Botox Cosmetic: What Can It Do For You?
Reviewed by Yael Halaas, MD
Year after year, Botox injections are the most popular cosmetic procedure in the United States. And it's no surprise. This wonder toxin can banish those wrinkles on your forehead and around your eyes for up to six months. This includes putting the brakes on that pesky number 11 that appears in the glabella (the space between your eyebrows and above your nose).
Wrinkles are created when nerve cells within the muscles beneath the skin release acetylcholine, which in turn triggers a muscle contraction that creates wrinkles. Botox basically disrupts the release of this chemical, paralyzing the muscle. Wrinkle-busting results are visible within one week and remain for a minimum of three months.
Botox Cosmetic and similar treatments are derived from the bacterium Clostridium botulinum. This is the very same bacterium that causes the deadly food poisoning known as botulism, but the cosmetic doses are much, much lower and the toxin is diluted.
There are several brands and types of botulinum-toxin-based injectables on the market today, and there are even more in the pipeline. Botox Cosmetic, Botox and Dysport are derived from botulinum toxin type A, while Myobloc is derived from botulinum type B. Despite their similarities, these products should not be used interchangeably. Each requires special preparation and dosing.
Botox: Other Uses
Botox Cosmetic is approved for moderate to severe frown lines between the eyebrows (glabellar lines) and crow's feet. It is also approved for:
- Eyelid spasm (blepharospasm)
- Eye muscle spasm
- Severe neck muscle spasms (cervical dystonia)
- Excessive underarm sweating (severe primary axillary hyperhydrosis)
- Migraine headache
- Leaky bladder due to nerve damage from multiple sclerosis or spine injury
- Overactive bladder that does not respond to other treatments
In addition, Botox is used off-label on forehead creases and bands on the neck. Botox is currently being studied as a possible treatment for knee and hip osteoarthritis, temporomandibular joint (TMJ) disorder and benign prostatic hyperplasia (BPH).
Myobloc is approved for the treatment of adults with cervical dystonia.
Botox Injections: Do They Hurt?
The areas most commonly treated with Botox are the forehead, the glabella and the outer eye area. Botox is injected with a very fine needle into the muscle or muscles that are causing the wrinkle or furrow. Usually, you get several injections in each muscle. The whole process takes about 30 minutes.
There may be some pain or discomfort associated with these injections, but this is usually minimal. Some people have reported stinging and pressure at the injection site.
There is little downtime after Botox injections. Try to avoid moving the treated muscles for the first few hours. You will start to see results within one week (maybe sooner).
In subsequent months, as the effects start wearing off, you will notice a very gradual fading of the wrinkle-erasing effects.
Botox is considered extremely safe, but it does have its share of risks. They include:
- Redness or numbness at injection site
- Flu-like symptoms
- Muscle weakness that limits facial movement
Botox: Black Box Warning
The U.S. Food and Drug Administration (FDA) now requires that Botox and similar products carry a black box warning about a rare but potentially life-threatening complication that may occur if the toxin spreads beyond the injection site. This is the strongest warning that can be issued by the FDA.
Importantly, none of these complications occurred among individuals using Botox for cosmetic reasons. Most of the hospitalizations and deaths were seen in children with cerebral palsy who were treated with botulinum toxin for muscle spasms. Some serious hospitalizations have been reported in adults treated with botulinum toxin for involuntary muscle movement and frequent neck spasms.
Protect yourself from Botox risks and complications by:
Choosing a qualified physician. Botox shots require a precise knowledge of facial anatomy. Your risk of complications increases when these injections are placed in unskilled hands.
RSVPing "no" to Botox parties. Botox and other injectables such as Sculptra should always be administered with sterile instruments in an appropriate setting (a doctor's office or a medical spa) not in your neighbor's living room!
Be upfront with your physician. Tell him or her about any pre-existing medical conditions and all medications you currently take before treatment with Botox. Certain people may not be candidates for Botox injections, including pregnant women and individuals who take certain medications. The effects of Botox may become more pronounced if it is used while you are taking certain antibiotics or other drugs that interfere with neuromuscular chemicals.
The price for Botox injections is between $175 and $500 for one area (about 20 to 25 units for the glabella), between $275 and $600 for two areas and between $375 and $800 for three areas. The usual product charge is between $10 and $15 per unit used. Prices vary a great deal depending on the region and the surgeon.
Insurance does not cover the cost of cosmetic procedures, including Botox injections. If the cost is prohibitive, ask your doctor about any available financing options or payment plans.
To view a comparison chart explaining the pros and cons of all available injectables, please click here.
Marcia V. Ormsby, MD
Annapolis Aesthetic Surgery, Inc.
116 Defense Hwy.,
Annapolis, MD 21401
Oleh Slupchynskyj, MD
The Aesthetic Institute of New York & New Jersey
44 E 65th St.
New York, NY 10021
Yael Halaas, MD, FACS
60 East 56th Street
New York, NY 10022