Botox- einer der meist verwendeten Begriffe in der Plastischen Chirurgie und Dermatologie. Alle sprechen davon, aber nur wenige wissen was es ist, wie es wirkt und was es alles kann!
Was ist Botox eigentlich?
Botox ist eigentlich ein geschützter Eigenname der Firma Allergan, einem der größten Hersteller von Beauty-Produkten für den Wirkstoff Botulinum-Toxin (BTX). Wie der Name bereits verrät handelt es sich bei Botox um ein Gift, das auf Nerven wirkt. Durch eine Hemmung der Nerven-Leitung wird der Muskel gehemmt. In zu hohen Dosen kann es zu einer Muskel-Blockade im gesamten Körper und damit zu einem Atem und Herzstillstand kommen. Es ist jedoch unmöglich „versehentlich“ so viel Botox zu spritzen, dass dies passieren könnte. Denn hier müsste die 50-100 fache Menge der üblichen Dosis injiziert werden.
Wo wird Botox überall eingesetzt?
Botox wurde Anfang des 18. Jahrhunderts entdeckt und bis in die 1970er nicht medizinisch genutzt. Auch heutzutage ist es hauptsächlich auf Grund des Einsatzes in der Ästhetischen Chirurgie bekannt – Dabei ist es viel mehr als das!
Anfänglich wurde Botox genutzt um Schielen zu verbessern, danach setzte man es ein um Spastiken (unwillkürliche Muskel-Verkrampfungen) jeglicher Art zu bekämpfen und erst ab 2002 darf BTX für ästhetische Zwecke eingesetzt werden. Seitdem ist Botox in aller Munde und wird auch für Zähneknirschen, muskulär induzierte Kopfschmerzen, vermehrte Schweißproduktion, Migräne usw. eingesetzt! Die wohl bekannteste Anwendung ist und bleibt jedoch das Glätten der Zornesfalte.
Wie wirkt Botox?
Wie oben angedeutet ist Botox ein Nervengift. Wird es in einen Muskel gespritzt, hemmt es dort die Freisetzung des Neurotransmitters Acetylcholin. Dieser kommt nur an der „motorischen Endplatte“- der Verbindung zwischen Nerv und Muskel vor. Dadurch wird nur die Muskel-Funktion gestört, andere Funktionen wie Temperaturempfinden oder Fühlen bleiben unbeinträchtigt.
Gibt es Nebenwirkungen?
Ja, die gibt es! Wie bei jedem Gift, macht natürlich die Dosierung die Schwere der Nebenwirkungen aus. Bei der ästhetischen Anwendung kann es zu Schluckbeschwerden, trockenen Augen oder Störungen im Bereich der Nackenmuskulatur kommen. All dies kommt jedoch extrem selten vor. Als häufigste Nebenwirkungen treten ästhetische Assymmetrien in den Gesichtszügen auf. Durch unterschiedliche Mengen an BTX sind die Muskeln einer Seite mehr und die der anderen weniger stark gehemmt. Hier sollte auf eine genaue Unterspritzung und eine feine Dosierung höchsten Wert für ein ästhetisch einwandfreies Ergebnis gelegt werden.
Z.B.: Wenn man bei Behandlung der Fältchen im Mundbereich den rechten Musculus depressor angulis oris, der den Mundwinkel nach unten zieht stärker hemmt als den links, steht der rechte logischerweise höher.
Viel öfter kommt es allerdings zu kleineren Nebenwirkungen wie kleinen Blutergüssen oder Schwellungen. Diese sind meist jedoch unbedenklich und nach kurzer Zeit wieder verschwunden.
Was muss man bei der Behandlung mit Botox beachten?
Im Vorfeld muss man sich im Klaren sein, dass durch Botox manche Muskeln nicht mehr einsatzfähig sind oder in ihrer Funktion gehemmt werden. Dies ist gewollt und auch der Haupteffekt von Botox. Das Glätten von Falten bewirkt als Nebeneffekt auch eine eingeschränkte Mimik. Bei einem Übermaß an Botox gepaart mit Fillern und Straffungen kann dadurch das so bekannte „Katzengesicht“ entstehen. Wie so oft gilt unserer Meinung nach der Spruch „weniger ist mehr“. Eine gezielte Behandlung mit spezifischer Ausschaltung von kleinen Muskeln hat oft mehr Effekt als eine Ganz-Gesicht Behandlung. Der Anspruch sollte immer sein, die natürliche Schönheit lediglich zu unterstreichen und ein Höchstmaß an natürlicher Mimik beizubehalten. Ästhetische Einzelfälle lassen wir hier außen vor.
Gibt es Kontraindikationen für Botox? Wann darf man sich nicht spritzen lassen?
In Schwangerschaft und Stillzeit, sowie bei diversen Muskelerkrankungen, Nervenleiden, Hauterkrankungen im Injektionsgebiet, Gerinnungsstörungen und bei der Einnahme von Aminoglykosidantibiotika ist von einer Unterspritzung mit Botox abzuraten.
