Botox injections

Definition

Botox is a well-known brand name for a medicinal form of botulinum toxin type A, also known as onabotulinumtoxinA. The toxin is produced by a specific bacterium that causes the food poisoning botulism. When injected in small doses into specific muscles, Botox doesn't poison you but acts as a muscle relaxant with effects that can last for several months.

There are two forms of the botulinum toxin medicine, Botox and Botox Cosmetic. Botox is used to treat certain medical problems. Botox Cosmetic is used to improve facial wrinkles. But you may hear both referred to as simply Botox.

Botox injections: Before-and-after results

Botox injections: Before-and-after results

At left, a look at a woman's wrinkles before Botox injections. At right, the same woman pictured three weeks after Botox injections. ...

Why it's done

Botox injections block certain chemical signals from nerves, mostly signals that cause muscles to contract. This results in targeted muscle paralysis, which can have therapeutic or cosmetic effects, especially where muscles are chronically tight or spastic.

Botox
The Food and Drug Administration (FDA) has approved Botox to treat the following medical conditions:

• Neck pain and abnormal head position associated with severe muscle spasms of the neck (cervical dystonia)
• Lazy eye (strabismus)
• Twitching of the eyelids (blepharospasm)
• Muscle stiffness in elbow, wrist and finger muscles due to increased muscle tightness in the upper arms (upper limb spasticity)
• Excessive underarm sweating (hyperhidrosis), where the Botox weakens the action of the sweat glands rather than muscles
• Chronic migraine — a condition that causes headaches on more than 14 days a month, including a migraine on at least eight of those days

Doctors sometimes use Botox to treat other conditions, such as back pain, bladder dysfunction, pelvic floor problems and others. But more evidence of Botox's effectiveness for these conditions is needed before it can be considered standard therapy.

Botox Cosmetic
Botox Cosmetic can temporarily relax the facial muscles that underlie and cause wrinkles, making them less noticeable. The FDA has approved Botox as a temporary treatment for moderate to severe frown lines between the eyebrows. However, Botox can be used to treat other facial wrinkles as well, such as the lines that fan out from the corners of the eyes (crow's-feet) and the forehead furrow.

Botox won't reverse wrinkling caused by sun damage. Also, it's less desirable to treat the lines around your mouth because muscles in this area are needed for eating and talking. Your skin type, skin thickness and degree of wrinkling all play a role in determining whether these injections are effective for you.

Risks

Botox injections are relatively safe when performed by an experienced doctor. But side effects and complications can occur.

Side effects that you should mention to your doctor if they're bothersome or don't go away include:

• Pain and bruising at the injection site
• Redness
• Itching
• Headache
• Nausea
• Temporary muscle weakness
• Increased body sweat

Although very unlikely, there is a possibility that the effect of botulinum toxin may spread to other parts of the body and cause botulism-like signs and symptoms.

Call your doctor right away if you notice any of these effects hours to weeks after receiving Botox:

• Muscle weakness all over the body
• Vision problems
• Trouble speaking or swallowing
• Trouble breathing
• Loss of bladder control

Other serious but very uncommon side effects to watch out for include:

• Allergic reaction (itching, hives, swelling, chest tightness, trouble breathing)
• Eye pain, bleeding or bruising around your eye
• Blistering, peeling of your skin or severe rash
• Chest pain, shortness of breath or uneven heart rate
• Flu-like symptoms
• Face or neck pain
• Seizures

Doctors generally recommend against using Botox when you're pregnant or breast-feeding, since the effects on the baby aren't known. The benefits of the treatment should exceed the risks.

Select your doctor carefully
Botox must be used only under a doctor's care. It can be dangerous if it's administered incorrectly. Ask for a referral from your primary care doctor or look for a doctor who specializes in your condition and who has experience in administering Botox treatments. A skilled and properly certified doctor can advise you on the procedure and can help determine if it best suits your needs and health.

How you prepare

Before scheduling Botox injections, you need to meet with your doctor to discuss the factors that determine whether Botox is likely to work well for you. This meeting generally includes:

• Your medical history and physical exam. Your doctor asks questions about conditions you have or have had and conducts a physical exam.
• Medication use. Your doctor asks about medication use. You may need to stop using certain medications before your Botox procedure. These include blood-thinning medications, such as aspirin, aspirin-containing medications, clopidogrel (Plavix), warfarin (Coumadin) or heparin. Talk to your doctor before stopping these medications, as it may be best to continue these medications in people who have had blood clots, stroke, heart attack, angina or transient ischemic attacks. Also, let your doctor know if you've received any other Botox product before (especially in the last four months), recently received antibiotics by injection, or take muscle relaxants, allergy or cold medicines, or sleep medicine.
• A discussion of your expectations. You and your doctor talk about your motivations and expectations. He or she explains what Botox can and can't do for you and what your results might be.
• A discussion of costs. Botox injections can be expensive and they're not always covered by insurance. Make sure you know in advance how much the injections will cost and whether your insurance provider will cover them.

If you're being treated for excessive sweating
If you're being treated with Botox for excessive underarm sweating, your doctor may ask you to do the following before receiving injections:

• Shave your underarms.
• Avoid deodorant use for 24 hours before treatment.
• Avoid foods or activities that may make you sweat more, such as hot foods or exercise, for 30 minutes before the procedure.

What you can expect

Before the procedure
Your doctor or nurse may prescribe medicine to numb the area where the injection will be given.

During the procedure
Your doctor uses a thin needle to inject tiny amounts of Botox into your skin or muscles.

• When treating excessive underarm sweating, your doctor injects Botox into the skin under your arms.
• When treating facial wrinkles or other conditions, your doctor injects Botox into specific muscles. By carefully choosing the muscles to treat, your doctor weakens only the muscles needing treatment.

The number of injections needed depends on many factors, including the extent of the area being treated. For wrinkle treatment, aesthetic factors also play a role.

Botox injections take about 10 to 15 minutes and are usually done in a doctor's office. You may experience mild pain with the injections, but most people find the discomfort tolerable.

After the procedure
Botox injections require little downtime, although you may experience bruising or other minor local side effects from the injection. Expect to resume your normal daily activities right after the procedure. Take care, though, not to rub or massage the treated areas. This can cause the toxin to migrate to a different area.

Results

When being treated for conditions such as wrinkles or a twitching eyelid (blepharospasm), you'll notice results within a few days, although the full effect takes about two weeks.

For other conditions — such as lazy eye or cervical dystonia — it may take a week or two before you notice improvement.

Results aren't permanent. After about three to six months, the effects of Botox begin to fade. To maintain treatment, you need follow-up injections every few months.

Botox injections: Before-and-after results

Botox injections: Before-and-after results

At left, a look at a woman's wrinkles before Botox injections. At right, the same woman pictured three weeks after Botox injections. ...