HOW DOES BOTULINUM TOXIN WORK ?

Botulinum toxin injections, commonly known as Botox, are among the most widely used aesthetic treatments to reduce wrinkles. Although highly popular, many people still wonder : how does botulinum toxin actually work ? In fact, not everyone is familiar with its cellular and muscular mechanism of action, which is what allows for visible and lasting results.

In this article, we will explain in detail how botulinum toxin acts on muscles and neurons, and how this results in reduced wrinkles and muscle contractions.

Contents

What is botulinum toxin ?

Botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum. There are different types of this toxin, but the most commonly used for medical and aesthetic purposes is type A (Botox, Dysport, Xeomin).

Nature of botulinum toxin

La toxine botulique est l’une des substances les plus puissantes connues pour bloquer la transmission des signaux nerveux. En d’autres termes, elle agit comme un inhibiteur de communication entre les nerfs et les muscles, provoquant une paralysie temporaire des muscles dans les zones ciblées.

How does nerve transmission work in muscles ?

To understand how botulinum toxin works, it is essential to understand how muscles normally contract.

  • Les mouvements musculaires sont commandés par le système nerveux. Lorsqu’un signal est envoyé depuis le cerveau ou la moelle épinière pour bouger un muscle, il voyage le long d’un neurone moteur jusqu’à atteindre la jonction entre le neurone et le muscle, appelée jonction neuromusculaire.
  • At this junction, the nerve releases a neurotransmitter called acetylcholine into a small area known as the synaptic cleft (the space between the nerve and the muscle cell).
  • Acetylcholine binds to specific receptors on the surface of the muscle cells, which triggers their contraction.

Mechanism of action of botulinum toxin

La toxine botulique de type A agit directement sur ce processus de transmission nerveuse, bloquant ainsi la libération d’acétylcholine et inhibant la contraction musculaire.

  • Inhibition de la libération d’acétylcholine : la toxine botulique agit au niveau des terminaisons nerveuses en bloquant la libération de l’acétylcholine. Elle le fait en clivant des protéines spécifiques dans les vésicules contenant l’acétylcholine, empêchant ainsi ces vésicules de fusionner avec la membrane de la cellule nerveuse. En d’autres termes, la toxine “désactive” le mécanisme de libération d’acétylcholine.
    Without this neurotransmitter, the muscle is no longer able to receive the signal it needs to contract. The muscle therefore remains relaxed.
  • Temporary effect on muscles : the effect of botulinum toxin is temporary because nerve cells eventually generate new endings capable of releasing acetylcholine. This means the results of the injection typically last between 3 and 6 months, depending on the treated area and the patient's metabolism.
  • Precise targeting of muscles : during a botulinum toxin injection, the doctor targets specific muscles to relax only the areas responsible for expression lines. For example, to treat forehead lines or crow’s feet, botulinum toxin is injected into the muscles responsible for repeated contractions in these areas. This provides smoother skin in the injected area while maintaining a natural facial expression.

 

Effect on expression lines

Expression lines appear as a result of repeated contractions of the underlying facial muscles. These wrinkles are especially visible on :

By temporarily relaxing the muscles, botulinum toxin prevents the repetitive contractions that create and deepen wrinkles over time. The skin above the relaxed muscles becomes smoother.

Muscle relaxation process

The muscle relaxation caused by botulinum toxin is not immediate.

Here is how the process unfolds :
• Injection : botulinum toxin is injected directly into the targeted muscle. The product begins to block nerve signals shortly after injection.
• Onset time : although some people notice improvement within 2 to 3 days, final results are seen after 7 days.
• Duration of effect : muscles remain relaxed for approximately 3 to 6 months, until the nerve endings regenerate.

Differences between Botox and other aesthetic treatments

It is important to distinguish Botox from other injectables such ashyaluronic acid.

  • Botox : relaxe les muscles responsables des rides d’expression (rides dynamiques).
  • Hyaluronic acid : fills static wrinkles, hydrates the skin, and restores lost volume.

These two treatments are often complementary but work differently. Hyaluronic acid is a dermal filler, whereas botulinum toxin acts on the underlying muscles through a muscle-blocking mechanism.

Long-term effects of Botox

Repeated botulinum toxin injections have long-term benefits. When muscles are continuously relaxed, wrinkles do not form as easily, which can slow down the facial aging process in the treated areas. However, it is essential to observe reasonable intervals (4 to 6 months) between injections to avoid developing a tolerance to the toxin.

Safety of botulinum toxin injections

Botulinum toxin injections are considered safe when performed by an experienced doctor. The most common side effects are minor, such as redness or bruising at the injection site, and generally disappear after a few days.

Photo of doctor Valeria Romano in Geneva

Article written by Dr Romano Valeria

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