Understanding the Versatility of Botulinum Toxin with Dr Ivan Tan

In Dr. Ivan Tan‘s course of practice, he has opted Botulinum Toxin to countless of issues his patients face. Just what about Botulinum Toxin that is so versatile?

Can you please share with us how Singapore is now more accepting to the use of Botox compared, to say, ten years ago?

There has definitely been a dramatic change in the acceptance and attitudes towards the use of Botox over the last decade. However, these changes has been gradual. 10 years ago, when patients came for Botox, they did so in secrecy. They will not let their friends or family know that they have had the treatment. There is this taboo associated with Botox treatment that it is vain, unnatural and extravagant.

With the existence of the internet and social media, information became widely available. Many of the misconceptions and myths people held about Botox has also been debunked. Over the years, this taboo has slowly been lifted and we see patients coming with their friends or family together for their treatments. Botox is now widely accepted as a routine part of grooming by many of our patients.

What is Botulinum Toxin actually?

Botulinum toxin is the chemical produced by a bacteria called Clostridium Botulinum. This chemical attaches itself to the neuromuscular junction between the nerve ending and the muscle so it blocks the signal from the nerve to the muscle. Without the nerve signal, the muscle cannot contract and thus becomes relaxed. This chemical is naturally degraded by our body over 3-4 months so the effects of Botox typically lasts 3-6 months. Botox is the most famous brand of botulinum toxin.

I think of Botox treatment as a retraining programme for our expressions. For example, in our highly stressed society, many people unknowingly start to frown. With repeated use of the frown muscles, they becomes bigger and stronger and consequently it is easier for the person to frown and the vicious cycle perpetuates. This expression slowly becomes automatic (sub-conscious) and habitual resulting in permanent frown lines. By injecting Botox, we can relax the frown muscles to break the vicious cycle. And because the person is unable to frown over a period of time, the person will slowly kick the habit of frowning. The end result gives us a more relaxed and refreshed look.

Besides the face, Botulinum Toxin can also assist in other areas of our body. Can you please share more on that with us?

Botox can be used for a wide range of indications that involves muscles e.g. urinary incontinence from overactive bladder muscles, limb spasticity from hypertonic muscles, facial ticks from involuntary muscle twitching and even chronic headaches and migraines.

Botox can also be used to control oiliness on the face and excessive sweating on the palms or underarms.

Are there any myths about Botulinum Toxin that we should now about?

The common myths are many people think that injecting Botox is like putting poison in your body, but Botox has actually successfully purified this toxin to make it safe for medical use; Botox stays and exerts its effect where it is injected. It is helpful to know that anything, even poison when used in the right situation can become medicine as in the case of chemotherapy medicine that is mostly toxins. Anything can become poison if used inappropriately like in the case of Panadol overdose.

Another myth about Botox is it will build up in your body as you inject more and more.  But the fact is Botox is actually a naturally obtained neurotoxin and is fully biodegradable. In fact, our blood contains the enzyme to break down this toxin. Botox results only lasts 3-6 months that is the time our bodies take to breakdown the toxin and get rid of it.

And a lot of people always think that once you started Botox, the condition will get worse when you stop.  But actually It is not possible for your skin condition to be worse than before the Botox treatment. In the worst case scenario, you will only get back to where you first started.

Many people also worried that Botox will make you look artificial and frozen. This bad public image was passed down throughout the years when Botox was first introduced. At that time, it was thought that no wrinkles meant good results and so doctors were trying to stop all wrinkle forming muscles from moving. The current approach is now to soften and diminish wrinkles but not to remove them totally. The aim now is to have a refreshed and youthful look with intact natural facial expressions.

What is the difference between the different types of Botulinum Toxin in the market?

There are 2 types of botulinum toxin in the market; type A and B. Cosmetic use of the toxin is limited to the type A ones and the 3 brands available in Singapore are Botox, Dysport and Xeomin. Each brand has its own strength and weakness.

Every doctor will have his or her own preference which to use. As a brand, Botox is the most established followed by Dysport and Xeomin is the new kid on the block. The clinical outcome rely mostly on the doctor’s skill rather than the brand.

How can a patient know that a suitable dose/vial of Botulinum Toxin is used for certain areas of their concern areas?

I think it is difficult for patients to know what is suitable in details of dosage and subtypes of toxins. This is relatively specialised knowledge, and what is more important is selecting a doctor whom your trust and has excellent communication with.

Seeing a doctor for Botulinum treatments are no different from seeing one for a medical issue. So do communicate with your doctor regarding your concerns and expectations and work out a plan which you are comfortable with.

How can a patient know that they are not being overcharged for a Botulinum Toxin now that the aesthetics industry is a competitive one?

Patients today are better informed that they used to be. Information is also widely available in the form of websites, forums and other print materials. We encourage our patients to do a little research by reading up on forums, speaking to their friends and also speaking to their doctor. However it is important to bear in mind that there is no fixed dosage or type of Botulinum Toxins used for specific indications.

Different doctors use different dosages and injection techniques. Ultimately it is the trust and relationship that you build with your doctor that is most important.