Exploring the Evolution of Botulinum Toxin: Past, Present and Future
- Dr. Khor See Ming
- Oct 14, 2023
- 8 min read
Updated: Jun 22
“A lot kills, a little cures.” This phrase fittingly describes Botulinum Toxin A (BTA), one of the most potent toxins known to humankind. In large doses, it can cause fatal paralysis. Yet in controlled amounts, it can be an effective treatment for reducing wrinkles and giving a more youthful appearance.
Let’s explore how this powerful neurotoxin evolved into a certified treatment in both modern medicine and aesthetic care.
Introduction
Botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum. This bacterium produces eight antigenically distinct exotoxins (A, B, C1, C2, D, E, F, and G). All serotypes disrupt nerve signaling by inhibiting acetylcholine release at the presynaptic neuromuscular junction, leading to muscle relaxation or paralysis.
Among these, Serotype A is the only form currently approved and used in aesthetic treatments. It is used in both traditional intramuscular injections and in mesobotox.
Why is Botulinum toxin known as “Sausage Poison” ?
In the late 18th century, a group of Belgian musicians attending a funeral had a meal consisting of smoked and pickled ham, which would ultimately lead to their untimely deaths. Following this tragic event, the ham was sent for analysis, leading to the discovery of the pathogen Clostridium botulinum. The bacterium was named due to its pathological association with sausages (the Latin word for sausage is 'botulus').
Medical History: Early Clinical Uses of Botulinum Toxin
The medical application of botulinum toxin began in the 1970s, when ophthalmologist Dr. Alan Scott first demonstrated the effectiveness of botulinum toxin type A (BTA) in treating strabismus (commonly known as crossed eyes) in humans. This marked the beginning of its therapeutic journey in neurology and ophthalmology.
By 1989, the U.S. Food and Drug Administration (FDA) officially approved BTA for the treatment of three specific conditions:
Strabismus
Blepharospasm (abnormal, involuntary blinking or eyelid twitching)
Hemifacial spasm (sudden muscle contractions on one side of the face)
These approvals applied to patients under 12 years old, establishing BTA as a viable treatment for childhood neuromuscular disorders.
In the following years, botulinum toxin's therapeutic scope expanded significantly:
In 2000, the FDA approved BTA for cervical dystonia, a painful condition involving involuntary contractions of the neck muscles.
In 2004, BTA received approval for treating severe primary axillary hyperhidrosis, a condition characterized by excessive underarm sweating.
By 2010, it was approved as a preventive treatment for chronic migraines, offering relief to patients suffering from frequent and debilitating headaches.
When Was Botulinum Toxin First Used in Cosmetic Treatments?
The cosmetic use of Botulinum toxin A (BTA) began in the late 1980s and early 1990s, long before it was formally approved for aesthetic purposes. Physicians initially observed that patients receiving BTA for medical conditions like blepharospasm and facial spasms experienced a smoother, more youthful appearance in the surrounding skin.
The turning point came in 2002, when the U.S. Food and Drug Administration (FDA) officially approved BTA for the temporary improvement of glabellar lines, the vertical frown lines between the eyebrows.
Followed by another FDA approval in 2013, its cosmetic use expanded to treat lateral canthal lines, more commonly known as crow’s feet.
Common Cosmetic Uses of BTA Injection
Today, Botulinum toxin A (BTA) is the most common cosmetic procedure performed worldwide, valued for its effectiveness, minimal downtime, and natural-looking results when applied properly. It is most effective for dynamic wrinkles, also known as “the wrinkles in motion”.
While FDA approval covers specific areas like frown lines and crow’s feet, many practitioners use BTA off-label for a broader range of aesthetic concerns. Common cosmetic uses include:
Forehead wrinkles
Periorbital lines
Eyebrow lift
Bunny lines
Perioral line
Marionette smiles
Gummy smile
Chin puckering
V-shape face
Neckline and platysmal band
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How Long Does a BTA Injection Last?
You’ll typically start to see results from BTA injections within 3 to 5 days, with the full effect visible by 2 weeks after treatment. The results are natural-looking and generally last between 4 to 6 months.
When BTA is injected into the right muscles using the correct dosage by a skilled aesthetic doctor, you can maintain a youthful, expressive appearance without looking frozen. To sustain the best results, 2 to 3 treatments per year are usually recommended.
Is Botulinum Toxin the Right Choice for You?
Botulinum toxin A (BTA) is a well-known injectable treatment that temporarily relaxes targeted facial muscles to reduce wrinkles and enhance facial contours. It’s a popular option for both aesthetic and functional purposes, but it’s not for everyone. Here’s how to know if you’re a suitable candidate.
Who is a good candidate for BTA injection?
BTA injections are ideal for individuals who:
Begins to notice fine lines or dynamic wrinkles on the forehead, around the eyes, or between the eyebrows due to everyday facial expressions.
In their 20s to 30s, and want to prevent signs of premature aging, even if they already maintain a good skincare routine.
Wish to maintain a youthful, refreshed appearance with a non-invasive treatment.
Have strong glabellar muscles (between the brows) that create a tense or angry look, common among men, which is why BTA is sometimes called "BROtox".
Concerned about a square jawline due to enlarged masseter muscles and are seeking a more contoured, V-shaped jaw.
Who Should Avoid BTA Injection?
