Botulinum Toxin Injections—Medical
(Botulinum Toxin Type A; Botulinum Toxin Type B; Botox Injections)
DefinitionBotulinum toxin is made from a type of bacteria. It is a toxin that affects nerves. An injection puts this toxin into muscle. There, it blocks the release of the chemical signal from the nerves to muscles. This will decrease the muscle contraction. Botulinum toxin is used for cosmetic and medical reasons. The injection process is often called botox injection, although any brand of the botulinum toxin may be used.
Reasons for ProcedureThe injection is FDA-approved to treat:
- Cervical dystonia—abnormal spasms of neck muscles
- Blepharospasm—spasm of eyelid muscles
- Strabismus—crossed eyes
- Hyperhydrosis—excessive sweating
- Chronic migraines
- Tension headaches
- Achalasia—spasm of esophageal muscles causing difficulties in swallowing
- Spasmodic dysphonia
- Muscle spasms due to cerebral palsy
- Spasticity associated with multiple sclerosis
- Spasticity in leg and arm muscles due to brain injury/stroke
- Focal limb dystonias
- Incontinence due to bladder problems
- Anal sphincter disorders
- Peripheral nerve pain
- Temporomandibular disorder (jaw disorder)
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Possible ComplicationsComplications 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 the eyelids or brow line.Temporary issues may include:
- Stinging around the injection sites
- Flu-like symptoms
- 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
- Excessive weakness or wasting in certain muscles—the injection may slow any improvement in the muscle
- Neck weakness in people with long, thin necks
- Risk of the botulinum toxin spreading beyond the injection area—may cause botulism symptoms, including difficulty breathing and death in severe cases. Children with cerebral palsy may be at a higher risk for this side effect.
- This procedure may worsen nerve or muscle disorders, such as:
- Have an infection or inflammation in the area where botox will be injected
- Are sensitive to the ingredients in botox
- Are pregnant or breastfeeding
What to Expect
AnesthesiaMost often, none is given. Some people may prefer to have the area numbed for comfort. In this case, a topical anesthetic may be used.
Description of the ProcedureA thin needle will be used. The toxin will be injected through the skin into the targeted muscle. You will often need several injections in a small area.
After ProcedureRemember to:
- Remain upright for several hours
- Avoid alcohol
How Long Will It Take?The time needed 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 CareNormal activities may be resumed after the procedure.The toxin temporarily weakens targeted muscles. The treatment lasts up to 4 months. With repeated use, the effects may last longer.
Call Your DoctorIt is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:
- 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
American Society for Dermatologic Surgery
American Society of Plastic Surgeons
Canadian Dermatology Association
Allergan Physician Production Information. Botox cosmetic (botulinum toxin type A). Available at: http://www.allergan.com/assets/pdf/MSDS/ehs-botox.pdf. Updated January 11, 2010. Accessed February 12, 2014.
FDA approves Botox to treat chronic migraines. US Food & Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm229782.htm. Updated April 19, 2013. Accessed February 12, 2014.
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.
11/4/2009 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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 April 19, 2013. Accessed February 12, 2014.
3/19/2010 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: FDA approves Botox to treat spasticity in flexor muscles of the elbow, wrist and fingers. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm203776.htm. Updated April 24, 2013. Accessed February 12, 2014.
5/17/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Jackson JL, Kuriyama A, Hayashino Y. Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults: a meta-analysis. JAMA. 2012;307(16):1736-1745.
- Reviewer: Rimas Lukas, MD
- Review Date: 01/2015
- Update Date: 02/12/2014