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What You Need to Know About Botox / Dysport

By Stephen M. Schleicher, MD, Director, DermDOX Center for Dermatology

Botox, approved for cosmetic use in 2002, is now the most widely utilized cosmetic procedure in the United States with millions of injections administered each year. The simplicity of administration, rapidity of results, lack of serious side effects, and high degree of satisfaction has combined to revolutionize the field of minimally invasive aesthetic procedures.

Botox is a toxin produced by bacteria. Injected in dilute amounts it results in temporary paralysis of superficial muscles. The drug is FDA approved for the temporary correction of forehead frown lines and wrinkles about the eyes (crow’s feet). Botox is administered through a tiny needle; the entire procedure takes minutes and entails minimal discomfort. Desirable results are obliteration of unsightly, age-related lines within hours to days after injection. The effect lasts four months on average. Off-label Botox is used about the mouth and even on neck muscles, but the results in these locations are variable.

Side effects of Botox are uncommon and include headache and eyelid drooping. The latter, medically termed ptosis, is a temporary but disconcerting nuisance that may last anywhere from a few days to a few weeks.

The cost of Botox varies. Some providers (doctors, nurse practitioners, physician assistants) charge based on areas treated, others by the amount (units) administered. One vial of Botox (one hundred units) costs the provider hundreds of dollars. A recently approved competitor to Botox is Dysport, which acts in a similar manner. Competition is good, and the consumer can expect additional botulinum toxins (Xeomin and PurTox are on the horizon) and, best of all, more favorable pricing.

In 2009 the FDA added a black box warning of possible serious side effects related to use of Botox and Dysport. Given the millions of injections and the rarity of adverse events, it appears that serious reactions have only occurred as a result of off-label use for certain chronic disease states, not for the treatment of wrinkles and lines. Nevertheless, finding a well-trained, experienced health care provider to administer botulinum toxin is always a wise decision.

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