Botulinum toxin is made from a type of bacteria. It is toxic to the nerves. Another name for it is bacterial neurotoxin. An injection puts this toxin into muscle. There, it blocks the chemical signal from the nerves to the muscles. This will decrease the muscle contraction (tightening).
There are several types and brands of this toxin. Examples include Botox, Dysport, and Reloxin, which are formulations of botulinum toxin type A. Myobloc is another brand, but it is a formulation of botulinum toxin type B. These products are used for cosmetic and medical reasons.
This injection process is often called
botox injection, although any brand of the botulinum toxin may be used.
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This is most commonly used as a treatment to smooth wrinkles on the face and neck. It is FDA-approved for the treatment of frown lines between the brows and the treatment of wrinkles at the outer corner of the eyes (crow's feet).
Complications are rare. When they occur, they are temporary and mild. Side effects are related to the site of injection. For example, if injections take place near the eyes, there may be complications with eyelids or the brow line.
Temporary issues may include:
- Stinging around the injection sites
The following are less common reactions. They are generally mild and do not last long.
Other complications that may occur include:
- Excessive weakness of the muscle around the eyes—can cause drooping of the eyelids or obstruction of vision
- Difficulty swallowing—can occur in patients receiving injections in their neck
FDA Public Health Advisory for Botulinum Toxin
There is a risk that the botulinum toxin could spread beyond the injection area. This can cause botulism symptoms, including difficulty breathing and death. These symptoms appear to be more common in children with
who receive the injection to treat spasticity. The warning is for Botox , Botox Cosmetic, Myobloc , and Dysport. For more information, please visit:
This procedure may worsen nerve or muscle disorders, such as:
The toxin can also interact with medications, such as antibiotics. Tell your doctor about all of the medications that you are taking.
You should not have botox if you:
- Have an infection or inflammation in the area where botox will be injected
- Are sensitive to the ingredients in botox
- Are pregnant or breastfeeding
Most often, none is given. Some patients may prefer to have the area numbed for comfort. In this case, a topical anesthetic may be used.
A thin needle will be used. The toxin will be injected through the skin into the targeted muscle. You will often need several injections in a small area.
There is little recovery needed, but remember to:
- Remain upright for several hours
- Avoid alcohol
The length will depend on the number of sites involved. It is often less than 20 minutes.
You may have some minimal discomfort.
Normal activities may be resumed after the procedure.
The toxin temporarily weakens targeted muscles. The treatment lasts up to four months. With repeated use, the effects may last longer.
After arriving home, contact your doctor if any of the following occurs:
- Difficulty breathing
- Difficulty swallowing
- Difficulty speaking
- Severe lower eyelid droop or obstructed vision
- Excessive weakness around the injection site
- Rash or any other sign of an allergic reaction
In case of an emergency, call for emergency medical services right away.
Ondo WG, Gollomp S, Galvez-Jimenez N. A pilot study of botulinum toxin A for headache in cervical dystonia.
Ward A, Roberts G, Warner J, et al. Cost-effectiveness of botulinum toxin type A in the treatment of post-stroke spasticity.
J Rehabil Med. 2005;37(4):252-257.
11/4/2009 DynaMed Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: FDA gives update on botulinum toxin safety warnings. US Food and Drug Administration website. Available at:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm175013.htm. Updated August 3, 2009. Accessed September 3, 2014.
10/1/2013 DynaMed Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: US Food & Drug Administration. FDA approves Botox Cosmetic to improve the appearance of crow's feet lines. US Food & Drug Administration website. Available at:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm367662.htm. Published September 11, 2013. Accessed September 3, 2014.
Last reviewed August 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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