Anti-wrinkle injections started life as a humble neurotoxin produced by a bacteria, Clostridium botulinum. The toxin blocks nerve signals that result in a muscle contraction, which leaves the muscle temporarily paralysed – useful for the bacteria’s life cycle, not so great for its host (us). The metabolite of a bug found its way into medicine, which is strangely not uncommon in science.
This specific neurotoxin is very well studied and utilised in cosmetic dermatology to arrest wrinkles and prevent new lines from developing as skin creases with muscle contractions. We use tiny amounts injected into the corners of the muscles to partially (not entirely) disable the muscle. The administration to the corners or edges of a muscle allows one to retain a full range of facial expressions while reducing the impact on the surface of the skin.
Managing the visual passage of time on our faces is not the only use of these powerful substances. The toxin has morphed and refined from a dreaded lurgy to being a staple in the medical toolbox, used for a multitude of medical and cosmetic uses.
How medicine uses neurotoxins
Disabling a muscle or muscle group using anti-wrinkle injections can have multiple benefits depending on the application.
At ENRICH Clinic in Melbourne, we use it cosmetically to treat:
- Forehead wrinkles
- Frown lines
- Around mouth/lip lines
- Crow’s feet
- Dimpled chin
- Platysmal bands on the neck
- Large jaw muscles/square jaw
- Drooping eyebrows
- A gummy smile
But when used medically, we might use it for:
- Jaw clenching
- Migraines and headaches
- Pelvic floor dysfunction
- Pelvic pain conditions
- Crossed eyes (strabismus)
- Neck and limb spasticity
- Urinary incontinence with neurological conditions
The mottled tale of a potent poison
In India, the Maharajas (leaders or kings) used the poison extracted from sausages to kill their enemies, effectively giving them botulism, even though they didn’t know it then. Poisoning is a classic method of murder in days gone by, and eating bad sausage was as good a way to send off a foe as any.
Modern western researchers have been talking about botulism since at least the 1700s, with German physician Justinus Christian Kerner studying the ‘sausage poison’. Alas, he couldn’t identify the culprit.
Emile Van Ermengem, however, did: C. botulinum was discovered in 1895 when Van Ermengem was investigating the mass death of mourners at a funeral. After testing ham from the funeral, he found the same toxic substance in both the dead mourners and the ham. He originally named it Bacillus botulinus, with botulinus meaning sausage in Latin.
This discovery was monumental. Van Emerngen reveals that botulism is a poison rather than an infection, an important distinction. This finding was significant since he also found that no toxin was produced when salt or heat was present. Thus, salting and cooking food means no botulism, which was great news for a world burdened with mysterious and increasing cases of food poisoning.
Canned food took the world by storm in 1809, but as you can imagine, microbes presented a real problem for this process because nobody understood germs yet. Soon enough, Karl Friedrich developed a new technique for inactivating the toxin using heat, and today we still use this process for canned foods.
In 1944, Edward Schantz cultured C. botulinum for the first time and finally isolated the toxin and its differing types.
It was only in 1949 that researchers discovered that the toxin could block neuromuscular signal transmission. This toxin was highly toxic to humans, and at that time, it was the most poisonous thing humans knew. There were even (unsuccessful) attempts to use it in biological warfare during World War II.
Soon, the toxin would be crystallised and concentrated, but it was still another few decades before we’d start using this substance therapeutically. The first use of the toxin was in 1980 for a case of crossed eyes. A decade later, the US Food and Drug Administration approved the substance for several childhood conditions: crossed eyes, twitchy eyelids and involuntary facial twitching. In 2000, the FDA approved it as a treatment for cervical dystonia, a painful neck condition characterised by uncontrollable spasming.
The first approval for cosmetic use was in 2002 for glabellar lines – horizontal forehead creases – then two years later, treatment for hyperhidrosis – excessive sweating – was approved. In 2010, chronic migraine joined the approved treatment list, with 2011 seeing urinary incontinence due to neurological conditions added. Upper limb spasticity is also now approved for upper limbs.
Only a handful of approved cosmetic uses exist, for example, treating crow’s feet, but that doesn’t mean those are its only uses. Other uses are known as ‘off-label’ – but do the job. These include an eyebrow lift, a gummy smile, depression and temporomandibular joint disorders.
This powerful substance with other cosmetic or medical interventions offers a minimally invasive and effective alternative to many more involved procedures.
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