Your Health - Botulinum Toxin Injections

Botulinum Toxin Injections

(Botulinum Toxin Type A; Botulinum Toxin Type B; Botox Injections)

Pronounced: Bow-tox

Definition

Botulinum toxin is made from a type of bacteria. It is toxic to the nerves. Another name for it is bacterial neurotoxin. An injection puts this toxin into muscle. There it blocks the chemical signal from the nerves to muscles. This will decrease the muscle contraction (tightening).

There are several types and brands of this toxin. They can be used for cosmetic and medical reasons.

This injection process is often called botox injection, although any brand of the botulinum toxin may be used.

Wrinkles

Reasons for Procedure

This is most commonly used as a treatment to smooth wrinkles on the face and neck. It is FDA approved for the treatment of frown lines between the brows.

It is also FDA-approved to treat:

Cervical dystonia (abnormal spasms of neck muscles)
Blepharospasm (spasm of eyelid muscles)
Strabismus (crossed eyes)
Hyperhydrosis (excessive sweating)

The injection has also been used to treat other conditions such as:

Migraine headaches
Achalasia (spasm of esophageal muscles causing difficulties in swallowing)
Muscle spasms due to cerebral palsy
Spasticity in leg muscles following a stroke

Strabismus

Possible Complications

Complications are rare. When they occur they are temporary and mild. Side effects are related to the site of injection. For example, if injections take place near the eyes, there may be complications with eyelids or brow line.

Temporary issues may include:

Redness
Bruising
Stinging around the injection sites

The following are less common reactions. They are generally mild and do not last long.

Nausea
Fatigue
Flu -like symptoms
Headache

Other complications that may occur include:

Excessive weakness of the muscle around the eyes—can cause drooping of the eyelids or obstruction of vision
Difficulty swallowing—can occur in patients receiving injections in their neck
Compensatory hyperhidrosis—people being treated for hyperhidrosis may develop increased sweat production at another area of the body

FDA Public Health Advisory for Botulinum Toxin

There is a risk that the botulinum toxin could spread beyond the injection area. This can cause botulism symptoms, including difficulty breathing and death. These symptoms appear to be more common in children with cerebral palsy who receive the injection to treat spasticity. The warning is for Botox , Botox Cosmetic, Myobloc , and Dysport. For more information, please visit: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm175013.htm

This procedure may worsen nerve or muscle disorders, such as:

- ALS (amyotrophic lateral sclerosis)
- Myasthenia gravis
Excessive weakness or atrophy (wasting) in chosen muscles—the injection may slow any improvement in the muscle (does not apply to cosmetic procedures)
Very long, thin necks—botox injections in a long thin neck may cause neck weakness (does not apply to cosmetic procedures)

The toxin can also interact with medications such as antibiotics. Be sure to inform your doctor about all of the medications you are taking.

Inform your doctor if you are pregnant or plan to become pregnant or plan to breast-feed.

What to Expect

Anesthesia

Most often, none is given. Some patients may prefer to have the area numbed for comfort. In this case, a topical anesthetic may be used.

Description of the Procedure

A thin needle will be used. The doctor will inject the toxin through the skin into the muscle. You will often need several injections in a small area.

After Procedure

There is very little recovery needed, but you remember to:

Remain upright for several hours
Avoid alcohol

How Long Will It Take?

The length will depend on the number of sites involved. It is often less than 20 minutes.

Will It Hurt?

You may have some minimal discomfort.

Post-procedure Care

Normal activities may be resumed after the procedure. For the best recovery follow your doctor's instructions .

The toxin temporarily weakens targeted muscles. The treatment lasts up to 4 months. With repeated use, the effects may last longer.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

Difficulty breathing
Difficulty swallowing
Difficulty speaking
Severe lower eyelid droop or obstructed vision
Excessive weakness around the injection site
Rash or any other sign of an allergic reaction

In case of emergency, call 911.

RESOURCES:

American Society for Dermatologic Surgery
http://www.asds-net.org/

American Society of Plastic Surgeons
http://www.plasticsurgery.org/

CANADIAN RESOURCES:

Canadian Dermatology Association
http://www.dermatology.ca/

Health Canada
http://www.hc-sc.gc.ca/

References:

Allergan Physician Production Information. Botox cosmetic (botulinum toxin type A). Published April 2008.

Baran R, Maibach H. Textbook of Cosmetic Dermatology . 3rd ed. New York, NY: Taylor and Francis; 2004.

Conn HF, Rakel R. Conn’s Current Therapy. 54th ed. Philadelphia, PA: WB Saunders Company; 2002.

Habif T. Clinical Dermatology . 4th ed. St. Louis, MO: Mosby; 2004.

Ondo WG, Gollomp S, Galvez-Jimenez N. A pilot study of botulinum toxin A for headache in cervical dystonia. Headache . 2005;45(8):1073-1077.

Ward A, Roberts G, Warner J, et al. Cost-effectiveness of botulinum toxin type A in the treatment of post-stroke spasticity. J Rehabil Med . 2005;37(4):252-257.

¹11/4/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : FDA gives update on botulinum toxin safety warnings. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm175013.htm . Updated August 3, 2009. Accessed November 4, 2009.

Last reviewed October 2009 by Mervin Low, MD, PC and Brian P. Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.