Although BOTOX® Cosmetic is not a filler, it is often used with dermal
filler procedures. BOTOX® Cosmetic is a simple, nonsurgical treatment
that can temporarily smooth
moderate to severe frown lines between the
brows in people from 18 to 65 years of age.
BOTOX® works by relaxing the facial muscles. It is a purified protein
produced by the clostridium botulinum bacterium, and has been approved by the FDA
since 2002 for treatment of glabellar lines – commonly known as frown lines
– between the eyes and above the nose. Treatments typically take 5 –
10 minutes. Although results may vary, after one 10-minute treatment—a
few tiny injections— within days there’s a noticeable improvement in moderate
to severe frown lines between the brows, which can last up to 4 months.
Since the needle is so tiny and the procedure so quick, healthcare professionals
do not usually numb the area being treated. However, in sensitive areas, such as
around the lips, some medical practitioners may apply local anesthesia just prior
to the treatment.
In 2007, almost 4.6 million procedures were performed with FDA-approved BOTOX®
Cosmetic, ranking BOTOX® as the leading cosmetic medical procedure
in the United States. While women received over 90% of the procedures performed
with BOTOX®, a growing number of men are receiving BOTOX®
each year. In fact, nearly twice as many men now receive BOTOX®
injections as did 5 years ago.1
Many plastic surgeons, dermatologists and other healthcare professionals who use
BOTOX® employ it for a wider spectrum of facial lines and wrinkles
that includes forehead lines, bunny lines (across the top of the nose), marionette
lines (below the corners of the mouth), smile lines and smoker’s lines.
BOTOX® is now also used as an effective treatment for hyperhydrosis
(excess sweating), and other disorders. Ask your healthcare
professional about the variety of treatments now available with BOTOX®.
It is advisable to select a healthcare professional who has performed at least hundreds
of BOTOX® procedures because techniques are often refined over time
for more natural, appealing looks. Inexperienced practitioners will be more likely
to leave you with a “frozen” look, or to drop a brow, or to leave you
with more uneven and unnatural looking results. We have determined a number
of medical practitioners nationally who have extensive experience with BOTOX®
cosmetic medical procedures. To see a list of experienced healthcare professionals
in your area, or to receive a special discount on your next BOTOX®
Locate a Specialist.
Post-marketing reports indicate that the effects of BOTOX® Cosmetic
and all botulinum toxin products may spread from the area of injection to produce
symptoms consistent with botulinum toxin effects. These may include asthenia, generalized
muscle weakness, diplopia, blurred vision, ptosis, dysphagia, dysarthria, urinary
incontinence, and breathing difficulties. These symptoms have been reported hours
to weeks after injection. Swallowing and breathing difficulties can be life threatening
and there have been reports of death. The risk of symptoms is probably greatest
in children treated for spasticity but symptoms can also occur in adults treated
for spasticity or other conditions, particularly in those patients who have underlying
conditions that would predispose them to these symptoms. In unapproved uses, including
spasticity in children and adults, and in approved indications, cases of spread
of effect have occurred at doses comparable to those used to treat cervical dystonia
and at lower doses.
No definitive serious adverse event reports of distant spread of toxin effect associated
with dermatologic use of BOTOX®/BOTOX® Cosmetic at
the labeled dose of 20 Units (for glabellar lines) or 100 Units (for severe primary
axillary hyperhidrosis) have been reported.
BOTOX® Cosmetic is contraindicated in the presence of infection at
the injection site(s) and in individuals with known hypersensitivity to any botulinum
toxin preparation or to the components in the formulation. Risks resulting from
administration at higher dosages other than those approved by the FDA are unknown.
Individuals with pre-existing neuromuscular disorders should only receive BOTOX®
Cosmetic with caution. Co-Administration of BOTOX® Cosmetic and aminoglycosides
or other agents interfering with neuromuscular transmission should only be performed
with caution as the effect of the toxin may be potentiated. BOTOX®
is not recommended for use during pregnancy.
For additional information, please refer to the
BOTOX® Package Insert and Medication Guide. Consult
your physician to determine if BOTOX® is right for you.
Mark M. Hamilton, MD F.A.C.S., Indianapolis, IN ~ Kimberly J. Butterwick MD, San Diego, CA
Gregory Nikolaidis MD, Marble Falls, TX ~ Alan B. Brackup MD FACS, Langhorne, PA
Carey J. Nease MD, Chattanooga, TN