What is Botox?
Botox, botulinum type A, is a purified protein substance produced by the bacteria Clostridium Botulinum. There are seven types of botulinum toxins, A-G.
How does it Work?
Botulinum toxin A weakens or paralyzes striated muscles by inhibiting the release of acetylcholine ( a neurotransmitter) at the neuromuscular junction. Once the treated muscles are weakened, the overlying skin flattens, minimizing dynamic facial skin creases. Onset of the paralytic effect typically occurs 2 – 3 days after injection and lasts between 3 – 6 months. Repeat injections will be required to maintain the paralytic effect.
What is it used to Treat?
Botox was FDA approved in April, 2002, for the treatment of glabellar wrinkles (frown lines between the eyebrows). Other FDA approved uses include the treatment of blepharospasm, strabismus, and cervical dystonia. It has also been used for many off-label indications (treatments that have been widely used, however, are not yet FDA approved), including the cosmetic treatment of lateral periocular rhytides (crow’s feet), brow ptosis (droop), central forehead wrinkles, perioral lipstick lines, and platysmal bands in the neck. Other off-label uses include the treatment of hyperhidrosis, headache, back pain, and limb spasticity.
What are the potential side effects?
The most common side effects include pain and bruising at the injection site. Other less common side effects include headache, blepharoptosis (eyelid droop), brow ptosis (brow droop), lack of expressivity, diplopia (double vision), ectropion (outward turning of the eyelids), temporary dysphagia (difficulty swallowing, can be seen after treatment of platysmal bands), an asymmetric smile, drooling, a Bell’s palsy – type appearance, flu-like symptoms, nausea, and rashes at sites distant from injection sites. Rare case reports have been described of patients who developed chronic, severe headaches lasting several months, as well as a prolonged chronic fatigue-like syndrome. There is potential for patients to develop resistance to Botox, however, this is very rare and has only been seen in patients treated with very high doses for conditions such as cervical dystonia.
Who shouldn’t use botox?
Pregnant or nursing women, individuals with neuromuscular disorders such as Myasthenia Gravis or Eaton-Lambert Syndrome, and people taking the following medications: aminoglycoside antibiotics, penicillamine, quinine, and calcium channel blockers (a blood pressure medication).