Botulinum toxin is made from a type of bacteria. It is a toxin that affects nerves. An injection puts this toxin into muscle. There, it blocks the release of the chemical signal from the nerves to muscles. This will decrease the muscle contraction.
Botulinum toxin is used for cosmetic and medical reasons.
The injection process is often called
botox injection, although any brand of the botulinum toxin may be used.
The injection is FDA-approved to treat: Cervical dystonia—abnormal spasms of neck musclesBlepharospasm—spasm of eyelid musclesStrabismus—crossed eyes
The injection has also been used to treat other conditions, such as: Tension headachesAchalasia—spasm of esophageal muscles causing difficulties in swallowing
Muscle spasms due to
cerebral palsySpasticity associated with multiple sclerosisSpasticity in leg and arm muscles due to brain injury/strokeFocal limb dystoniasIncontinence due to bladder problemsAnal sphincter disordersPeripheral nerve painTemporomandibular disorder
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Complications are rare. When they occur, they are temporary and mild. Side effects are related to the site of injection. For example, if injections take place near the eyes, there may be complications with the eyelids or brow line.
Temporary issues may include: RednessBruisingStinging around the injection sites
The following are less common reactions. They are generally mild and do not last long. NauseaFatigueFlu-like symptoms
Other complications that may occur include: Excessive weakness of the muscle around the eyes—can cause drooping of the eyelids or obstruction of visionDifficulty swallowing—can occur in patients receiving injections in their neckCompensatory hyperhidrosis—people being treated for hyperhidrosis may develop increased sweat production at another area of the bodyExcessive weakness or wasting in certain muscles—the injection may slow any improvement in the muscleNeck weakness in people with long, thin necks
Risk of the botulinum toxin spreading beyond the injection area—may cause botulism symptoms, including difficulty breathing and death in severe cases. Children with
may be at a higher risk for this side effect.
This procedure may worsen nerve or muscle disorders, such as:
Amyotrophic lateral sclerosis
The toxin can also interact with medications such as antibiotics. Tell your doctor about all of the medications that you are taking.
You should not have botox if you: Have an infection or inflammation in the area where botox will be injectedAre sensitive to the ingredients in botoxAre pregnant or breastfeeding
Most often, none is given. Some people may prefer to have the area numbed for comfort. In this case, a topical anesthetic may be used.
A thin needle will be used. The toxin will be injected through the skin into the targeted muscle. You will often need several injections in a small area.
Remember to: Remain upright for several hoursAvoid alcohol
The time needed will depend on the number of sites involved. It is often less than 20 minutes.
You may have some minimal discomfort.
Normal activities may be resumed after the procedure.
The toxin temporarily weakens targeted muscles. The treatment lasts up to 4 months. With repeated use, the effects may last longer.
It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor: Difficulty breathingDifficulty swallowingDifficulty speakingSevere lower eyelid droop or obstructed visionExcessive weakness around the injection siteRash or any other sign of an allergic reaction
If you think you have an emergency, call for medical help right away.
Allergan Physician Production Information. Botox cosmetic (botulinum toxin type A). Available at: http://www.allergan.com/assets/pdf/MSDS/ehs-botox.pdf. Updated January 11, 2010. Accessed February 12, 2014.
FDA approves Botox to treat chronic migraines. US Food & Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm229782.htm. Updated April 19, 2013. Accessed February 12, 2014.
Ondo WG, Gollomp S, Galvez-Jimenez N. A pilot study of botulinum toxin A for headache in cervical dystonia.
Ward A, Roberts G, Warner J, et al. Cost-effectiveness of botulinum toxin type A in the treatment of post-stroke spasticity.
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11/4/2009 DynaMed Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: FDA gives update on botulinum toxin safety warnings. US Food and Drug Administration website. Available at:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm175013.htm. Updated April 19, 2013. Accessed February 12, 2014.
3/19/2010 DynaMed Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: FDA approves Botox to treat spasticity in flexor muscles of the elbow, wrist and fingers. US Food and Drug Administration website. Available at:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm203776.htm. Updated April 24, 2013. Accessed February 12, 2014.
5/17/2012 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Jackson JL, Kuriyama A, Hayashino Y. Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults: a meta-analysis.
Last reviewed January 2015 by Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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