Now that I have established the safety of BOTOX in my first post and detailed the mechanism of action in my most recent post we can discuss why to bother injecting botulinum toxin at all. The uses are varied but first a few words about the Food and Drug Administration(FDA). The FDA allows pharmaceutical manufacturers to market, whether to consumers or to physicians, only claims about their products that have been approved by the FDA. FDA approval usually requires that a product be shown to be safe and effective through several phases of clinical trials. Once a pharmaceutical has been approved for one purpose, a licensed physician may prescribe the drug for other purposes. For example, the beta-blocker, nadolol, which is approved for use by the FDA to lower blood pressure is also prescribed by physicians to improve migraine headache severity and frequency.
Allergan, the makers of BOTOX, and Merz, the makers of Xeomin, are allowed by the FDA to advertise to both consumers and physicians for only certain problems. This list, while more extensive for BOTOX than Xeomin, includes not only cosmetic but also medical indications. The cosmetic indications are two: temporarily improving the look of ‘frown lines’ between the eyebrows and ‘laugh lines’ or ‘crow’s feet.’ Many other off-label possibilities exist which I will get to in a minute. First, the medical indications requiring a specialist include blepharospasm (an abnormal twitching or closing of the eyelid), cervical dystonia (a spasm of a neck muscle causing pain and an abnormal turning of the head, also known as ‘spasmodic torticollis’), strabismus (eye misalignment), urinary incontinence caused by a spastic bladder and other muscle rigidity or spasm often caused by cerebral palsy. Other medical indications, which can be treated by a properly trained physician, included chronic migraine headaches and axillary hyperhidrosis (yes, excessively sweaty under arms).
The list of off-label uses includes forehead wrinkles, eyebrow lift, bunny lines (wrinkles at the bridge of the nose when smiling), lip lines (also known as “smoker’s lines”), gummy smile (showing the upper gums when smiling), marionette lines (wrinkles formed just below the corners of the mouth when grimacing), chin crease, neck bands (the neck muscle that flare out and pull on the jaw line), masseter shaping (rounding the angle of the jaw), calf shaping (softening the inside of the calf) and palmar hyperhidrosis (you guess it, excessively sweaty palms). Finally, some on-going research involves using BOTOX to treat depression. There is probably more but I think you get the idea, lots of different uses.
Thanks for your attention,
Robert Zieber, MD
De Luz Medical Aesthetics