House Calls / Dr. Michael Schwartz

Botox injections have become a popular non-surgical approach to enhance one's appearance. Since 2002, when it was first approved for cosmetic use, millions of individuals have undergone Botox procedures to reduce facial wrinkles, eyelid droop and crow's feet. In addition, many non-cosmetic medical uses for Botox have been sanctioned since its initial approval. Despite its popularity and obvious benefits, there are some risks associated with Botox that should be considered.

Botulinum toxin (the main ingredient used in Botox) is a very potent neurotoxin (nerve blocker) produced by the bacteria Clostridium botulinum.

When inhaled, consumed or injected, even a small dose can be life-threatening. The first recorded case of botulism food poisoning was identified in the 1700s, and was said to have been caused by eating German sausage.

However, the actual bacteria causing the disease was not identified until 1895, and the specific toxin produced was first isolated in 1947. Botulism, commonly recognized as a type of food poisoning, can cause severe medical problems. For example, those who eat foods contaminated with the toxin may exhibit changes in vision, difficulty speaking or swallowing and a dry mouth. Some may also develop muscle paralysis which can be life threatening should it affect the muscles needed to breathe. Fortunately, botulism is not a contagious disease.

Notwithstanding its potential adverse affects, when used in small amounts the toxin can be an effective cosmetic enhancer. Generally, Botox is injected into the body through small needles, temporarily preventing muscles from contracting and thus inhibiting wrinkling of the skin. The procedure is quick to perform but can take up to several days to see results. Most commonly, dermatologists, plastic surgeons and ophthalmologists perform these procedures. However, any physician can be trained and certified in using the medication. In addition, in some states, nurses and physician assistants can be trained and licensed to administer Botox under the supervision of a physician.

According to Dr. Michael Fiorillo, a renowned board-certified plastic surgeon in New York, "Botox and the other neurotoxins are generally very safe drugs if administered by a trained doctor. If an untrained individual is administering the product, it can lead to many adverse effects including eye droop, blurred vision, eye tearing, facial asymmetry or weakness." Dr. Fiorillo emphasizes that only experienced health-care professionals should administer Botox. Additionally, it is recommended that patients avoid alcohol, aspirin and ibuprofen-type medications for at least one week prior to the procedure as this can increase the risk of bleeding and bruising. He also advises that patients do not use the product if they are pregnant, nursing or have any muscular diseases.

Because Botox is a nerve blocker, physicians are now using it to successfully treat various health ailments including muscle spasms, overactive bladder, obesity, chronic headaches, underarm sweating, hair loss, tremors, eye twitching, trigeminal neuralgia (severe facial nerve pain) and treatment of cerebral palsy.

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Despite its efficacy for treating a wide range of ailments, the benefits of a Botox treatment will only last a few weeks and thus necessitates repeated injections every three months. Unfortunately, many of these treatments are not yet approved by the FDA and are therefore not covered by insurance. Also, there are some mild side effects associated with Botox injections which can include the following: headaches; muscle stiffness; bruising; rashes and itching; nausea; fatigue and weakness; and allergic reactions.

Other reactions are rare, but when they occur can be frightening. I recall one patient who came to see me for knee pain. During my examination, I noted she had complete paralysis of the left side of her face. I became quite concerned that the patient had suffered a stroke or had a disease known as Bell's palsy. However, the patient seemed unconcerned by her drooping face and said, "Don't worry about my face; I just had a Botox injection." The patient was surprised to learn that this side effect often takes several weeks to completely resolve.

Beware of "Botox parties." These events are often catered by both professionals and nonprofessionals in the comfort of an individual's home. They are advertised as "filler-parties," where champagne and hors d'oeuvres are served while patients receive injections of the medication. Physician groups are obviously concerned about these gatherings, especially in cases where unqualified people are injecting the Botox. There is also concern that the treatment area is not sufficiently sterile and there is no informed consent of the potential adverse side effects. Finally, in the event of an emergency, there is usually no way to administer lifesaving resuscitation since these "parties" are seldom performed in a physician's office.

It is exciting that this unique medication is beginning to be used for treating serious medical conditions. The potential benefits of Botox are already being appreciated by patients suffering from severe migraine headaches and unwanted tremors from neurologic diseases. As for the cosmetic benefits, I am sorry to be a party-pooper, but I caution you to make certain your health care professional is trained and experienced in administering Botox for cosmetic purposes.

Dr. Michael Schwartz is board-certified in internal medicine with a private practice in Darien. For comments or questions, please visit his website at