Botox Dermatologic Uses

Cosmetic therapy with botulinum toxin is widely accepted as safe, effective, and affordable. These factors, along with the refinement of aesthetic dermatology to include a better balance between the correction of skin "defects" and the enhancement of expression, have made botulinum toxin injections the most commonly performed cosmetic procedure in the U.S. across all age groups. FDA-approved botulinum toxin is sold in the U.S. under the trade names Botox and Dysport.

Aging: Crease lines and wrinkles are a natural process of aging which result from the combination of three factors: #1) aging (including intrinsic "old age" and extrinsic aging from the sun), #2) gravity (skin sagging), and #3) muscular action (lines of facial expression). While filler injections with collagen or hyaluronic acid injections (among others) can be used to plump out (or fill in) wrinkles, many facial lines are largely the result of muscle overactivity and would, thus, be inadequately remedied with filling alone.

Clinical Science and Considerations: Botulinum toxin used for cosmetic purposes is a highly purified protein that affects the neuromuscular junction and causes weakness of the muscle. Only the smallest amount of toxin is injected to obtain the desired effect. Each area requires up to a few injections. No anesthesia is typically needed, but a topical numbing cream can be applied to reduce any discomfort associated with the tiny needle pricks. The injections are easily administered in an office setting.

Dermatologic Applications: While most cosmetic botulinum injections are used in the face to reduce movement-associated wrinkles, they are also used for hyperhidrosis (excessive sweating) of the underarms, palms, and soles. To follow are the most common dermatologic uses::

• Frown lines
• Horizontal forehead creases
• Crow's feet (around the eyes)
• Bunny lines (radiating down the sides of the nose)
• Chin dimpling
• "Smoker's lines" (around the mouth)
• Neck bands
• Hyperhidrosis (under arms, palms, soles)

Side Effects: Botulinum toxin injections are remarkably safe. Minor side effects include bruising and brief pain (or headache) at the injection site. Transient eyelid drooping has occurred in 1%-2% of patients who receive frown line treatments. This risk can be further reduced by avoidance of skin manipulation (rubbing) and maintaining an upright position for several hours after injection.

Contraindications: The use of botulinum toxin injections has not been studied in pregnant women, so should be avoided in those who are pregnant or breastfeeding. A history of neuromuscular disease may also be a relative contraindication to treatment.