Botulinum Toxin (Botox, Myobloc®) Injection is Top Cosmetic Treatment: More Than 1.6 Million Procedures
NEW YORK, NY (February 25, 2002) — Botulinum toxin injection (BTX), commonly known by the product names Botox and Myobloc®, was the top cosmetic procedure among the nearly 8.5 million cosmetic surgical and nonsurgical procedures performed in 2001, according to new statistics from the American Society for Aesthetic Plastic Surgery (ASAPS). More than 1.6 million BTX procedures were performed last year, an increase of 46% since 2000 and 2356% since 1997. BTX for wrinkle treatment is an "off-label" use, but an announcement of Food and Drug Administration approval of Botox for cosmetic uses is expected soon.
"For many people, Botox or Myobloc® treatment represents their first experience with cosmetic surgery," says Malcolm Paul, MD, president of the 35-year-old American Society for Aesthetic Plastic Surgery, which conducted the largest survey to day of U.S. physicians performing cosmetic surgery. "As a quick and effective treatment, with excellent results and virtually no downtime, it's perfect for those patients who have minimal signs of facial aging such as forehead furrows and crow's feet." BTX can often delay the need for more extensive surgery, adds Dr. Paul, but people should not think it achieves the same results as surgical procedures.
Although the term "botulism" refers to a variety of illnesses produced by a certain class of bacteria, the compounds (toxins) produced these organisms have been found to have therapeutic medical benefits. Beginning in the 1970s and '80s, BTX was used in the treatment of conditions such as weak eye muscles, involuntary spasmodic winking, muscle spasms of the face and neck, as well as facial asymmetry from nerve paralysis. Today, BTX has a new role in aesthetic surgery for the temporary treatment of frown lines, forehead furrows, "crow's feet," lines and wrinkles of the lower face, and even nasal muscles (to decrease the flaring of nostrils).
Treatment of lines and wrinkles
Aesthetic plastic surgeons have found that the type of lines and wrinkles that respond best to BTX are those caused by the muscles — specifically those muscles that are repeatedly over-contracted during facial expressions such as frowning or squinting. Patients who show early signs of aging, as well as those who may not be suitable candidates for more extensive facial aesthetic surgery, may be good candidates for this procedure. If facial surgery is elected, BTX may also be used as an adjunct, enhancing the result.
There are several different varieties of toxins produced by the bacterium Clostridium botulinum. Botox is a Type A strain, while the newer Myobloc® is a Type B strain. Both strains have been found to achieve similar results for cosmetic uses, though direct comparisons are still being clinically evaluated.
How it works
BTX blocks the transmission of impulses from the nerve cells to the muscle. This causes a temporary muscle weakening. By selectively interfering with the muscle's ability to contract, thereby reducing excessive contractions, existing lines are smoothed out over time and future lines may be prevented.
The vertical forehead creases that develop between the eyes as well as the horizontal lines on the forehead were the first aesthetic areas to be treated by plastic surgeons with BTX. After the procedure, these lines will be improved at rest, and frowning will no longer create as deep a furrow.
Some physicians speculate that BTX injections may actually delay degenerative changes; however, as yet there are no long-term scientific data available.
The procedure is performed with the patient in a sitting position. The patient should maintain an upright position for about 4 hours until the toxin attaches to and acts upon the nerve-muscle connection. During the injection, which is performed with a tiny needle, the patient is asked to contract the muscles in the area being treated so that the surgeon can determine the proper location for injection. The diluted toxin, in most cases, is injected directly into the muscle.
Duration of effect
The effects of the BTX are usually noted within 24 to 48 hours after injection. On average, they last for approximately 4 months (range, 1 to 5 months). Therefore, improvements are temporary and injections may be repeated to maintain the desired effect. Some surgeons believe that the duration of muscle "relaxation" is cumulative and lasts longer with each treatment, although there are no supporting scientific data. In some case studies, a small percentage of patients are reported to experience no improvement at all following the injections.
Possible risks and side effects
To date, no systemic complications associated with BTX have been documented. As with all biologic products, there is a rare possibility of an allergic reaction. Among the most common side effects are local numbness, swelling, bruising, or a burning sensation during injection. Headaches or nausea may also occur. These are usually temporary and typically disappear within a few hours. Bruising and swelling may persist for several days.
There have been cases of mild to moderate drooping of one or both eyelids, which usually lasts about 2 weeks. These effects, or more serious problems, may occur as a result of inaccurate injection of the toxin - one of many reasons, says Dr. Paul, why it is important to choose a board-certified physician with appropriate training. "People may think that the procedure is only a simple injection and not realize that it requires an in-depth knowledge of the facial muscles and the relationship of these muscles to normal facial movement," says Dr. Paul. "A skilled aesthetic plastic surgeon will use Botox or Myobloc® to enhance a person's appearance, not create an unnatural or 'mask-like' quality to the face."
Currently, there are no known long-term effects of repeated BTX injections.
Individuals who take aspirin or anti-inflammatory medications may experience increased bruising from BTX injection. Taking certain medications (specific antibiotics, for example) may increase the potency of the BTX. Therefore, patients should provide a full disclosure to their surgeon of all medications they are taking.
Pregnant or nursing women should discuss undergoing this procedure with their surgeon. Currently, it is not known whether BTX has any effect on a fetus or whether it is found in breast milk, so most physicians recommend discontinuing injections during pregnancy and lactation.
BTX injections are commonly performed by members of the American Society for Aesthetic Plastic Surgery, board-certified plastic surgeons who specialize in cosmetic procedures. "One advantage in consulting with an ASAPS-member plastic surgeon for Botox injections is that he or she has the training and experience to assess whether this type of treatment will really solve your problem, or whether a minimally invasive or other surgical procedure may be the best solution," says Dr. Paul.
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.
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