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Botox: Cosmetic and medical uses

What is Botox?
How does it work?
Cosmetic uses
Medical uses
Procedure
Cost
Risks
Summary
Botox is a protein made from Botulinum toxin that temporarily paralyzes muscle. In small doses, it can reduce skin wrinkles and help treat a range of medical conditions, including eyelid spasms and some types of migraine.

The bacterium Clostridium botulinum produces Botulinum toxin, which is the same toxin that causes botulism.

Botox is a toxin, but when doctors use it correctly and in small doses, it can have benefits. It has both cosmetic and medical uses.

As a cosmetic treatment, Botox injections can reduce the appearance of skin wrinkles.

Also, the Food and Drug Administration (FDA) have approved it as a treatment for various health issues, including eyelid spasms, excessive sweating, some bladder disorders, and migraine.

In this article, we explain how Botox works and explore its uses, side effects, and other risks.


What is Botox?
Credit Image: Leren Lu/Getty Images
Botox derives from C. botulinum bacteria, which are present in many natural settings, including soil, lakes, forests, and the intestinal tracts of mammals and fish.

Naturally occurring C. botulinum bacteria and spores are generally harmless. Problems only arise when the spores transform and the cell population increases. At a certain point, the bacteria begin producing Botulinum toxin, the deadly neurotoxin responsible for botulism.

Botulinum toxin is extremely dangerous. Some scientists have estimated that 1 gramTrusted Source of a crystalline form of the toxin could kill 1 million people and that a couple of kilograms could kill every human on the planet.

However, when Botox is appropriately used in a therapeutic context, it is safe and has few side effects, the American Osteopathic College of Dermatology report.

Manufacturers make Botox injections with very small doses of Botulinum toxin. The drug can temporarily paralyze muscles, which can benefit people with various muscle or nerve disorders.

Commercial preparations of Botulinum toxin include:

onabotulinumtoxin A (Botox)
abobotulinumtoxin A (Dysport)
incobotulinumtoxin A (Xeomin)
rimabotulinumtoxin B (Myobloc)
prabotulinumtoxin A (Jeuveau)
People casually use the term “Botox” to describe all of these products, though Botox is a registered trademark that one company owns.

How does it work?
Botox is a neurotoxin. These substances target the nervous system, disrupting the nerve signaling processes that stimulate muscle contraction. This is how the drug causes temporary muscle paralysis.

In order for any muscle to contract, the nerves release a chemical messenger called acetylcholine at the junction where nerve endings meet muscle cells. Acetylcholine attaches to receptors on the muscle cells and causes the cells to contract, or shorten.

Botox injections prevent the release of acetylcholine, which stops the muscle cells from contracting. In this way, the toxin helps the muscles to become less stiff.


Cosmetic uses
The primary use of Botox is reducing the appearance of facial wrinkles.

According to the American Board of Cosmetic Surgery, Botox injections are the most popular cosmetic procedure nationwide. In 2016, over 7 million people had Botox treatments.

The effects are temporary, lasting 3–12 months, depending on the type of treatment.

People often request the injections in the following areas of the face:

wrinkles between the eyebrows, called frown lines, glabellar lines, or elevens
wrinkles around the eyes, known as crow’s feet
horizontal creases in the forehead
lines at the corners of the mouth
“cobblestone” skin on the chin
However, the FDA have only approved the injections for use around the eyes and on the forehead.

Research has not shown whether Botox could improve dark circles under the eyes. Learn more here.

Some people also try Botox to improve the appearance of their hair. There is little evidence that this works, however. Find out more here.


Medical uses
Healthcare professionals also use Botox to treat a variety of medical conditions, most of which affect the neuromuscular system.

