want to maintain it, you need to continue getting the Botox injections several times a year.

Nefertiti lift 

A cosmetic procedure that uses botulinum toxin injections to deal with the sagginess in the lower face and neck area is known as Nefertiti lift. The procedure is named after Queen Nefertiti of ancient Egypt as she had a long and thin neck. 

The Nefertiti lift is done to attain a youthful look without cosmetic surgery. It gives temporary results, though; you can expect your results to last for 3 to 6 months. 

However, if you wish to maintain the Nefertiti lift’s effect, you can consider repeating the treatment after a few months. 

The platysma band of muscles that are present in your neck and cover the area between your collarbone and bottom of your face are targeted when Nefertiti lift is done. 

You can expect the following results if you get a Nefertiti lift: 

  • Reduced lines in the lower part of your face 
  • A more pronounced and defined jaw
  • The sagging and fold in the lower part of your face reduced or erased
  • Softened necklines 
  • The skin of the chin becomes smooth and dimpled 
  • The lower portion of your face and neck becoming symmetrical 

The time duration for the full results to appear is usually 2 to 3 weeks. 

With the help of several studies, it has been established that the Nefertiti lift procedure has been giving positive results. One study mainly was focused on examining different articles written on this procedure. We can conclude that the Nefertiti lift is a highly effective cosmetic treatment by studying those articles. Moreover, this study had details of one article that found out that 88.4 per cent of participants in the survey had seen positive appearance changes in their neck after they got Nefertiti lift. 12 

Side effects of Botox 

The most common side effect that you may experience after getting Botox in Singapore is the development of bruises at the injection site. However, these are temporary and are not a cause of concern. You may also develop headache, but it happens in rare cases and does not last for more than 24 to 48 hours. 

In some cases, the individuals who got Botox experienced drooping of one of their eyelids. Eyelid drooping usually goes away within three weeks. However, the movement of Botox around the face leads to this problem. To prevent it, avoid rubbing the area where Botox is injected for 12 hours, or you can also lay on your back for at least an hour after the Botox treatment. Plucking of eyebrows during this time is prohibited. 

Comparing Botulinum Injections

“Botox” is the colloquial term used for botulinum toxin type A since its approval by the FDA for the temporary treatment and correction of glabellar lines (frown lines between the eyebrows). But this is not the only wrinkle smoother; other brands provide the same
aesthetic results. For example, Dysport, Jeuveau, and Xeomin have the same active ingredient (botulinum toxin type A) found in their formulation and are FDA approved. So how do you differentiate between these? Let’s find out with comparative discussion.

DYSPORT

FDA Approval:  Dysport was first approved by the FDA in April 2009 for therapeutic uses to treat muscle spasticity like Botox.

The overview: The product of Medici’s pharmaceuticals is slightly less potent than Botox due to its molecular weight. Dysport and Botox share the same 150 kDa of botulinum toxin type A, but the weight of the protective proteins are not the same. In addition, the protective proteins are not uniformly distributed like those in Botox. Therefore, Dysport has a higher rate of diffusion that makes it ideal for treating larger areas such as foreheads- though the cost is generally comparable to Botox. Dysport contains lactose and cow’s milk protein, making it unsuitable for patients with milk allergies.

The Results: Some studies show that the results show up immediately (within 24 hours of the injection), but the effects are not long-lasting the Botox. The shorter life span of the results is an ideal option for patients who are not sure awhether they will like the results of botulinum toxin A.

XEOMIN

FDA Approval: Xeomin was approved by the FDA in July 2011 to treat frown lines and also approved to use medically to treat muscle spasticity and excessive drooling.

The overview: Xeomin by Merz does not blend botulinum toxin-A with complex proteins, although it contains inactive human albumin and sucrose. Therefore, the product does not require refrigeration, and it is slightly more comfortable with injecting because it is stored at room temperature. As a result, fewer units of Xeomin are needed to achieve the desired results. However, there’s not much price difference between Botox, Dysport and Xeomin. In addition, the patients resistant to Botox and Dysport may succeed with Xeomin due to its purified state of botulinum toxin-A.

