Botox is the trade name for the medical derivative of the botulinum toxin. While botulinum toxin is the most potent neurotoxin known to man, botox is commonly used cosmetically. In minute, diluted doses, botox is injected to specific muscles, causing local flaccid paralysis. Botox is also available under the names Dysport, Myoblock, Xeomin, and Neuroblock.

Medical Uses

Use in Cosmetics
Botox gains its appeal as a cosmetic drug because it does not require general anesthesia or surgery. It is less expensive and carries few of the risks associated with anesthesia and other medical cosmetic procedures. It has been approved by the FDA as an anti-wrinkle treatment since 2002, but had been used for a decade prior "off-label". The American Society for Aesthetic Plastic Surgery listed botox cosmetic injections as the fastest-growing cosmetic treatment performed by surgeons in the U.S. In 2002, there were between 1.1 to 1.6 million patients using cosmetic botox treatments.

Some of the uses for which Botox is currently approved includes treating the following:

• Horizontal forehead furrows
• Glabellar Frown Lines
• Horizontal furrows at the nasal bridge
• Eyebrow Asymmetry
• Eyebrow Contour
• Eyebrow prosis
• Lateral Canthal Rhytids (crows feet)
  
  

(Before and After of Cosmetic Botox Injection)

Following the injection of botox, cosmetic results begin in first 24-72 hours. The effects are temporary, and last anywhere from 2 to 6 months depending on the concentration of the botox injected and the location. To maintain results, serial injections are necessary. Some reports show that the length of time between required follow-up injections may increase after multiple treatments.

From (#Mendez-Eastman, 2003 and #Cote et al 2005).

Other Medical Uses
Botox has many other uses than wrinkle reduction and the following health concerns have been treated with Botox (#Freitag, 2007 and #Mendez-Eastman, 2003):

• Cerebral Palsy
• Muscular Spasms
• Urinary Incontinence
• Headaches
• Tinnitus
• Excessive Sweating
• Excessive Salivation
• Post-stroke spasticity
  
  

Risks and Complications

The most common complications following botox injection include bruising at the injection site, mild headache, dry eye, ptosis (drooping eyelids), and asymmetry. As botox is temporary, undesired effects will fade and then disappear over time. No allergic responses have been reported.

Most risks following cosmetic procedures are minor and transitory, and consist of such symptoms as bruising, pain at the injection site, and swelling.

Adverse effects are higher when treating medical ailments, a combination of the higher doses administered and higher risk factors associated with the specific illness being treated.

Rarely, botox can spread beyond the site of injection. If it travels to the respiratory muscles, respiratory paralysis can occur and can be fatal. Four children undergoing treatment for cerebral palsy have died following leg injections of botox, causing the Food and Drug Administration (FDA) to issue a warning regarding its use in February 2008. The doses administered for treating cerebral palsy are generally much higher than cosmetic doses, and no deaths have been reported following cosmetic doses of botox (#Coté et al 2005).

History

The cosmetic potential of Botox was first discovered in the 1950s, when Dr. Alan Scott and Dr. Edward J. Schantz prepared a batch of botulinum toxin to study its use as a drug for producing weakness of extraocular muscles in treatment of facial and eyelid spastic disorders. These patients reported back other benefits, such as the improvement in facial lines, in addition a reduction in spasms. These data led to the study of botox as treatment for other facial wrinkles (#Mendez-Eastman, 2003).

Legal History

Botulism has been used since 1991 to treat eye spasms and other neurological disorders (#Kuczynski, 2002). It was approved by the Food and Drug Administration (FDA) on April 15, 2002 for cosmetic use to treat frown lines (#Abelson, 2002).

References

Coté TR et al. 2005. Botulinum toxin type A injections: adverse events reported to the US Food and Drug Administration in therapeutic and cosmetic cases. J Am Acad Dermatol. 53(3):407-15.


Freitag FG. 2007. Botulinum toxin type A in chronic migraine. Expert Rev Neurother. 7(5):463-70.

Lacy DB, Tepp W,  Cohen AC,  DasGupta, BR,  Stevens, RC. 1998. Crystal structure of botulinum neurotoxin type A and implications for toxicity.  Nat Struct Biol 5: 898-902


Mendez-Eastman, SK. 2003. Botox: A review. Plastic Surg Nursing. 23(2):64

Polo, M. 2008. Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile). Am J Orthod Dentofacial Orthop 133(2):195-203.

ALEX KUCZYNSKI, "Is It Botox, or Is It Bogus?". December 5, 2004.


Donald Kennedy. "Beauty and the Beast." Science 295 (5560). March 1, 2002. p. 1601.


Reed Abelson, " F.D.A. Approves Allergan Drug for Fighting Wrinkles". April 16, 2002.