Botox Injections
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Botox Injections

(Botulinum Toxin Type A)

Pronounced: Bow-tox

Definition

Injection of the bacteria, botulinum toxin Type A, into the skin or muscle blocks the signal from nerves to muscles. As a result, the muscles stop contracting.

There are several types of Botox (Botox Medical, Botox Cosmetic, Dysport Myobloc) that can be used for various conditions. While it is most commonly used to temporarily reduce or eliminate wrinkles, it is also effective in treating other conditions (eg muscle spasms, excessive sweating).

Wrinkles

frown line

© 2008 Nucleus Medical Art, Inc.

Parts of the Body Involved

Botox can be injected into any area of skin or muscle where temporary reduction in muscle contraction is desired. The most common areas include:

  • Face
  • Neck

To reduce excessive sweating, Botox may be injected into:

  • Palms
  • Underarms

Reasons for Procedure

Botox is most commonly used as a treatment to smooth wrinkles on the face and neck.

Botox is also FDA-approved to treat cervical dystonia (abnormal spasms of neck muscles), blepharospasm (spasm of eyelid muscles), strabismus (“crooked eyes”), and hyperhydrosis (excessive sweating). Botox has also been used to treat migraine headaches , achalasia (spasm of esophageal muscles causing difficulties in swallowing), muscle spasms due to cerebral palsy , and spasticity in leg muscles following a stroke .

Strabismus

Lazy eye

© 2008 Nucleus Medical Art, Inc.

Risk Factors for Complications During the Procedure

You should let your doctor know if you have a nerve or muscle disorder such as ALS ( amyotrophic lateral sclerosis , “Lou Gehrig’s disease”) or myasthenia gravis since Botox may make these conditions worse.

  • Excessive weakness or atrophy (muscle wasting) in muscles targeted for Botox injection may increase the chance of prolonged muscle weakness. (Note: This does not apply if the procedure is done for cosmetic reasons.)
  • Excessive weakness of the muscle around the eyes may occur causing drooping of the eyelids or obstruction of vision.
  • In persons with very long, thin necks, Botox injections in the area may cause neck weakness. (Note: This does not apply if the procedure is done for cosmetic reasons.)

What to Expect

Prior to Procedure

There are no special preparations prior to Botox injections.

Anesthesia

Anesthesia is usually unnecessary for this procedure, although some patients may prefer a topical anesthetic or other numbing medicine to reduce discomfort.

Description of the Procedure

Using a thin hypodermic needle, Botox is injected into the targeted skin or muscles. The procedure frequently involves several injections in a small area.

After Procedure

There is very little recovery necessary after Botox. Remain upright for several hours and avoid alcohol.

How Long Will It Take?

The procedure length varies depending on how many sites are injected. It typically lasts less than 20 minutes.

Will It Hurt?

Discomfort from Botox injections is usually minimal.

Possible Complications

Temporary redness, bruising, and stinging around the injection sites may occur. Nausea, fatigue, flu -like symptoms, and headache are very uncommon reactions. If they do occur they are generally mild and transient.

Temporary paralysis of muscles near the site of injection can occur. In rare cases, temporary eyelid droop may occur for several days or weeks after the injections. Difficulty swallowing can occur in patients receiving injections in their neck (for cervical dystonia).

Patients being treated for hyperhidrosis, excessive sweat production, may develop compensatory hyperhidrosis, or increased sweat production at another area of the body.

Some patients develop antibodies to botulinum toxin type A, which may reduce the effectiveness of future Botox treatments.

Average Hospital Stay

Botox does not require a hospital stay. It is performed as an outpatient procedure in a doctor’s office.

Postoperative Care

There is no postoperative care needed. Normal activities may be resumed after the procedure.

Outcome

Botox effectively weakens targeted muscles temporarily. The treatment lasts from 3-4 months. With repeated use, the effects of Botox may last longer.

Call Your Doctor If Any of the Following Occurs

Complications from Botox are rare, and when occurring 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. See your doctor if you experience these complications:

  • Severe lower lid droop or obstructed vision
  • Difficulty swallowing
  • Excessive weakness around the injection site

RESOURCES:

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

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

Cleveland Clinic Department of Plastic Surgery
http://www.clevelandclinic.org

CANADIAN RESOURCES:

BC Health Guide, British Columbia Ministry of Health
http://www.bchealthguide.org

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

References:

Baran R et al. Textbook of Cosmetic Dermatology . 3rd ed.Taylor and Francis; 2004.

Habif T. Clinical Dermatology . 4th ed. 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):1073-7.

Rakel R. Conn's Current Therapy 2005 . 57th ed. WB Saunders; 2005.

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):252-7.



Last reviewed March 2008 by Ross Zeltser, 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.


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