The Results: It takes 5 to 7 days to see visible results with Xeomin, and the effects last a similar amount of time to Botox, Jeuveau and Dysport.

 

JEUVEAU

FDA Approval: #NEWTOX was approved by the FDA in February 2019 for use in cosmetic procedures.

The overview: The splashy JEUVEAU launch party in February 2019 that branded the new botulinum optimistically hoped the newbie would prove itself a worthy competitor to Botox. Jeuveau shared the same molecular weight as Botox and was formulated with human albumin and sodium chloride that offer similarities between Botox and Jeuveau. Price-wise, it is 20% to 30% more economical than Botox. It appears its marketing campaigns primarily target the millennials- So making a separate niche for Jeuveau. ( Please take note that Health Science Authority has not approved JEUVEAU as a medical device, and it is not available in Singapore aesthetics clinic)

The Results: There is very little data available because it is new to the market. However, the trials have shown the same efficacy and safety profile as Botox. The patients begin to see the results in 3 to 5 days, and they last for 3 to 6 months. 

Bottom line 

Botox is a successful cosmetic procedure that can bring back the youthful look of your face. It can be an effective treatment in improving your facial appearance, from removing wrinkles to adding a defined look to your jaws. 

The Botox before and after results can show you the noticeable difference in your facial appearance, which can help you gain your lost confidence back. 

Additionally, you can also get Botox in Singapore if you have certain medical conditions such as strabismus, cervical dystonia, achalasia, and so on. 

References

  • ASPS National Clearinghouse of Plastic Surgery Procedural Statistics. 2018 Plastic Surgery Statistics Report. American Society of Plastic Surgeons. plasticsurgery.org
  • Harii K, Kawashima M, Furuyama N, Lei X, Hopfinger R, Lee E. OnabotulinumtoxinA (Botox) in the Treatment of Crow’s Feet Lines in Japanese Subjects. Aesthetic Plast Surg. 2017 Oct;41(5):1186-1197. DOI: 10.1007/s00266-017-0844-9. Epub 2017 Jul 21. PMID: 28733805; PMCID: PMC5605642.
  •  France, K.M Kumar, A., Fioranelli, M, et al. The history of Botulinum toxin: from poison to beauty. Wein Med Wochenschr 167, 46-48 (2017). 
  • Lew, Mark F. M.D. Review of the FDA-Approved Uses of Botulinum Toxins, Including Data Suggesting Efficacy in Pain Reduction, The Clinical Journal of Pain: November 2002 – Volume 18 – Issue 6 – p S142-S146
  • Orasanu B, Mah ajan ST. The use of botulinum toxin for the treatment of overactive bladder syndrome. Indian J Urol. 2013 Jan;29(1):2-11. DOI: 10.4103/0970-1591.109975. PMID: 23671356; PMCID: PMC3649594.
  • Spiegel LL, Ostrem JL, Bledsoe IO. FDA Approvals and Consensus Guidelines for Botulinum Toxins in the Treatment of Dystonia. Toxins (Basel). 2020 May 17;12(5):332. DOI: 10.3390/toxins12050332. PMID: 32429600; PMCID: PMC7290737.
  • Oliveira AF Filho, Silva GA, Almeida DM. Application of botulinum toxin to treat sialorrhea in amyotrophic lateral sclerosis patients: a literature review. Einstein (Sao Paulo). 2016 Jul-Sep;14(3):431-434. DOI: 10.1590/S1679-45082016RB3594. PMID: 27759834; PMCID: PMC5234759.
  • Wu WTL. Microbotox of the Lower Face and Neck: Evolution of a Personal Technique and Its Clinical Effects. Plast Reconstr Surg. 2015 Nov;136(5 Suppl):92S-100S. DOI: 10.1097/PRS.0000000000001827. PMID: 26441119.
  • #Botox in Singapore

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