New Uses for Botox?

I thought Botox was for smoothing skin, but I keep hearing about other uses. Does it really cure migraines and relieve bladder problems? How safe is it?

– July 10, 2006

Shots of the toxin sold under the brand-name Botox are widely used to smooth out facial lines such as forehead furrows, frown lines and crow’s feet. According to the American Society of Plastic Surgeons some 3.8 million Botox procedures were performed in the United States in 2005.

Botox is made from botulinum toxin A, a bacterial toxin that, in high doses, can cause potentially fatal illness. However, the tiny amounts injected into the skin blocks the local release of acetylcholine, a neurotransmitter needed for muscle function. The effect is to paralyze the facial muscles that over time create lines. As a result, you won’t be able to squint, frown or raise your eyebrows as long as the effect lasts, usually about four months. Then, if you liked the results, you’ll have to have the procedure repeated.

In addition to its cosmetic uses, Botox has been approved by the FDA for treatment of the following medical conditions:

  • Blepharospasm: This disorder of the muscles that control the movement of the eyelids causes spasms that lead to rapid, uncontrollable blinking. When both eyes are affected, it becomes difficult to open the eyes; in severe cases patients may be functionally blind because they can’t keep their eyes open long enough to see. Injecting Botox into the affected muscles can solve the problem.
  • Cervical Dystonia: Here, the head twists in abnormal positions due to involuntary contractions of the neck and shoulder muscles. Repetitive neck contractions can cause uncontrollable head movements. Although there are other therapies available to address this, Botox is the most effective treatment available.
  • Severe Underarm Sweating: This condition is caused by overactive sweat glands. Botox can temporarily block the chemical signals from the nerves that stimulate sweat glands, and seems to help more than 50 percent of patients treated.
  • Crossed Eyes: Botox can help by lengthening the injected eye muscle while shortening the opposing muscle. Effects last about three months and then treatment must be repeated.

In addition to these conditions Botox appears to provide short-term relief for some patients with migraine headache, overactive bladder and tennis elbow and is being studied for symptomatic relief of other disorders ranging from cerebral palsy to arthritis and stroke.

Bear in mind that while health insurance probably will cover the cost of FDA-approved Botox treatment for medical problems, it won’t reimburse for cosmetic procedures or experimental approaches for medical conditions.

Like many treatments, Botox isn’t 100 percent safe, so be sure to assess benefits and risks with your doctor. If you’re interested in Botox injections for cosmetic purposes, I urge you to find a qualified plastic surgeon or dermatologist who has a positive track record of performing the procedures. Improperly used Botox injections can lead to serious health problems, severe facial paralysis, deformity and, in the wrong hands, death.

Andrew Weil, M.D.

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