Kann Botox natürlich wirken?
Ja, auf alle Fälle. Den meisten Patienten kennt man nicht an, dass sie eine Botox Behandlung hinter sich haben. Familienmitglieder, enge Freunde und Bekannte merken oft ein glatteres Gesicht, jedoch die Mimik ist bei kleinen Dosen nicht eingeschränkt. Einzig und allein das Zornig-Schauen fällt manchmal schwer- aber das ist ja eh oft auch so gewollt 😉
Ab wann fängt Botox an zu wirken? Wie lang wirkt Botox?
Da Botox die Ausschüttung des Neurotransmitters Acetylcholin hemmt stellt sich die Wirkung erst nach einigen Tagen ein. Die ersten Effekte kann man bereits nach 3 Tagen sehen, nach spätestens 14 Tagen sollte sich der Effekt dann vollständig eingestellt haben. Natürlich gibt es hier immer wieder Ausnahmen nach oben und unten.
Aufgrund der Zerstörung von Nervenfasern durch Botox ist der Effekt so lang anhaltend, bis sich diese neu gebildet haben und somit nie irreversibel. Eine Neubildung von Nervenfasern (Reinnervation) beginnt oft schon nach 8 Wochen, nach 3-8 Monaten sind diese dann meist vollkommen wieder hergestellt. Deshalb sollte Botox in regelmäßigen Zeitabständen injiziert werden. Auf eine ausreichende Intervalllänge ist aufgrund Anti-Körperbildung allerdings auch zu achten.
Die Patienten stellen sich meist erneut bei Ihrem behandelnden Arzt vor, da sie die zuvor gelähmte Muskulatur merklich wieder ansteuern können. Dies ist nach der 1. Injektion von Botox meist früher der Fall als nach Folgeinjektionen. Oft wird nämlich auch die Mimik verlernt, so dass die Patienten die zuvor durch Botox gelähmte Muskulatur gar nicht mehr so häufig ansteuern.
Kann man direkt nach dem Spritzen wieder Sport machen?
Es wird empfohlen in den ersten 24-48h nach der Injektion auf Sport, Sauna, Massagen und anstrengende Tätigkeiten zu verzichten. Durch eine erhöhte Durchblutung oder mechanische Beanspruchung kann der Wirkstoff leichter diffundieren und in umliegende Areale, wo man keinen Effekt wünscht, gelangen.
Was kann man also mit Botox alles behandeln? Wo spritzt man es?
Grundsätzlich gibt es vor allem in der Neurologie verschiedene Indikationen für eine Botoxbehandlung: Muskelspastiken, Migräne, Kopfschmerzen.
Weiterhin kann man Botox im kieferorthopädischen Bereich als Maßnahme gegen das Zähneknirschen erfolgreich einsetzen.
Und vor allem im ästhetischen Bereich gibt es zahlreiche Wünsche nach Botox. Das Glätten von Falten, welche durch Muskelzug bedingt sind. Schlaffalten oder durch Schwerkraft bedingte Falten kann man mit Botox allerdings nicht behandeln!
Oft gewünscht Regionen sind also die Zornesfalte, die Stirn, die sog. Krähenfüße (äußerer Augenwinkel), Fältchen um den Mund, am Kinn oder auf der Nase.
Aber auch zur Gesichtverschmälerung und Wadenverschmälerung wird Botox gern verwendet. Hier wird dann die Muskelatrophie durch die lähmende Wirkung des Nervengiftes angestrebt.
Wir finden dieses Thema sehr spannend und werden dir in den kommenden Wochen anhand von Fotos und Videos immer wieder ein paar Anwendungsbeispiele zeigen.
Dieser Text erhebt keinen Anspruch auf Vollständigkeit. Solltest du eine Behandlung mit Botox wünschen wird dich dein behandelnder Arzt bestmöglich beraten.
Quellen:
- Burgen, A. S. V., F. Dickens, and L. J. Zatman. „The action of botulinum toxin on the neuro‐muscular junction.“ The Journal of physiology 109.1-2 (1949): 10-24.
APA - Jankovic, J., and K. Schwartz. „Botulinum toxin injections for cervical dystonia.“ Neurology 40.2 (1990): 277-277.
- Homann, C. N., et al. „Botulinumtoxin–Die Dosis macht das GiftEin historischer Abriss.“ Der Nervenarzt 73.6 (2002): 519-524.
- Kollewe, Katja, et al. „Blepharospasm: long-term treatment with either Botox®, Xeomin® or Dysport®.“ Journal of Neural Transmission 122.3 (2015): 427-431.
- Aktories, Förstermann, Hofmann, Starke,
Allgemeine und spezielle Pharmakologie und Toxikologie (S. 1099) - Dressler, Dirk, and Fereshte Adib Saberi. „Botulinum toxin: mechanisms of action.“ European neurology 53.1 (2005): 3-9.
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