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Botox Injection

Botox injection

Definition

Botox is the brand name of an injectable toxin produced by the bacterium Clostridium botulinum. This is the same toxin that causes food poisoning. Botox was first approved for use by the Food and Drug Administration (FDA) in 1989. Used in small amounts in a sterile, purified form, Botox blocks the release by nerve cells of a chemical called acetylcholine. Acetylcholine stimulates muscle contractions but when Botox is injected into the muscle it decreases or blocks the signals that cause muscles to contract.

Purpose

Botox is used to treat muscle spasms of the neck (cervical dystonia). It is also injected into the muscles that regulate eyeball movement to treat lazy eyes (amblyopia) or crossed eyes (strabismus). Botox is also injected into the eyelid muscles to treat uncontrollable blinking or twitching (blepharospasm) caused by abnormal muscle contractions. Botox is also used cosmetically to treat facial wrinkles and creases and decrease signs of aging in patients 65 years of age and younger. It is most often used on wrinkle lines on the forehead, crow's feet (lines around the eyes), and frown lines between the eyebrows. Botox is not effective for wrinkles caused by sun damage or those caused by the effects of gravity. It may also be used to treat severe underarm perspiration (hyperhydrosis) that has not responded to other treatments. Other uses for Botox are currently being investigated

including use for prostate symptoms in men with enlarged prostate and for treating symptoms in patients with migraine headaches .

Precautions

People who are physically healthy and have no history of neuromuscular diseases (such as multiple sclerosis or myasthenia gravis), who are not pregnant or nursing, and who are at least 18 years old are the best candidates for Botox treatment.

Description

A topical anesthetic cream may be used to numb the area(s) where Botox will be injected. Small amounts of Botox are injected into the desired location(s). The amount of medication injected will depend on the condition being treated and how the patient responds to Botox. For cosmetic Botox treatment, the patient may be asked to contract the facial muscle to be injected by frowning or squinting.

The procedure is essentially painless with only slight discomfort from the injection. The discomfort ends after the procedure is complete. The procedure usually takes less than 30 minutes.

Botox injection is one of the most popular cosmetic medical procedures in the United States. The overwhelming majority of Botox users are women aged 35 to 50 years of age. The cost per treatment is $300 to $1000 with an average cost of approximately $400. Insurance coverage varies and depends on the reason the procedure is being done.

Preparation

A meeting with the physician who will perform the procedure will help determine how well the procedure will meet the patient's expectations. The physician will complete a medical history and determine what medications the patient is taking. Photographs may be taken before the procedure.

It is recommended that consumption of alcohol be avoided for at least one week before the procedure. To decrease bruising , aspirin and anti-inflammatory medication should be discontinued at least two weeks before the procedure.

Aftercare

There is essentially no recovery period and little or no bruising, bleeding, or pain after the procedure. Normal activities can be resumed without interruption. Rarely headache may occur for a few hours after the procedure and last for a day or two. There may be tenderness at the injection site(s).

After the procedure, patients are encouraged to repeatedly use face muscles that were injected to attract Botox to the intended area(s). The patient should refrain from touching or massaging the injection site(s) for twelve hours or lying down for three or four hours after the procedure because of the possibility that the toxin will spread beyond the treatment area to other areas (migration). Avoid exercising for 24 hours after the procedure.

Complications

Not everyone will experience side effects and if side effects do occur, they are usually minor and require little or no treatment. Side effects of the procedure include redness, headache, flu-like symptoms, nausea, temporary facial weakness or drooping, and migration of the toxin beyond the intended treatment area. Migration of the toxin beyond the intended treatment area into non-targeted muscles may cause other symptoms including difficulty swallowing, muscle weakness, slurred speech, and trouble breathing.

Results

Botox used for cervical dystonia decreases abnormal head position and neck pain caused by muscle spasms. Results normally last a few months.

Botox improves eyelid twitching or spasms and crossed eyes caused by muscle contractions. Botox results usually become evident within three days and last up to three months for blepharospasm. For strabismus, treatment results become apparent within one to two days of the injection and last for two to six weeks.

Results from Botox used for cosmetic reasons are noticeable within a few days but it may take up to two weeks for full effects to become evident. Results usually last for four to six months. As the effects of Botox wears off, lines and wrinkles begin to reappear. With repeated use, lines and wrinkles are less prominent in appearance because the muscles become “trained” to relax from not being used. Botox for severe underarm sweating may decrease sweat production by 50% or more with results lasting about six months.

QUESTIONS TO ASK YOUR DOCTOR

  • What are the benefits of the procedure?
  • What are risks associated with the procedure?
  • What results can I expect?
  • What is the recovery period after the procedure?
  • How long will the results last?
  • Was it the cost of the procedure?
  • Will my insurance cover the cost?

Caregiver concerns

The procedure should be performed in a controlled medical setting so that adverse reactions or side effects during or after the procedure can be handled as indicated. Botox should be administered using sterile technique and performed only by a physician trained and experienced in performing the procedure. The physician should be board certified in dermatology, otolaryngology (ears, nose, and throat), or plastic surgery.

Resources

OTHER

“Botox.” http://www.medicinenet.com/botox_treatment/article.htm

“Botox.” http://www.nlm.nih.gov/medlineplus/botox.html

“Botox: Another Shot at Looking Young.” http://health.discovery.com/centers/plasticsurgery/face/botox.html

“Botox: Is this the wrinkle treatment for you?” http://www.mayoclinic.com/health/botox/SN00040

“Botox Injections.” http://www.emedicinehealth.com/botox_injections/article_em.htm

“Botox Injections.” http://www.emedicine.com/plastic/topic509.htm

“BotulinumToxin (BOTOX) for Treating FacialWrinkles.” http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZ7QNLURDD&sub_cat=2019

“Botulinum Toxin Type A.” http://www.medicinenet.com/botulinum_toxin_type_a/article.htm

“Information on Botox Injections.” http://www.smartplasticsurgery.com/botox_injections.html

“What is Botox?” Ezinearticles. http://ezinearticles.com/?What-is-Botox?&id=350685

“What is Botox and How Does it Work?” http://www.pier55.com/Health-Fitness/Botox-Treatment.shtml

June G. Borazjani R.N., M.S.N., C.P.H.Q.

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