Definition

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.

Reasons for Procedure

The injection is FDA-approved to treat:

• Cervical dystonia—abnormal spasms of neck muscles
• Blepharospasm—spasm of eyelid muscles
• Strabismus—crossed eyes
• Hyperhydrosis—excessive sweating
• Chronic migraines

The injection has also been used to treat other conditions, such as:

• Tension headaches
• Achalasia—spasm of esophageal muscles causing difficulties in swallowing
• Spasmodic dysphonia
• Muscle spasms due to cerebral palsy
• Spasticity associated with multiple sclerosis
• Spasticity in leg and arm muscles due to brain injury/stroke
• Focal limb dystonias
• Incontinence due to bladder problems
• Anal sphincter disorders
• Peripheral nerve pain
• Temporomandibular disorder (jaw disorder)

Possible Complications

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:

• Redness
• Bruising
• Stinging around the injection sites

The following are less common reactions. They are generally mild and do not last long.

• Nausea
• Fatigue
• Flu-like symptoms
• Headache

Other complications that may occur include:

• Excessive weakness of the muscle around the eyes—can cause drooping of the eyelids or obstruction of vision
• Difficulty swallowing—can occur in patients receiving injections in their neck
• Compensatory hyperhidrosis—people being treated for hyperhidrosis may develop increased sweat production at another area of the body
• Excessive weakness or wasting in certain muscles—the injection may slow any improvement in the muscle
• Neck 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 cerebral palsy may be at a higher risk for this side effect.

• This procedure may worsen nerve or muscle disorders, such as:
  • Amyotrophic lateral sclerosis (ALS)
  • Myasthenia gravis

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 injected
• Are sensitive to the ingredients in botox
• Are pregnant or breastfeeding

What to Expect

Call Your Doctor

It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:

• Difficulty breathing
• Difficulty swallowing
• Difficulty speaking
• Severe lower eyelid droop or obstructed vision
• Excessive weakness around the injection site
• Rash or any other sign of an allergic reaction

If you think you have an emergency, call for medical help right away.

American Society of Plastic Surgeons http://www.plasticsurgery.org

Health Canada http://www.hc-sc.gc.ca

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. Headache. 2005;45(8):1073-1077.

Ward A, Roberts G, Warner J, et al. Cost-effectiveness of botulinum toxin type A in the treatment of post-stroke spasticity. J Rehabil Med. 2005;37(4):252-257.

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. JAMA. 2012;307(16):1736-1745.