Shara Aaron, MS, RD
Botulinum toxin (botox) is made from a type of bacteria. Another name for it is bacterial neurotoxin. An injection of botox blocks the chemical signal from the nerves to the muscles, resulting in temporary paralysis of that muscle. This will decrease muscle contraction and reduce the formation of wrinkles.
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.
Botox is a general term. Any brand of the botulinum toxin may be used.
This is most commonly used as a treatment to smooth wrinkles on the face and neck. It is FDA-approved for the treatment of frown lines between the brows (glabella wrinkles) and the treatment of wrinkles at the outer corner of the eyes (crow's feet).
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 the brow line.
Temporary issues may include:
The following are less common reactions. They are generally mild and do not last long.
Other complications that may occur include:
FDA Public Health Advisory for Botulinum Toxin
There is a risk that the botulinum toxin could spread beyond the injection area. This can cause botulism symptoms, including difficulty breathing and death. These symptoms appear to be more common in children with
who receive the injection to treat spasticity. The warning is for Botox , Botox Cosmetic, Myobloc , and Dysport. For more information, please visit:
The toxin can also interact with medications, such as antibiotics. Tell your doctor about all of the medications that you are taking.
You should not have botox if you:
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.
A thin needle will be used. The toxin will be injected through the skin into the targeted muscle. You will often need several injections in a small area.
There is little recovery needed, but remember to:
The length will depend on the number of sites involved. It is often less than 20 minutes.
You may have some minimal discomfort.
Normal activities may be resumed after the procedure.
The toxin temporarily weakens targeted muscles. It can take up to 72 hours before the effects are noticeable. The treatment typically last for 3-4 months. With repeated use, the effects may last longer.
It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:
If you think you have an emergency, call for emergency medical services right away.
American Academy of Dermatology
American Society of Plastic Surgeons
Canadian Dermatology Association
Ondo WG, Gollomp S, Galvez-Jimenez N. A pilot study of botulinum toxin A for headache in cervical dystonia.
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
http://www.ebscohost.com/dynamed: 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 April 17, 2013. Accessed September 3, 2014.
10/1/2013 DynaMed Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: US Food & Drug Administration. FDA approves Botox Cosmetic to improve the appearance of crow's feet lines. US Food and Drug Administration website. Available at:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm367662.htm. Updated September 11, 2013. Accessed September 3, 2014.
Last reviewed September 2016 by Michael Woods, MD
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