Botox^® and Wrinkles

Botox^® (botulinum toxin) is a protein that causes botulism, a serious and sometimes fatal foodborne illness. In very diluted form, however, Botox® has become a popular treatment for  facial wrinkling. By injecting tiny amounts of diluted toxin into the forehead muscles and the muscles around the eyes, dermatologists can temporarily ease some of the wrinkles caused by aging.

The toxin has  several other medical uses, including certain eye disorders, severe underarm sweating and severe muscle spasms in the neck and shoulder.

Although Botox® can be deadly, the risk for contracting botulism from the diluted toxin used medically is quite low.

Medical Uses

Botox® has two types: A and B. Type A is prescribed for lazy eye, or strabismus, a condition in which one eye wanders. It is also prescribed for another eye disorder called blepharospasm, a spasm of the muscles around the eye. Type A also is used to treat frown lines between the eyebrows. Type B is used to treat cervical dystonia, which causes severe muscle spasms in the neck and shoulder.

The toxin is also approved for treating severe underarm sweating that can't be relieved by prescription antiperspirants. This condition is called auxiliary hyperhidrosis. The toxin also appears to reduce scarring from facial wounds left by the removal of skin cancers.

Current research trials are exploring a range of other medical uses for the toxin, including treatments for cerebral palsy, myofacial pain syndrome, arthritis pain, overactive bladder and migraine headaches.

Wrinkle Treatment

Botox®,  eases wrinkles by immobilizing muscles. The toxin blocks nerve signals that tell the muscles to contract. Without those signals, the muscles cannot move. When the immobilized muscles are those responsible for breathing, for example, the result can be fatal, as in botulism. When those muscles are between your eyebrows, the result can be a smoother face.

In addition to treating wrinkles between the eyebrows, the toxin is also used for wrinkles on the bridge of the nose, at the corners of the eyes and on the neck, and the horizontal lines on the forehead.

The toxin is diluted with a normal saline solution and injected five to 10 times with a small needle. The results are not immediate. It takes three to seven days to work, and the effect is temporary, lasting three to four months. At that point, the muscles resume their ability to contract. Because of this, treatment is often repeated regularly. With recurring treatment, the muscle eventually becomes thinner and the treatment results may last longer.

Who Uses It

Although middle-aged women have been the primary patients for this treatment, an increasing number of men are signing up for the toxin. Men usually have larger facial muscles than women, and require larger doses of the toxin to achieve the same results.

The cost for toxin treatment varies, depending on the extent of treatment needed. Typically, treatment ranges from $300 to $700 per session. Treatments usually are not covered by health insurance.

Advocates of Botox® as a treatment for wrinkles point out that the sessions are much cheaper than cosmetic surgery. Opponents argue that the temporary nature of the treatments make them expensive in the long run. In addition, the toxin can be used only on muscles that aren't needed for other purposes. The muscles around the mouth, for example, should not be treated with the toxin, because they are needed for talking and eating. Some experts say that a more feasible use for the toxin might be as a "trial run" for a cosmetic procedure, allowing a person to see what a permanent procedure could accomplish.

Cautions and Side Effects

Botox® should only be given by qualified health care providers familiar with the treatment's effects. The toxin may make certain medical conditions worse, for example. These include heart disease, and nerve or muscle disorders such as Lou Gehrig's disease or myasthenia gravis.

You should take these precautions:

• Do not use aspirin or other anti-inflammatory medication before getting treatment, because these drugs can make you bruise more easily.

• Do not bend over or lie down for six hours after an injection. This helps prevent the toxin from spreading to other muscles.

• Aboid drinking alcohol after a toxin injection.

These are possible temporary side effects of Botox® treatment:

• Soreness at the injection site. You should avoid pressing on the spot after getting an injection.

• Muscle soreness throughout the body.

• Difficulty swallowing.

• Rash.

• Less frequent blinking. You may need to use eye drops or ointment to maintain the moisture in your eyes until the toxin's effects wear off enough for you to blink normally.

Treatments may trigger the creation of antibodies against the toxin. This may make additional treatments less effective.

Talk to your health care provider if you have other questions about Botox®.