Botox (Botulinum Toxin Type A) is the brand name for a cosmetic treatment that temporary improves facial lines (wrinkles) between the eyebrows and in other areas. It is a sterile, purified form of the Clostridium botulinum, a bacterium that contains the toxin responsible for food poisoning. Saline is added to Botox to dilute its potency before use, in varying amounts according to the physician.

Normally, the brain sends electrochemical messages to the muscles, causing them to contract and move. These messages are sent from a nerve to the muscle by a substance called acetylcholine. The cosmetic use of Botox works by producing a protein that blocks nerve signals to muscle, causing paralysis of the injected muscle. It stops the release of acetylcholine from the nerve which relaxes the muscle. This greatly reduces, and in some cases prevents, movement of the muscles.

It takes 24 to 48 hours for the muscle weakness or paralysis to develop. The results, however, are not permanent. After about two to six months, the nerve will recover and start releasing acetylcholine again, causing the muscles to become active. At this point, the patient will require a new injection of Botox.  

Botox was originally used to treat muscle disorders, including facial dystonias, uncontrolled blinking and lazy eye. In addition, fewer units per injection of Botox may be used to treat hyperhidrosis (a disorder characterized by excessive sweating) by paralyzing sweat glands in the underarms, hands and feet. Botox was approved for cosmetic use in the United States by the U.S. Food and Drug Administration (FDA) in 2002.

Studies have suggested that Botox can be effectively used as a treatment for a number of other conditions, including migraine headaches, overactive bladder, tennis elbow (lateral epicondylitis) and enlarged prostate. However, additional research is needed to determine the safety and effectiveness of using Botox to treat these conditions.

Wrinkles that appear across the forehead, between the eyebrows (glabellar lines), around the eyes (crow’s feet) and on the bridge of a person’s nose are the result of muscle movement (e.g., frowning, squinting) over time. Muscle bands on the neck may also become visible with age. When Botox is injected into these wrinkles, it temporarily reduces the contractions of the underlying muscles. This diminishes the appearance of wrinkles for up to 120 days, according to the FDA.

Improvement in the appearance of wrinkles will vary according to the practitioner performing the injections and the depth of the facial lines. Botox is not typically used for lines around the mouth because the underlying muscles in this region are needed for essential functions, such as talking and eating. It is important to note that Botox injections will not radically alter a patient’s facial appearance or affect their ability to make facial expressions.

There are some effects from aging that cannot be temporarily remedied with Botox. Excess fat around the face, loss of skin elasticity and decreased muscle tone will not respond to treatment with Botox.

According to the American Society for Aesthetic Plastic Surgery (ASAPS) 3,181,592 Botox injections were given in 2006.  It was the leading cosmetic procedure (both surgical and nonsurgical) among both men and women. The treatment is indicated for use by adults between the ages of 18 and 65.

There is growing controversy in the medical community over the mass treatment of patients who attend “Botox parties.” During these gatherings, individuals socialize with one another, consult with a Botox practitioner and receive injections of the toxin. Some practitioners contend that Botox parties are a good way for patients to receive more affordable injections in a more relaxed atmosphere. However, critics claim that the bulk distribution of Botox is potentially dangerous because each vial of Botox is intended for a single patient during a single treatment session, and there is no preservative in Botox to prevent contamination if a single vial is used repeatedly. In addition, Botox parties often involve the consumption of alcoholic beverages, which may intensify bruising in some patients.

In addition, the FDA is growing concerned that there is a great potential for Botox abuse. Recent ASAPS reports indicate that Botox is being dispensed by unqualified people in home-based offices, hotel rooms, gyms, salons and other retail settings.

Currently, Botox is the only drug of its kind available for use in the United States. However, other similar drugs are presently awaiting FDA approval for use in the United States. One such drug, Myobloc (Botulinum toxin type B), has been approved for the treatment of cervical dystonia (muscle spasms in the neck) and patients may consent to “off-label use” of the drug for cosmetic purposes. The term “off-label” refers to the use of approved drugs for a purpose other than which it was originally intended, and that was not approved by the FDA.