Botulinum toxin

Botulinum toxin (BTX) has been in medical use for decades to treat conditions of muscle spasms or hyperactivity. BTX works by preventing the release of acetylcholine (Ach), a chemical produced by nerve endings to stimulate muscle function and sweat glands. By blocking Ach release, BTX paralyzes and relaxes the muscles injected or stops sweat secretion. The nerve endings recover from BTX blockade after several months by generating new nerve endings.

In dermatology, BTX has been used for both medical and cosmetic purposes. Many facial wrinkles are due to underlying muscle activity. With BTX, these muscle-associated wrinkles soften and improve dramatically. There is also early research to suggest that BTX may modify pain signals and may be effective for a variety of pain conditions, including migraines. Sweat gland secretion is halted in areas of BTX injection. As a result, BTX is an excellent option for treating hyperhidrosis, a condition of excessive sweating, often on the armpits, hands and feet. The beneficial effects of BTX are temporary and injections must be repeated to maintain the benefits. Intervals between injections vary depending on the condition treated.

The Federal Food and Drug Administration (FDA) has approved Botox Cosmetic for the treatment of glabellar lines (wrinkles between the eyebrows). BTX, however, has been safely used for years for other non-FDA approved indications, such as wrinkles on the forehead and around the eyes (crow’s feet). Wrinkles around the lips, cheeks, chin, and neck have also been improved with BTX. As with any medication, there are potential side effects with BTX. Potential complications are usually temporary in nature. They include bruising, swelling, and pain at the injection site. Other potential side effects are related to the areas and muscles injected. BTX around the forehead and eyes may cause drooping of the eyebrows or eyelids, cause a headache, and double vision. If properly performed, these side effects are rare. Speak to your physician about the potential side effects of BTX.

Procedure Details: BTX injection occurs in an outpatient office setting. Several injections are needed depending on the condition treated. The smallest needles are used for the injections and most patients do not require any additional sedation or anesthesia. A topical anesthetic cream may be used in very pain-sensitive patients. Patients return home or to work immediately. Postoperative instructions are to avoid massaging the injected area and to use as much as possible the muscles treated. Muscle relaxation and paralysis begin shortly after injections but is not maximal until 2 weeks later. For migraines and hyperhidrosis, maximal BTX benefits may be delayed for weeks.