Is Botox Safe For Treatment Of Wrinkles?

By Steven J. Yoon, MD

Maryland Eye Associates

. http://marylandeyeassociates.com

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Is Botox Safe For Treatment Of Wrinkles?

The botulinum toxin is a protein produced by the bacteria Clostridium Botulinum. It is a powerful neurotoxin that is known to cause botulism; a type of rare poisoning related to improperly handled food products.

The botulinum protein travels to neuromuscular junctions, the communication site between the nerves and muscles, and prevents the release of acetylcholine. By stopping the transmission of this signal, the muscle affected becomes temporarily flaccid and paralyzed.

In the 1980s ophthalmologists in the United States and Canada began to use a refined form of botulinum for the treatment of strabismus (misalignment of the eyes) and blepharospasm (uncontrolled blinking). It is still the most effective treatment for blepharospasm.

In 2002, Botox cosmetic was approved for the treatment of moderate to severe frown lines between the eyebrows (glabellar lines). Botulinum prevents wrinkle formation by inhibiting the contraction of the muscles beneath the skin. Results are visible within one week after treatment, and typically remain for a minimum of three months. Along with the frown lines, Botox cosmetic has been used off-label for crow's feet, forehead creases, bunny lines, smoker's lines, marionette lines, and platysmal bands. Other therapeutic uses of Botox include severe neck spasms, chronic migraines, excessive underarm sweating and upper limb spasticity.

Dynamic wrinkles occur when muscles contract during facial expressions. Areas most prone to dynamic wrinkles are those where the muscles are most active. For instance, when we smile the outer corners of our eyes wrinkle, and when we frown the vertical lines between our eyebrows become prominent. In our youth the skin rapidly went back into position, but with age and the loss of collagen, the wrinkles remain longer and become static wrinkles. While botulinum is ideally used for dynamic wrinkles, dermal fillers may be the treatment of choice for wrinkles that exist in the absence of any facial expression.

Botulinum treatments are considered extremely safe, but like any other prescription treatment, it is not without its risks. Side effects reported include bruising or discomfort at the injection site, dry mouth, headache and flu-like symptoms. Uncommonly, one may experience drooping of the eyelid, which usually improves within days. The FDA states the cosmetic use of Botox appears to be safe, however requires black box labeling, warning of fatal swallowing and breathing complications if the toxin spreads. By injecting directly into the target muscles, the risk of spreading to unwanted areas of the body is greatly reduced, and these complications have not occurred with Botox for cosmetic use. Those who are pregnant, breastfeeding or have neurologic disorders should not receive botulinum treatments.

There are several types of botulinum-based injectables on the market today. Botox cosmetic has had a monopoly for nearly a decade, however has run into some recent competition with the FDA approval of Dysport (2009) and Xeomin (2010). All contain the same active ingredient, botulinum toxin type A, however the preparations are slightly different for the three products. Having options available for the treatment of dynamic wrinkles may prove to be better for both the consumer and provider.