PROCEDURES OF THE FACE, HEAD AND NECK: BOTULINUM TOXIN (BOTOX® COSMETIC) FOR FROWN LINES

Botox® is a brand name for a botulinum toxin, a protein produced by the Clostridium botulinum bacterium. It works by blocking nerve impulses, which "paralyzes" targeted muscles. It has been used for several years as a drug to treat certain medical conditions. It was approved by the Food and Drug Administration (FDA) in April 2002 for cosmetic use to treat frown lines (wrinkles between the brows) in people age 65 or younger.

How Does It Work?

The paralyzing effect of the drug can reduce the frown lines that are caused by movement of certain muscles. A physician uses a very fine needle to inject a tiny amount of the drug around the area to be treated. This paralyzes the muscles that cause the lines, creating a smoother appearance. Generally, this does not otherwise affect facial expression.

How Long Does It Last?

It may take a few days for any changes to become noticeable. The effects of the injections wear off after three to six months, and treatment must be repeated to maintain the smoothing effect.

What Are the Side Effects and Complications?

The most common side effects are headache, respiratory infection, a "flu-like" feeling, nausea and temporary eyelid droop. Less common side effects include facial pain, redness around the injection sites, or weakness of the adjacent muscles. Occasionally, these side effects may last for a few months.

Rare, but serious complications can occur, particularly if the toxin migrates to muscle fibers beyond the ones targeted. These complications can include:

· Drooping brows or lips

· Double vision

· Eyelid problems, including inability to close the eyes.

· Infection at the injection site

· Allergic reaction

Who Shouldn't Get Botulinum Toxin Treatments?

Because botulinum toxin injections are medical treatments, not everyone is a good candidate. It's important to discuss your situation and your expectations with your doctor. You and your doctor should use special caution before deciding on botulinum toxin treatments if you have any of the following conditions:

· Existing weakness in the targeted muscles

· Ptosis (drooping eyelids)

· Deep facial scars

· Very thick facial skin

· Neruomuscular disorders

· Cervical dystonia (a condition involving involuntary movement of the neck muscles)

· Pregnancy or nursing

· Noticable facial asymmetry

· Skin disorders around the planned injection sites

Who Should Do Botulinum Toxin Treatment?

Botulinum toxin treatments are serious medical procedures, and it is unsafe and illegal for anyone but a licensed health care provider to perform them. Treatments are performed by several types of physicians. An Eye M.D. (ophthalmologist) is a good choice because he or she is the most familiar with the anatomy and function of the areas surrounding the eyes.

Are Botulinum Toxin Treatments Covered by Insurance?

Because they are considered cosmetic, treatments are generally not covered by medical insurance. Some providers may offer payment plans for cosmetic procedures. It is important to discuss charges with your provider before deciding to undergo treatment.