What do wrinkles and muscle tics have in common? Both are caused by repeated or inappropriate muscle activity and both can be treated using the same drug, Botox.
With such wide-ranging effects, Botox may sound like a wonder drug. But it's actually short for
botulinum toxin
—one of the deadliest food poisons known to humankind. Some may remember the infamous Bon Vivant soup incident, in which cans of vicychoise infected with the botulinum toxin killed unsuspecting soup lovers. But the same quality that can make
botulism
lethal—its ability to paralyze muscles—makes it therapeutic when used in carefully controlled doses.
Used to treat a variety of muscular disorders, Botox is the drug of choice for the neuromuscular condition, dystonia, which causes muscles involved in a particular movement to contract inappropriately. The classic form of dystonia involves the neck, and is called torticollis. Other common forms involve spasms of the eyelids (blepharospasm), half of the face (hemifacial spasm), and vocal cords (spasmodic dysphonia).
Unlike muscle strain or
tendinitis
, dystonia is a neurologic disorder in which the brain incorrectly signals muscles to go into an abnormal contraction.
"Strain is where you get an achiness in the forearms [for example] but you don't get a change in the position of the muscle. With dystonia, the hand or limb or neck changes position creating an imbalance in the muscles so that the normal position gets tighter and tighter," says George Plotkin, MD, former acting director of neurophysiology at Brigham & Women's Hospital in Boston.
When Botox is injected directly into a contracted muscle, it is weakened and cannot contract, restoring balance to the group of muscles involved in a particular movement.
"Even though the signal coming from the brain is that the muscle should contract to a certain point, it can't," Plotkin explains.
Doctors have used Botox to correct a variety of conditions involving inappropriate muscle and gland activity with varying degrees of success. They include:
- Eye Muscle Spasms
—Patients with limited eye closure and spasms that prevented them from driving (blepharospasm) have been very successfully treated with Botox.
- Spasticity
—Botox can be helpful in controlling spasticity due to stroke, head injury, multiple sclerosis, or congenital
cerebral palsy
.
- Esophageal Disorders
—When the lower sphincter muscle of the esophagus fails to relax and allow food to pass into the stomach, Botox can be an effective treatment.
- Excess Sweating
—Botox injected into the skin can control overactive sweat glands, but it can be difficult to treat a widespread area.
- Neurological Bladder Dysfunction
—Botox may be helpful for bladder problems caused by nerve dysfunction.
- Tension Headaches
—One study showed Botox to be effective in treating patients with recurrent tension headaches; but other studies failed to find it effective.
Botox has saved the careers of many professional musicians. Plotkin treated one concert guitarist who was unable to perform because his third finger pulled in. After treatment with Botox, he was able to cut a record.
"We have lots of success stories: pianists who fly in five days before they go on tour, get their injection, and go on tour," reports Dr. Plotkin. Whatever the extent of the disability, treatment with Botox "can make a big difference in people's lives" says Dr. Plotkin.
Frown. Smile. Grimace. Grin. Every facial expression forms a crease that will someday be etched in the skin as a wrinkle. You can't stop moving your face, but you can limit movement in key places using Botox. As a result of its successful use with facial tics, plastic surgeons discovered that Botox can smooth out wrinkles in places where muscle activity has a particularly noticeable effect.
Botox is used to treat wrinkles in two places: frown lines between the eyebrows, where it is most effective, and crow's feet. As Botox restricts muscle movement, it creates a smoother appearance even if it doesn't remove all traces of the wrinkle.
"There is certainly a component of wrinkles that's dynamic and caused by overactivity of the muscles; that component will be eliminated by Botox," says David Wainwright, MD, associate professor in the division of plastic surgery at the University of Texas-Houston Medical School.
Tiny quantities of the toxin are injected directly into the muscles of facial expression. It takes three small injections between the eyebrows to treat the frown line. The treated muscles weaken over the following week or so and the person is no longer able to contract the frown muscles. They can still lift their eyebrows normally and blink without problems. The injection is almost painless. It is important to remain upright for four hours after the injection and not touch the treated area.
Not surprisingly, younger patients—whose lines are not as deep—experience the greatest improvements. The effect lasts between 4-6 months, and treatments are generally repeated in nine months to a year. Ongoing treatments have the added benefit of preventing further wrinkling.
Side effects have not been a problem in using Botox for treating wrinkles or other conditions, aside from the occasional allergic reaction or temporary excessive muscle weakness. Some people have a slight headache for several hours after treatment. The most common significant complication, which is rare, is ptosis—a drooping of the eyelid caused by the Botox tracking into the eyelid muscle. It generally lasts just a few days, but more prolonged weakness is possible. Botox injections cannot be used during pregnancy or when breastfeeding.
Although Botox is classified under the orphan drug act as a treatment for at least five medical conditions—including blepharospasm and spasticity disorders—wrinkle treatment is not among them.
In 1994, the United States Food and Drug Administration (FDA) denounced the promotion of such unapproved use as "an example of promoting a potentially toxic biologic for cosmetic purposes." Even so, physicians, based on their knowledge and on available current information, were allowed to prescribe or inject a drug for a use not indicated in the "approved" labeling if it seems reasonable or appropriate. In April 2002, the FDA approved the use of Botox for reducing the appearance of frown lines for up to 120 days.
If you decide to undergo Botox treatment, be sure that you receive your care from a reputable physician highly experienced in the use of this substance. Several cases of botulism in Florida were attributed to home-prepared toxin injected by a physician whose license had previously been suspended. From quelling muscle spasms to smoothing out skin, Botox can be an effective treatment for many people if used properly.