The FDA have approved Botox for the following uses. Unless otherwise specified, the approval is for use in people 18 or older:

upper limb spasticity, in anyone older than 2 years
crossed eyes, or strabismus, in those older than 12 years
severe underarm sweating, or hyperhidrosis
preventing migraine in people whose migraine headaches last at least 4 hours on 15 or more days per month
reducing symptoms of an overactive bladder due to a neurological condition if anticholinergic medications do not help
eyelid spasms, or blepharospasm, due to dystonia
a neurological movement disorder called cervical dystonia that affects the head and causes neck pain
Some people also have Botox injections for off-label, or unapproved, uses, including as treatments for:

alopecia
sialorrheaTrusted Source, which involves producing too much saliva
psoriasis
dyshidrotic eczema, which affects the palms of the hands and soles of the feet
anismus, a dysfunction of the anal muscle
post-herpetic neuralgia
vulvodynia, pain and discomfort in the vagina without a clear cause
Raynaud’s disease, which affects circulation
achalasia, an issue with the throat that makes swallowing difficult
Other conditions
According to a 2017 reviewTrusted Source of existing evidence, other issues and medical conditions that may benefit from off-label Botox use include:

facial redness and flushing, including during menopause
keloids and scars from wound healing
hidradenitis suppurativa, an inflammatory skin disease
blistering lesions due to Hailey-Hailey disease, a rare genetic disorder
However, confirming that Botox is safe and effective for off-label uses will require more research. Scientists must also establish the appropriate ways to deliver treatment in each case.

Procedure
Clinicians use Botulinum toxin by diluting the powder in saline and injecting it directly into neuromuscular tissue.

It takes 24–72 hoursTrusted Source for the toxin to take effect. Rarely, it can take as long as 5 days for the full effects to show. They may last 3–12 months, depending on the treatment.

People should avoid using Botox during pregnancy or breastfeeding, or if they have ever had an allergic reaction to the drug or any of its ingredients.

What are the safety concerns about Botox during breastfeeding? Find out here.

Cost, time, and effectiveness
The cost of Botox depends on various factors, including:

whether it is for medical or cosmetic purposes
who provides the treatment
where the treatment takes place
the number of Botox units involved
For cosmetic use, The American Society for Aesthetic Plastic Surgery noted in 2016 that, on average:

the cost of a Botox treatment for frown lines or crows’ feet was $376
the procedure lasted 30 minutes
the improvement appeared in 1–5 days
repeat treatments were necessary every 4–6 months
the person could return to work at once
Medicare covers the cost of Botox for medical purposes that doctors deem necessary. However, due to the potentially high cost, it is important to confirm that the treatment is covered before the appointment.

When considering Botox for any reason, it is crucial to make sure that the provider is a qualified professional with the appropriate training.

For people looking to have cosmetic Botox, the American Academy of Facial Esthetics have a locator function that can help.

Anyone who believes that Botox might help with a medical condition should speak with their doctor.

Risks and side effects
People generally tolerate Botox injections well, and side effects are uncommon.

However, depending on the reason for the injections and the person’s response, Botulinum toxin can cause some unwanted effects, including:

dry eye, following cosmetic uses
an upset stomach
numbness
mild pain, swelling, or bruising around the injection site
a headache
temporary eyelid drooping
temporary unwanted weakness or paralysis in nearby muscles
urinary problems after treatment for urinary incontinence
a worsening of neuromuscular disorders
spatial disorientation or double vision after treatment for strabismus
corneal ulceration after treatment for blepharitis
cardiovascular events, such as arrhythmia and myocardial infarction
People should not use Botox if they have:

a sensitivity or allergy to it
an infection at the injection site
Depending on the type of treatment, there are concerns that the effects of Botox may extend beyond the injection site, possibly leading to symptoms such as difficulty breathing.

This is more likely to occur in some individuals than others, and genetic factors may play a role.

Also, some people receiving injections of Botulinum toxin type A develop antibodiesTrusted Source to the toxin that make subsequent treatments ineffective.

Summary
Botox has cosmetic and medical uses. It can reduce the appearance of wrinkles and help treat certain disorders related to the nervous and muscular systems.

If someone wants to try Botox, it is a good idea to speak to a healthcare provider about the risks, costs, and other considerations.