Is Botox Right for You?

Botulin toxin, sold commercially under the brand name Botox, is an exceptionally potent neurotoxin that has found a variety of remarkable uses in modern medicine. It is also the most popular nonsurgical medical cosmetic treatment in the UK and USA.

Researchers discovered in the 1950s that injecting overactive muscles with minute quantities of botulinum toxin type A decreased muscle activity by blocking the release of acetylcholine at the neuromuscular junction, thereby rendering the muscle unable to contract for a period of 4 to 6 months.

Alan Scott, a San Francisco ophthalmologist, first applied tiny doses of the toxin in a medicinal sense to treat crossed eyes and uncontrollable blinking, but a partner was needed to gain regulatory approval to market his discovery as a drug. Allergan, Inc., a small pharmaceutical company that focused on prescription eye therapies and contact lens products, bought the rights to the drug in 1988 and quickly received FDA approval in 1989. Allergan renamed the drug Botox.

Cosmetic benefits of Botox were quickly realized when the frown lines between the eyebrows appeared to soften following treatment for eye muscle disorders. The increased potential of Botox as a cosmetic treatment led to clinical trials and subsequent FDA approval in April 2002.

Currently, Botox is finding enormous additional potential in several therapeutic areas including the treatment of migraine headaches, cervical dystonia (a neuromuscular disorder involving the head and neck), blepharospasm (involuntary contraction of the eye muscles), and severe primary axillary hyperhidrosis (excessive sweating). Other uses of botulinum toxin type A that are widely known but not approved by FDA include urinary incontinence, anal fissure, spastic disorders associated with injury or disease of the central nervous system including trauma, stroke, multiple sclerosis, or cerebral palsy and focal dystonias affecting the limbs, face, jaw, or vocal cords. It is also used off label for the treatment of TMJ, but a side effect in some patients is a jaw left too weak to chew solid food for about 3 months after the injection.

Treatment and prevention of chronic headache and chronic musculoskeletal pain are emerging uses for botulinum toxin type A. In addition, there is evidence that Botox may aid in weight loss by increasing the gastric emptying time.

As an alternative to Botox, anti-aging creams are heavily marketed and advertised on television, with the promise of looking younger and the reduction in visible wrinkles on the skin.

Traditionally, they have been targeted towards women, but products specifically targeting men are now common. This change may be due to the fact that many societies in recent years have seen an increased focus on young looks, including in men. Some men report that looking younger makes it easier to get a good job.

There are a range of cosmetic ‘treatments’ for the appearance of wrinkles on the skin such as plastic surgery and botox injections. One of the marketed advantages of anti-aging cream is that it is an alternative to these more extreme cosmetic treatments.

Critics take the view that the manufacturers of these products prey on the fears of women, and that the advertisements abuse science by claiming that their products are scientifically proven to work. It is said that the ‘scientific data’ is based on the perception of women who have tried the product, and are asked whether or not they think they look younger. These are the hallmarks of a placebo.

However, it is plausible that some of the anti-aging products could have a rejuvenating effect, as promised. However, the effects of most anti-aging products likely depends on their concentration and mode of application, making their effects less certain.

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