Botox

Botox is the trade name of botulinum toxin A, a purified neurotoxin complex produced from Clostridium botulinum. This chemical blocks neuromuscular transmission by binding to motor nerve terminals and inhibiting the release of acetylcholine. Following intramuscular injection, the result is temporary chemical denervation muscle paralysis.

Botox has been used since 1980 to treat blepharospasm, hemifacial spasm and strabismus. More recently it was approved by the FDA to treat glabellar wrinkles (“frown lines” between the eyebrows). Today it is used to treat a wide range of medical conditions through the body.

Blepharospasm refers to a chronic, unremitting, bilateral, variably progressive dysfunction of the nerves that control muscles around the eyes. It manifests itself as an uncontrollable, forcible closure of the eyelids. In some cases, other muscles in the face can twitch as well, especially around the cheek and brow. Severe blepharospasm can cause the eyelids to be forcibly closed for a duration longer than the typical blink reflex, causing a variable interruption in the ability to see.

Hemifacial spasm is a neuromuscular disorder characterized by frequent involuntary contractions of the muscles on one side of the face. The earliest symptom is often an intermittent twitching of the eyelid that can lead to forced closure of the eye. The spasm may then gradually spread to the muscles of the lower face, which may cause the mouth to be pulled to one side. Eventually the spasms involve all the muscles on one side of the face almost continuously. The condition may be caused by a facial nerve injury or a tumor, or it may have no apparent cause.

The most common cosmetic applications for Botox are the reduction of glabellar frown lines, “crow’s feet” on the sides of the eyes, and horizontal forehead lines.

Facial lines and wrinkles have numerous causes. One way to evaluate facial wrinkles is to categorize them as static or dynamic. Dynamic wrinkles appear or are accentuated during facial movement. Botox is particularly beneficial at reducing the appearance of dynamic wrinkles, particularly in the forehead and periorbital regions. For example, Botox weakens the frontalis muscle, which elevated the eyebrows. During facial animation, the muscle contracts less, and appears smoother. Static wrinkles, which are present when the forehead is relaxed, are likely to be reduced but not eliminated.

The volume and concentration of Botox depend on the area being treated. The medicine is diluted in the office with saline, and injected intramuscularly with a small 30-gauge needle. The initial effect of Botox will become apparent an two or three days. The effects typically last for three to six months, depending on the location of injections and the condition being treated.

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