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The Botox Myths -see other articles
Despite the increasing uses of Botox, many people are still frustrated by the misconceptions surrounding it. Some of the misconceptions have come about through tawdry science, others through anecdotal evidence and others through ignorance.
Nearly every worthwhile drug in medicine is a diluted solution of a toxin. If you had a major cardiac event today and ended up in hospital most of the drugs that would be used to save your life, digoxin, atropine, lignocaine or adrenalin are all chemicals extracted from plants, microbes or animals that are used in a controlled fashion. Some drugs such as digoxin are extracted from the foxglove plant can actually stop your heart beating if they are used in a strong enough strength. If we dilute them they have less effect but could stop your heart from beating uncontrollably and allow it to beat normally. Other drugs such as atropine are extracted from deadly nightshade can block the nerves that slow down your heart and allow it to beat normally again. Roman girls put a diluted form of this compound into their eyes to dilate them and make their suitors feel they were chemically attracted to them. In a similar way, Botox is a mild dilution of botulinum toxin, which can cause a serious form of food poisoning. The safety of Botox is also ensured by its selective administration into a certain muscle or a group of muscles, which leaves it largely incapable of action outside the given area. Remember we give new born babies who suffer cerebral palsy or muscle spasms much higher doses every day without evidence of problems. Many physicians would agree that aspirin and antibiotics are potentially more harmful than Botox. However like any drug, anaphylaxis can occur and Botox procedures should be performed by trained physicians in proper clinics with adrenaline on standby.
Misconception No 2 Patients can develop an "addiction" to Botox injections
This misconception was based on a recent UK psychological study, which was apparently based on a survey of clients at eighty-one clinics. The study reached the conclusion that more than forty per cent of patients regularly using Botox expressed a "compulsive motive" for doing so. The research was conducted by Dr Carter Singh, a psychologist, and Martin Kelly, a plastic surgeon with London Plastic Surgery Associates. The results of the study showed that about forty percent of people who have resorted to Botox injections to reduce wrinkles were very prone to request another such treatment in the near future. Those who had received five or more injections displayed more "addictive traits" than those who had not.
Misconception No 16: There are risky side effects from Botox injections
This is a total misconception as side effects are uncommon, generally mild, and generally transient. These side effects include nausea, fatigue, malaise, flulike symptoms, and rashes at sites distant from the injections. The needle used can cause some side effects including bruising, pain, redness, headache and local numbness. The most common bothersome side effect is unwanted weakness in a muscle usually around the eye. Fortunately, this usually resolves in a few weeks and in the worst case scenario may last until the action of the toxin usually disappears in four to six months.
Misconception No 4: Botox injections distort a facial expression
This is one of the most common misconceptions about Botox procedures. Many people seem to forget that the resultant expression on a patient's face is really dependent on the skill of the proceduralist and has little to do with the Botox. This means that the ability of the brow to raise or lower, the ability of the frown to move or not, the ability of the crows feet to disappear or slightly remain is usually dependent on two factors, the amount of Botox added and to the location to where it is added. Accordingly, facial expressions can be distorted only in case of an overdose or misdirected injection of the drug. By analogy, if your house flooded after installing a new washing machine, surely you would blame the plumber and not the water company. The bottom line is those who want to look five years younger are strongly recommended to use services provided by certified experienced doctors rather than attending home-based charlatans who frequent beauty parlours and salons.
Misconception No 5: Botox injections cause headaches
On the contrary, although Botox can cause headaches in about 2-3% of people, it actually relieves them in the vast majority of patients treated. It has been known for some time that Botox can help prevent and treat migraine sufferers. To do this, doctors usually inject it into various trigger points that can differ from patient to patient. The duration of action of Botox in migraine prevention varies from about 10 to 13 weeks and the onset of effect may take a few weeks. Ideally, the medication should not be administered more frequently than every 3-4 months. I was interested to see a recent paper by Brazilian dermatologists Dr Bertha Miyuki Tamura and Dr Bobby Chang (Dermatol Surg 2003) who used known acupuncture points to achieve temporary relief of pain in acute migraine. They gave the treatment to 10 women who regularly suffered from severe and prolonged migraines and after 2 weeks, 90% were pain free and one had minimal pain. The results lasted between 4-6 months. This is about the same level of effect that we see in clinical practice.
Misconception No 17: Botox injections are good for facial lines only
This is a total misconception that is still held by a few people. In fact many of my patients are surprised to learn that young infants with muscular spasms and cerebral palsy receive higher concentrations of Botox than they do. They are also surprised to learn that it was actually doctors who were treating muscular spasms that discovered it had an anti-wrinkle effect as a beneficial side effect. In reality Botox is now used to treat sweating, migraine, incontinence, spasms, strokes, multiple sclerosis, anal fissures, writers cramp, cross eyes, cerebral palsy, prostate disease as well as chronic back and neck pain.
Misconception No 18: Botox is not yet used to treat back pain
On the contrary, there are many UK and Irish doctors already using Botox for this clinical indication. Studies began when researchers from the Walter Reed Army Medical Center in Washington, D.C., studied 31 patients with lower back pain. (Bahman Jabbari: Neurology, 2001). All of the patients had experienced pain for at least six months, with an average of six years, and were taking standard medications, which they continued to take during the study. Patients received either Botox injections or injections of a saline solution. Three weeks after the injections, 73% of those who received Botox injections said the amount of pain they experienced had gone down by 50% or more. Two months later, 60% of those who received Botox said their pain was still decreased by 50% or more.
Misconception No 19: Botox has little effect on underarm sweating
On the contrary, Botox has nearly a 100% effect on excessive sweating that can last up to a year. The condition known as hyperhidrosis is caused by the overstimulation of sweat glands by the autonomic nerves. Other sites commonly affected include the palms, soles, back and face. Botox injections now have been cleared for this use in most western countries are extremely effective in treated the condition. Although I have been treating patients for underarm sweating since 2001, the earliest publication that I can find relating to the subject is a study at the University of California San Francisco (Derm Surgery 2002). The study involved twelve patients who received injections of Botox® directly in the underarms. Amounts of the medicine used were similar to those used for wrinkles and frown lines. All patients reported decrease of underarm sweating within 48 hours of the treatment. Further follow-up suggested the treatment is effective for five to twelve months.