Botulinum toxin was initially approved by the Food and Drug Administration to treat skin lines in 2002, though it was used for cosmetic purposes starting in the late 1990s. Botulinum toxin is a naturally-produced chemical which is made by the bacterium Clostridium botulinum. If consumed in larger quantities, it can cause the disease botulism and can potentially be fatal. For cosmetic procedures, a tiny amount of botulinum toxin is used, which is well below the amount that could cause any dangerous or life-threatening side effects.

How does it work?

Botulinum toxin causes muscles to become paralyzed. For facial cosmetic procedures, the toxin is injected precisely into certain facial muscles which cause wrinkling of the skin (age lines). During a period of 1-2 weeks after the injection, the facial muscles gradually become paralyzed and lose their function, which causes age lines to become shallow or to disappear altogether. The muscles in which the botox was injected typically remain paralyzed for approximately 6 months before they regain their function (and cause age lines to return). Many people opt for repeat injections once this occurs.

Where is it used?

Botulinum toxin is most commonly used for lines that occur between the eyebrows (frown lines), forehead wrinkles, and beside the eyes (crow's feet). Some doctors have started using botox for lines in other parts of the face and neck as well with good results.

What doctors perform this procedure?

Botulinum toxin injections should always be performed by a licensed physician or health practitioner. Most commonly, botox injections are performed by plastic surgeons, facial plastic surgeons, or dermatologists. Other types of physicians have also incorporated botox and other cosmetic injectables into their practices.

How does the procedure work?

Every doctor has his or her own routine for botox injections. The procedure is done in the office and generally does not require any sedation or pain medication. Sometimes an ice pack or some numbing cream is placed on the skin to help minimize discomfort. Numbing injections are not typically used for botox treatments. The actual botox injections usually take no longer than 5 to 10 minutes. After the treatment, patients should avoid exercise or heavy lifting for the next 4 hours. Patients should also try to make facial expressions that cause the age lines (frown, wrinkle forehead, squint eyes) because this will help work the medication into the desired muscles.

What is the follow-up after the procedure?

Usually the full effect of the botulinum toxin will be seen by 2 weeks after the injection. At this time, patients are usually seen back by the doctor. If there are any remaining lines, these areas are usually given "touch up" injections at this time. Touch up injections are typically included in the price of the initial procedure.

What are the risks?

There may be some redness or swelling of the skin for a day or two after the injection. Significant bruising is rare. If too much botox is used or if it is injected in the wrong place, drooping of the eyebrow or upper eyelid can occur. This problem can usually be reversed with prescription eyedrops. Allergic reactions and other serious side effects are extremely rare.

How much does it cost?

Cost varies widely depending on the location of your doctor. Typically, botox will be more expensive in New York or Beverly Hills than in a small town in the Midwest. The average cost of a botox injection in 2005 was $375. Other sources have quoted average price between $400 and $500.

The above article is for educational purposes only and should not be considered specific medical advice.