A Definitive Look at BOTOX® -- History and Procedure
Dr. George Wooming

The History

Introduced over thirty years ago, botulinum toxin A or BOTOX® was first administered by injection into the muscles surrounding the eye to patients suffering from crossed eyes. The derivative of the bacterium Clostridium botulinum produces a protein that interferes with muscle spasms by blocking nerve impulses and temporarily relaxing the muscle. Early successful clinical trials resulted in BOTOX® gaining FDA approval for treatment and/or relief of neck pain caused by cervical dystonia, involuntary facial muscle spasms, and eye misalignment (strabismus). Currently, BOTOX® is being assessed for treating a variety of conditions including migraine headaches, lower back pain, and excessive perspiration.

On April 15, 2002, Allergan earned FDA approval of BOTOX® Cosmetic for treatment of glabellar lines (the area located between the eyebrows, including the corrugator and procerus muscles). Since the approval, BOTOX® injections have become the most sought-after cosmetic treatment in clinics nationwide. The popularity of BOTOX® is attributed to its non-surgical nature, low occurrence of side effects, affordability, and effectiveness in reducing moderate to severe brow furrows, horizontal forehead wrinkles, and the tiny lines located at the outer corners of the eyes.

The Procedure

Loss of the skin’s elasticity is inevitable during the aging process. Less elasticity causes wrinkles to form, and after repetitive contractions and movement these wrinkles and lines remain visible when the muscles are relaxed.

Whereas in the past, smoothing lines and wrinkles required surgery, today a simple, virtually painless, ten-minute procedure generally delivers an equally impressive and satisfactory result. Via a fine gauge needle, BOTOX® is injected into the problematic facial regions to relax, thus weaken, the muscles. The inception of action of BOTOX® can vary from 24 hours to up to ten days. The peak effect of BOTOX® typically occurs two to three weeks after injection and the duration of effect is three to six months. Treatments can be repeated as often as necessary, typically every four to six months, as no long-term effects have been detected.

To achieve optimal results, it is advised that patients adhere to a few guidelines and suggestions before and after treatment. Although there are no reports of adverse drug interactions in healthy patients, anti-inflammatory medication, vitamin E, and aspirin should not be ingested two weeks prior to BOTOX® treatment, to avoid bruising at the injection site. Patients taking aspirin or other blood thinners (Plavix or Coumadin) must consult with their prescribing physician before discontinuing such medications. Patients with a low pain tolerance are encouraged to take Tylenol® or a similar pain relief medication before treatment or they can apply an over-the-counter topical anesthetic, elamax 4% cream, two hours before the injection. Patients taking non-steroidal anti-inflammatories (NASAID's) should consult with their prescribing physicians before taking any additional pain medication.

Following the injection, ice can be applied to the area to reduce any swelling and discomfort. Since the procedure takes but ten minutes, patients can return to their daily routine immediately. However, a four-hour period must pass before lying down. Massaging the treated area is prohibited as this might cause the BOTOX® to extend to the surrounding muscles. To enhance BOTOX®’s effectiveness, exercising the muscle every fifteen minutes throughout the first hour post injection is highly recommended.

BOTOX® has been used successfully for years in treating patients for a variety of conditions. As with every injection compound, there are a few potential side effects that may occur with treatment. The most common include minor swelling and bruising, the necessity of a second treatment due to ineffectiveness following the first injection, and a drooping of the eyebrow or eyelid. These side effects are very rare and almost always reversible, usually correcting themselves within two to three weeks.

George A. Wooming, M.D. is a board certified dermatologist. He is a graduate of the University of Miami School of Medicine where he received his Doctor of Medicine degree. He holds memberships in the American Academy of Dermatology, the American Academy of Cosmetic Surgery, the American Society for Dermatologic Surgery, the Texas Medical Association and the Dallas County Medical Society.

Copyright © 2003 George Wooming, M.D. All rights reserved.

BOTOX® is a registered Trademark of Allergan, Inc. This site is not an official site of Allergan, Inc.