Botox and Applications

1399/07/14 - 14:17 / 123

Botox is a protein made from Botulinum toxin, which the bacterium Clostridium botulinum produces. This 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.


what is botox?


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 gram 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










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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
  • sialorrhea, 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









According to a 2017 review 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.



Clinicians use Botulinum toxin by diluting the powder in saline and injecting it directly into neuromuscular tissue. It takes 24–72 hours 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.



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

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


5 Medical Uses for Botox That Have Nothing to Do With Wrinkles


But while Botox is often associated with the expressionless and wrinkle-free faces of the rich and famous, it also can treat serious medical conditions and eliminate embarrassing problems. Obviously, if you're considering Botox injections, consult your doctor first. Botox is a prescription and must be administered by a trained professional. But if you're researching treatments for any of the following conditions, Botox may be one to investigate.


1. Incontinence. A recent study of 381 women at the Duke University School of Medicine showed that regular Botox injections worked better than a surgically implanted nerve stimulator to treat women with severe incontinence. That uncontrollable urge to urinate affects 17 percent of women over age 45 and 25 percent of women over age 75, according to Cindy L. Amundsen, M.D., the study’s lead author. Each treatment has its pros and cons: The surgical procedure is more invasive and more expensive, though the cost of Botox injections could add up over time and cause more adverse effects. According to the study, Botox participants reported a greater reduction in symptoms and higher satisfaction with the treatment.


2. Hyperhidrosis. Constant, excessive sweating can be embarrassing. The physical discomfort of feeling damp all the time, the stained clothes — it's no fun. When small doses of Botox are injected into the skin, they block nerves that supply the eccrine glands, which prevents the glands from producing sweat, according to the International Hyperhidrosis Society. The shots are shallow — just below the surface of the skin — and have been shown to reduce underarm sweating by 82 to 87 percent. Results may last up to a year.

In 2004, the FDA approved Botox for treating excessive underarm sweating, though research has shown Botox to reduce sweating in other areas, too. In 2007, a German woman whose right hand would sweat profusely to the point of dripping up to five times a day, received Botox injections in her hand for six months, and the excessive sweating stopped.


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3. Muscle spasms. In the U.S., Botox is approved to treat muscle spasms in the eyelids, face, neck, shoulders and upper body. Because Botox is a nerve impulse blocker, according to the the University of Pittsburgh Medical Center (UPMC), it attaches to nerve endings and prevents the release of chemical transmitters, which activate muscles. Basically, it blocks the message from the brain that tells the muscles to contract, which means the muscle doesn't spasm. However, treatment may need to be repeated every three months as nerve endings grow new connections, UPMC says.


4. Chronic migraines. The FDA approved Botox to treat chronic migraines in adults in 2010 and said the injections were shown to be effective at migraine prevention. Migraines are characterized by intense pulsing or throbbing pain in one area of the head and may be accompanied by nausea, vomiting and sensitivity to light and sound


For chronic migraines, Botox is injected every 12 weeks around the head and neck. One caveat: It has not been shown to work for treating migraines that occur 14 days or less per month, or for other forms of headache.


5. Strabismus. Also known as crossed eyes, Botox has been used to change the position of the eyes since the 1970s, according to the American Academy of Ophthalmology. Botox is injected directly into the eye muscle, relaxing the muscle and causing the eye to refocus. Injections are repeated every 3 to 4 months, though after multiple treatments, the effects last a little longer



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 antibodies to the toxin that make subsequent treatments ineffective.







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.




Neshat Khosravi - Microbiologist




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