Used for many years to treat unwanted spasms of facial muscles, we recommend Botox injections to reduce frowning and wrinkling. This smoothing of wrinkles can be performed before that special event or every 3-4 months for maintenance.

Botox injection before skin resurfacing procedures seems to enhance the skin smoothing effect. (Please see Laser Skin Resurfacing.)

Example 1
Attempted frowning before and after Botox injection. Smile wrinkles at the outer corner of the eyes respond especially well to the treatment. This woman has also undergone full face laser skin resurfacing.

Example 2

Example 3
This 30 year old lady desired elevation of her eyebrows with Botox.  The treatments were placed to weaken the muscles depressing the eyebrows.

FDA-approved uses:

• Strabismus and blepharospasm, approved in 1989
• Cervical dystonia, approved in 2000
• Hyperfunctional facial lines, approved in 2002

Therapeutic off-label uses:

• Focal dystonia
• Spasticity
• Stroke
• Cerebral palsy
• Spinal cord injury
• Multiple sclerosis
• Hyperhidrosis
• Tics and tremors
• Localized muscle spasms and pain
• Chronic low back pain
• Temporomandibular joint disorder
• Headaches (migraine and tension)

FDA Approval for Botox Cosmetic Underscores Need for Expanded Physician Understanding

The Food and Drug Administration's recent approval for the cosmetic application of botulinum toxin type A (BTX-A) finally made official a longstanding off-label use of the neurotoxin. Derived from the bacterium clostridium botulinum and produced and distributed in the United States by Allergan, Inc., BTX-A has been in use for years for a wide range of conditions such as focal dystonia, spasticity and other disorders relating to involuntary muscle activity Not until 1989 did the FDA grant approval for the use of BTX-A. That approval applied only to the treatment of strabismus essential blepharospasm and hemifacial spasm. Cervical dystonia was added to the list of approved uses in late 2000. These approved neurological conditions represent only a small number of the disorders found to respond to BTX-A, while physicians continue to demonstrate the new applications of the neurotoxin.

Approved use limited to glabellar lines, but many facial muscles are found to respond

In the exploration of off-label uses of Botox, facial plastic surgeons found that its acetylcholine-blocking action worked to minimize the effects of contracting facial muscles–contractions that over time cause wrinkles and furrows on the skin, particularly between the brows. In fact, the FDA approval for BTX-A is limited to only treating those glabellar lines that result from corrugator and/or procerus muscle hyperactivity, though the treatment has also been used to combat transverse forehead lines, lateral canthal wrinkles and for treatment of hypertrophic platysma bands, among other locations on the face.

The simplicity of the minimally invasive, in-office procedure, limited contraindication and risk, ease of recovery and the often dramatic results produced with Botox have made it the most popular cosmetic procedure performed in the United States. With FDA approval, Allergan, Inc. has already begun its media blitz to promote the cosmetic use of Botox, and demand for the procedure is sure to increase. Healthcare professionals can best help patients who desire Botox cosmetic procedures by becoming familiar with the indications and risks and, perhaps most importantly, by communicating the fact that the procedure should be performed only by a specialist with a deep understanding of the musculature of the face.

Who benefits most from cosmetic Botox?

The best candidate for BTX-A is under the age of 65, generally has thin skin and has wrinkling that is caused by hyperfunctioning facial muscles rather than photoaging. Patients should also have no scarring around the injection sites, no preexisting motor neuron disease and no history of hypersensitivity to the toxin. Pregnant or lactating women should avoid the procedure.

Risks & complications

BTX-A injections are extremely safe. Reported side effects are generally minimal and transient. Patients may report a stinging sensation at the injection site, particularly around the eyelids, and as with any injection, some bruising may occur. A somewhat common adverse effect is the paralysis of muscles adjacent to those injected, but this is temporary Rare adverse effects include asymmetry in the face and ptosis resulting from injections given too close to the brow or eyelid. This effect on the eyelid can also lead to an improper blink response and/or epiphora. Double vision (diplopia) can also result if an extraocular muscle is affected.

Experience is number-one criterion in selecting a source for treatment

A quick and simple procedure to perform, BTX-A treatment still requires the skill and experience of a specialist. The most common complication, toxin that migrates to surrounding muscles, may be more easily avoided by a surgeon who has expertise with these muscles. Patients in the Madison, Eau Claire, Friendship and Oshkosh areas who desire a Botox procedure can benefit from one of the pioneers of Botox, Bradley N. Lemke, MD, FACS.

Dr. Lemke is an eye plastic surgeon who is board-certified by the American Board of Ophthalmology and by the American Board of Cosmetic Surgery in Facial Cosmetic Surgery. His expertise in the use of botulinum toxin type A began with his role in the development of Botox for the treatment of blepharospasm. In private practice and at the University of Wisconsin Medical School, Dr. Lemke participated in the original clinical trials for Botox nearly two decades ago. Today he remains a pioneer in its use for ophthalmologic conditions and cosmetic uses. He is pleased to talk with you concerning the needs of your patients who are interested in Botox and may be reached by phoning 800.404.FACE.