Botulinum Toxin - Medical and Cosmetic Uses

Medical and Cosmetic Uses

Although botulinum toxin is a lethal, naturally occurring substance, it can be used as an effective and powerful medication. Researchers discovered in the 1950s that injecting overactive muscles with minute quantities of botulinum toxin type-A would result in decreased muscle activity by blocking the release of acetylcholine from the neuron by preventing the vesicle where the acetylcholine is stored from binding to the membrane where the neurotransmitter can be released. This will effectively weaken the muscle for a period of three to four months.

In cosmetic applications, a Botox injection, consisting of a small dose of botulinum toxin, can be used to prevent development of wrinkles by paralyzing facial muscles. As of 2007, it is the most common cosmetic operation, with 4.6 million procedures in the United States, according to the American Society of Plastic Surgeons. Qualifications for Botox injectors vary by county, state and country. Botox cosmetic providers include dermatologists, plastic surgeons, aesthetic spa physicians, dentists, nurse practitioners, nurses and physician assistants. The wrinkle-preventing effect of Botox normally lasts about three to four months, but can last up to six months.

In addition to its cosmetic applications, Botox is currently used in the treatment of spasms and dystonias, by weakening involved muscles, for the 60–70 day effective period of the drug. The main conditions treated with botulinum toxin are:

• Cervical dystonia (spasmodic torticollis) (a neuromuscular disorder involving the head and neck)
• Blepharospasm (excessive blinking)
• Severe primary axillary hyperhidrosis (excessive sweating)
• Strabismus (squints)
• Achalasia (failure of the lower oesophageal sphincter to relax)
• Local intradermal injection of BTX-A is helpful in chronic focal neuropathies. The analgesic effects are not dependent on changes in muscle tone.
• Migraine and other headache disorders, although the evidence is conflicting in this indication

Other uses of botulinum toxin type A that are widely known but not specifically approved by the FDA (off-label uses) include treatment of:

• Idiopathic and neurogenic detrusor overactivity
• Pediatric incontinence incontinence due to overactive bladder, and incontinence due to neurogenic bladder
• Anal fissure
• Vaginismus to reduce the spasm of the vaginal muscles
• Movement disorders associated with injury or disease of the central nervous system, including trauma, stroke, multiple sclerosis, Parkinson's disease, or cerebral palsy
• Focal dystonias affecting the limbs, face, jaw, or vocal cords
• Temporomandibular joint pain disorders
• Diabetic neuropathy
• Wound healing
• Excessive salivation
• Vocal cord dysfunction, including spasmodic dysphonia and tremor
• Reduction of the masseter muscle for decreasing the apparent size of the lower jaw
• Painful bladder syndrome
• Detrusor sphincter dyssynergia and benign prostatic hyperplasia

Treatment and prevention of chronic headache and chronic musculoskeletal pain are emerging uses for botulinum toxin type A. In addition, Botox may aid in weight loss by increasing the gastric emptying time.