Botox Through the Decades By Malena Amato MD

Botox (Botulinum Toxin type A) has been approved since 1989 to treat a variety of medical conditions involving muscular spasm for all ages. It was originally used on humans in the 1970’s by ophthalmologists in the form “oculinum” for the treatment of crossed eyes. More recently, the use botulinum toxin has been used by ophthalmologists to treat a disabling eyelid condition called blepharospasm as well as other eyelid and eye conditions. Since then, botox has been used by physicians to treat patients with crippling muscle spasms, sweating under the armpits, and is being considered for FDA approval against migraines and back spasms.

Botox has been used over the past few decades by Plastic surgeons, Ophthalmologists and Dermatologists for the treatment of facial wrinkles. It has become the anti-aging serum of the new millennium. Though it has only recently been FDA approved for marketing for cosmetic purposes, more than 1 million people used Botox last year for wrinkles.

Botulinum toxin is a toxic byproduct of a bacteria called Clostridium botulinum, that can be found as a contaminate in improperly processed canned food. Botulinum blocks achetylcholine, a chemical that transmits nerve signals to muscles to move. High doses of botulinum and its neurotoxin result in paralysis of muscles and can even be fatal. For therapeutic uses, the toxin is purified and largely diluted. Though some people are hesitant to receive a toxin, lethal doses are hundreds of thousands of units greater than a typical cosmetic injection, which contains on average 10-20 units.

Botox treatment for wrinkles is a relatively painless procedure as small amounts are injected with a small needle under the skin into the muscles controlling facial expression. Movement of these facial mucles are responsible for “dynamic” wrinkles, causing frown lines between the eyebrows, horizontal wrinkles across the forehead and crow’s feet at the corners of the eye. Treatment of these “dynamic” wrinkles with botox  has also had a benefit to reduce or soften static lines (lines present at rest)  as well. The effects of botox usually lasts 3-4 months.

The majority of people using botox are women, though the use of Botox for men is a growing market. Though infrequent, there are few side effects of botox, including drooping of the eyelids or eyebrows, loss of muscle function around the mouth causing drooling or drooping of the side of the lip. Botox can be variably effective in people, so it is important to go to an experienced injector who has an understanding of anatomy and facial function. Other types of botulinum neurotoxin are now FDA approved and available including Xeomin, Dysport and Myobloc, and some with equal efficacy. Longer acting neurotoxins are on the horizon!