Botulinum Toxin Injections—Medical

(Botulinum Toxin Type A; Botulinum Toxin Type B; Botox Injections)

Definition

Botulinum toxin is made from a type of bacteria. It is toxic to the nerves. Another name for it is bacterial neurotoxin. An injection puts this toxin into muscle. There, it blocks the chemical signal from the nerves to muscles. This will decrease the muscle contraction (tightening).

There are several types and brands of this toxin. Examples include Botox, Dysport, and Reloxin, which are formulations of botulinum toxin type A. Myobloc is another brand, but it is a formulation of botulinum toxin type B. These products are used for cosmetic and medical reasons.

This injection process is often called botox injection , although any brand of the botulinum toxin may be used.

Reasons for Procedure

The injection is FDA-approved to treat:

Cervical dystonia (abnormal spasms of neck muscles)
Blepharospasm (spasm of eyelid muscles)
Strabismus (crossed eyes)
Hyperhydrosis (excessive sweating)

The injection has also been used to treat other conditions, such as:

Migraine headaches and tension headaches
Achalasia (spasm of esophageal muscles causing difficulties in swallowing)
Muscle spasms due to cerebral palsy
Spasticity in leg and arm muscles due to brain injury
Incontinence due to bladder problems
Anal sphincter disorders
Peripheral nerve pain
Temporomandibular disorder (jaw disorder)

Strabismus

Possible Complications

Complications are rare. When they occur, they are temporary and mild. Side effects are related to the site of injection. For example, if injections take place near the eyes, there may be complications with eyelids or brow line.

Temporary issues may include:

Redness
Bruising
Stinging around the injection sites

The following are less common reactions. They are generally mild and do not last long.

Nausea
Fatigue
Flu -like symptoms
Headache

Other complications that may occur include:

Excessive weakness of the muscle around the eyes—can cause drooping of the eyelids or obstruction of vision
Difficulty swallowing—can occur in patients receiving injections in their neck
Compensatory hyperhidrosis—people being treated for hyperhidrosis may develop increased sweat production at another area of the body
Excessive weakness or atrophy (wasting) in chosen muscles—the injection may slow any improvement in the muscle
Neck weakness in people with long, thin necks
Risk of the botulinum toxin spreading beyond the injection area—may cause botulism symptoms, including difficulty breathing and death in severe cases (Children with cerebral palsy may be at a higher risk for this side effect.)

This procedure may worsen nerve or muscle disorders, such as:
- Amyotrophic lateral sclerosis (ALS)
- Myasthenia gravis

The toxin can also interact with medicines, such as antibiotics. Tell your doctor about all of the medicines that you are taking.

You should not have botox if you:

Have an infection or inflammation in the area where botox will be injected
Are sensitive to the ingredients in botox
Are pregnant or breastfeeding

What to Expect

Anesthesia

Most often, none is given. Some patients may prefer to have the area numbed for comfort. In this case, a topical anesthetic may be used.

Description of the Procedure

A thin needle will be used. The doctor will inject the toxin through the skin into the targeted muscle. You will often need several injections in a small area.

After Procedure

There is very little recovery needed, but remember to:

Remain upright for several hours
Avoid alcohol

How Long Will It Take?

The length will depend on the number of sites involved. It is often less than 20 minutes.

Will It Hurt?

You may have some minimal discomfort.

Post-procedure Care

Normal activities may be resumed after the procedure. For the best recovery, follow your doctor's instructions .

The toxin temporarily weakens targeted muscles. The treatment lasts up to four months. With repeated use, the effects may last longer.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

Difficulty breathing
Difficulty swallowing
Difficulty speaking
Severe lower eyelid droop or obstructed vision
Excessive weakness around the injection site
Rash or any other sign of an allergic reaction

In case of an emergency, call for medical help right away.

RESOURCES

American Society for Dermatologic Surgery http://www.asds.net/

American Society of Plastic Surgeons http://www.plasticsurgery.org/

CANADIAN RESOURCES

Canadian Dermatology Association http://www.dermatology.ca/

Health Canada http://www.hc-sc.gc.ca/

References

Allergan Physician Production Information. Botox cosmetic (botulinum toxin type A). Published April 2008.

Baran R, Maibach H. Textbook of Cosmetic Dermatology . 3rd ed. New York, NY: Taylor and Francis; 2004.

Conn HF, Rakel R. Conn’s Current Therapy . 54th ed. Philadelphia, PA: WB Saunders Company; 2002.

Habif T. Clinical Dermatology . 4th ed. St. Louis, MO: Mosby; 2004.

Ondo WG, Gollomp S, Galvez-Jimenez N. A pilot study of botulinum toxin A for headache in cervical dystonia. Headache . 2005;45(8):1073-1077.

Ward A, Roberts G, Warner J, et al. Cost-effectiveness of botulinum toxin type A in the treatment of post-stroke spasticity. J Rehabil Med . 2005;37(4):252-257.

11/4/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : FDA gives update on botulinum toxin safety warnings. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm175013.htm . Updated August 3, 2009. Accessed November 4, 2009.

3/19/2010 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : FDA approves Botox to treat spasticity in flexor muscles of the elbow, wrist and fingers. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm203776.htm . Updated March 9, 2010. Accessed March 19, 2010.

5/17/2012 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Jackson JL, Kuriyama A, Hayashino Y. Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults: a meta-analysis. JAMA. 2012;307(16):1736-1745.

Revision Information

Reviewer: Mervin Low, MD, PC
Update Date: 05/17/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.