From a Chinese Medicine perspective our nervous system is Qi (pronoucned “chee”). It’s essentially the energy and communication system of our bodies. It’s the “Yang” aspect of that Yin/Yang image we’re all so strangely familiar with. In contrast, blood is our “Yin.” Blood is a more literal translation- basically, it’s our circulatory system including, shockingly enough, our blood! In ancient Chinese Medicine theory, Qi carries our blood throughout the body. It brings blood and therefore nutrients to the organs, the muscles, and the skin (yes, you’re right- technically the skin is an organ). So if we translate that theory to the physiological functions of the body, our nervous system helps nourish our body by controlling the circulatory system, or the flow of blood throughout the body.
Botox, or Botulinum toxin Type A, or Clostridium botulinum if you want to get fancy and scientific, is a neurotoxin that has been used in humans for a wide array of concerns from migraines and sweating to the reduction of lines and wrinkles. As far as this blog post is concerned, we are discussing the use of Botox for cosmetic reasons - in some medical settings, the positive aspects of Botox outweigh the potential negative side effects.
As far as this blog post is concerned, we are discussing the use of Botox for cosmetic reasons - in some medical settings, the positive aspects of Botox outweigh the potential negative side effects.
Botox is injected into facial muscles in order to paralyze nerve conduction. As a result, the muscle relaxes and smooths, and therefore we see that ever so elusive and desirable reduction in the signs of aging. Sounds a-okay, right? So long as you’re okay with not being able to use full facial expression, what’s not to love?
Before we dive into the negative side effects of this, I want to clarify something important. I’m about to refer to some scientific research about the side effects of Botox. You should know though, that it’s not okay for scientists to study medical interventions with the intent to find the negative effects. That would be knowingly and purposely causing harm to participants, and I think we can all agree that that’s just not cool. Therefore, the included evidence is either conducted on animals or seen in studies utilizing Botox for other reasons. In other words, the negative effects were observed while studying other outcomes. There are no studies about “negatives of Botox used for cosmetic purposes” because, as we said, it’s not cool to knowingly go into a study to see what harm an intervention might cause.
Moving on. Let’s start with the muscle itself, which is where the injection goes. What happens after repeated use of Botox? Turns out, the muscle will start to atrophy. If the nerves of the muscle never fire, it never contracts. Just as with growing strong in the gym, this is important for the muscle health in terms of actual muscle mass. Sure, you don’t want a bulging forehead so you’re not trying to figure out how to lift weights with it, but if the muscle itself starts to shrink and wither away, the beautiful plumpness of your face will actually start to decrease. That firmness we seek in the world of beauty will grow soft and thin. Over time, Botox can become less effective, which is why we’re told to start young and prevent wrinkles instead of eliminate them. But what’s really happening is the significant reduction in contractile muscle tissue and as a result a reduction in the strength and structure of the muscle. If you’ve ever known someone with a spinal injury, one where nerve conduction to the legs is cut off, you might be familiar with the fact that the muscle mass in their legs continuously decreases without use. This is what happens with Botox injections in facial muscle. The science and beauty worlds are still waiting for research to answer whether or not the facial muscles can recover from this atrophy caused by Botox injections, but my question to you is this -what if it can’t? Combine that with decreased efficacy with repeat injections, and what will the end result be?
So what about the skin itself? Since I always like to bounce back and forth between Chinese medicine and modern western medicine, I’m going to revisit this Qi/Yang and Blood/Yin perspective. Over the past few months, I’ve worked with a handful of women to restore their skin after the use of Botox. In some cases, it was just undoing Botox that they didn’t like by re-stimulating nerve conduction, but the tougher cases are trying to recover that muscle tissue and build their thinned skin back up after long term use of Botox. Whoa, wait- did I just say “thinned skin?” Yes, I did. If we paralyze the Qi (aka the nerve conduction), and the Qi carries the blood, then is our skin still being properly nourished? In our medicine, the answer to that is a simple “no.” Over time, many women experience increased bruising with Botox injections. I have seen this many times in many patients. Simply put, if the blood isn’t optimally reaching the skin, not only will it dry and therefore loose elasticity and structure, but the replenishment of collagen and elastin will be stunted. Essentially we can address the folds and fatigue of the muscle with Botox, but the skin itself will continue to age, dry, and dismantle. So what we’re looking at now is a combination of atrophied muscle and thinned, broken down skin.
We'll dig into how Botox can affect people with autoimmune disorders next week in this series!
El-Heis, S., Burke, G., Gibb, W., & Ardern-Jones, M. R. (2017). Myaesthenia gravis exacerbation caused by axillary injection of botulinum toxin A for treatment of hyperhidrosis. Clinical And Experimental Dermatology, 42(3), 357–359. https://doi-org.uws.idm.oclc.org/10.1111/ced.13036
Fortuna, R., Aurélio Vaz, M., Rehan Youssef, A., Longino, D., & Herzog, W. (2011). Changes in contractile properties of muscles receiving repeat injections of botulinum toxin (Botox). Journal of Biomechanics, 44(1), 39–44. https://doi-org.uws.idm.oclc.org/10.1016/j.jbiomech.2010.08.020
Glass, G. E., Hussain, M., Fleming, A. N. M., & Powell, B. W. E. M. (2009). Atrophy of the intrinsic musculature of the hands associated with the use of botulinum toxin-A injections for hyperhidrosis: a case report and review of the literature. Journal of Plastic, Reconstructive & Aesthetic Surgery, 62(8), e274–e276.
Patient awarded $212 million for adverse reaction to Botox: inadequate warning of potential autoimmune reaction alleged. (2011). Biotechnology Law Report, (4), 482.