BTA injections are generally considered safe for most patients. However, it’s not recommended for individuals who:
Pregnant or breastfeeding
Have a neuromuscular disorder (e.g., myasthenia gravis)
Suffer from myopathies (muscle diseases)
Have an active skin infection in the treatment area (e.g., pustular acne, herpes simplex, or cellulitis)
Allergic to any ingredients in BTA
Have uncontrolled chronic or systemic health conditions
Be sure to inform your doctor about any current medications, as some may interact with BTA treatment.
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Common Side Effects and Complications from BTA Injections
Complications from cosmetic Botulinum Toxin A (BTA) injections are rare, temporary, and reversible. The most common side effect is bruising at the injection site, which is usually mild and short-lived. To reduce the risk of bruising, avoid the following for at least 10 days before treatment:
Aspirin, NSAIDs (e.g., ibuprofen), and anticoagulants.
Green tea, vitamin E, and omega-3 fatty acids.
Herbal supplements like ginseng, gingko, evening primrose oil, and garlic.
Some of the less common side effects include eyelid ptosis (drooping eyelid), mild diplopia (double vision), and ectropion (outward turning of the lower eyelid).
These side effects can be significantly reduced when injections are done with proper injection technique by a trained professional.
Aftercare: What to Do and Avoid After BTA Injections
You may gently cleanse your face on the same evening after the procedure. If you experience any bruising or swelling at the injection site, you can apply a cool compress to the area for 15 minutes to reduce discomfort.
A follow-up appointment is recommended 2 weeks after your first treatment to assess whether the dosage and results are optimal.
However, there are a few important things you should avoid after your BTA injections:
Do not rub or massage the treated areas for 24 hours after the treatment.
Do not excessively bend down on the day of treatment.
Do not carry out exhaustive physical exercise on the day of treatment.
Do not apply makeup immediately after treatment.
Do not carry out activities that can cause facial flushing (e.g., application of heat to the face, tanning, alcohol consumption).
Combine BTA with Other Aesthetic Treatments for Enhanced Results
Facial aging is a complex process involving more than just wrinkles, but also includes volume loss, skin laxity, pigmentation (dyschromia), and vascular issues. While Botulinum Toxin A (BTA) is highly effective on its own, combining it with other aesthetic treatments can significantly improve overall facial rejuvenation results.
Here are the treatment combinations that work synergistically to target multiple signs of aging simultaneously:
BTA and dermal fillers work together to reduce static lines and restore facial volume.
BTA and Fotona Laser resurfacing help smooth dynamic wrinkles while improving skin tone and texture.
BTA and thread lifting combine muscle relaxation with skin tightening for a lifted and sculpted look.
BTA and chemical peels target fine lines and pigmentation.
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The Future of Botulinum Toxin: Emerging Trends and Innovations
The future of Botulinum Toxin is filled with possibilities that far beyond its current cosmetic and therapeutic applications. As research progresses, we’re seeing rapid innovation in how this powerful compound is formulated, delivered, and used to meet evolving patient needs.
Emerging developments include longer-lasting formulations and topical delivery methods. Beyond aesthetics, ongoing studies are exploring its role in treating conditions such as chronic pain, depression, and even scar treatment.
With science and technology driving continuous discovery, Botulinum Toxin is poised to become an even more versatile solution, offering safer, smarter, and more targeted care across multiple fields of medicine and aesthetics.
For those interested in exploring these advanced treatments, consulting our trusted aesthetic skin specialist in Penang or visiting our reputable aesthetic skin clinic in Kuala Lumpur can provide personalized advice and access to the latest innovations.
FAQs
Is Botulinum Toxin the same as Botox?
Botulinum toxin is the active ingredient, while Botox is a brand name that uses Botulinum toxin type A to temporarily relax muscles and reduce wrinkles. Different brands may vary slightly in formulation and diffusion.
What are the differences between Botulinum Toxin and SkinBooster?
Botulinum Toxin (Botox Malaysia) is a neurotoxin that works by temporarily relaxing facial muscles to reduce dynamic wrinkles caused by muscle movement, such as frown lines and crow’s feet. It acts quickly, with results visible in a few days and lasting about 3 to 4 months.
Skin Boosters such as Plinest are injectable treatments mainly composed of hyaluronic acid that hydrate and improve the skin’s texture, elasticity, and overall quality. They work gradually by boosting collagen and moisture in the skin, with effects lasting around 4 to 6 months.
Both treatments are safe and can be combined for complementary benefits—Botox for wrinkle relaxation and skin boosters for skin rejuvenation
Is the procedure of BTA injection painful?
Most patients from our skin clinic in Kuala Lumpur, Dream Clinic describe the procedure as mildly uncomfortable rather than painful, similar to tiny pinpricks. An ice pack can be applied beforehand to minimize any discomfort during the injection. Feel free to consult our aesthetic skin specialists or walk into our aesthetic clinic to understand better!
Will BTA become less effective over time, or make me look worse if I stop?
No, BTA does not lose its effectiveness with regular cosmetic use, and it won’t make you look worse if you stop the treatment. However, once you stop, muscle activity will gradually return, and wrinkles may naturally reappear over time, not because of the treatment itself.
Is Botulinum Toxin (BTA) effective for all types of wrinkles?
Botulinum Toxin A (BTA) is most effective for dynamic wrinkles, which are lines that appear with facial movements, such as smiling, frowning, or raising your eyebrows. These include forehead lines, crow’s feet, and frown lines.
However, it is less effective on static wrinkles, which are visible even when your face is at rest. For static wrinkles, your doctor may recommend combining BTA with other treatments like dermal fillers or Fotona Laser for optimal results.
