What is a Botox Injection or botox shot?

Botulinum toxin injections, commonly known as botox shots are a drug made from a powerful poison which is used to prevent wrinkles in the face. The toxin which paralyzes muscles as a means of action was originally used for medical purposes such as relaxation of spasticity(overactive muscles) but some eye doctors realized when used to lessen spasticity around the eyes, it relieved the frown lines also! Now it's most popular use is cosmetic. Although it is made from a very deadly poison, when used properly, it has a very good safety record. The biggest problem related to botox occurred a few years ago when some doctors ordered "fake botox " from a company which was not licensed by the FDA. Four people wound up on ventilators for several weeks as a result of that, so always make sure your doctor uses stuff which is approved. Currently only two companies are allowed to make/sell botulinum toxin in the USA, Allergan, the original maker of Botox, and Johnson and Johnson which more recently launched Dysport, Botox's competitor. The most common problem related to the shots of these products is bruising if the doctor hits a blood vessel. I advise patients to stay away from aspirin or fish oil if they want the shots and use ice packs which help reduce bruising and have the added bonus of numbing the skin, so the shots do not hurt much. Because the needles used to give the shots are so tiny, bruising should be rare and pain minimal. Also, if the doctor injects too close to the edge of the brow, some of the drug could drift down into the muscles that lift the eyelid, causing a droop. This is a very rare complication and fortunately, because the drug is not injected into the muscles, usually it wears off quickly; in addition, there are eyedrops which can help open the lid if this effect occurs. This has happened only three times in my busy practice, so it is rare. The only negative thing about botox I can say (since I not only use it on patients but also on myself) is it is not permanent! It will wear off in three to four months and the muscles will then start to work and the lines recur. Fortunately for most of my patients, the more the drug is used, the longer the effect lasts. For example, I started using the drug to erase the frown line between my eyebrows which I get from squinting when I read. My employees thought I was always mad at them! The drug worked great to erase the line and I could see the muscles start to work in a few months but the first year I used Botox, it took 5-6 months for the wrinkle to appear. The next year I noticed that it took 6-7 months and the next year even longer! Why is that? Possibly when one can't crease, one begins to forget how to crease and secondly there is probably some atrophy of the muscles when paralyzed. If the muscles flatten, it may take longer for the crease to return. Some patients like the "frozen " look so they come in every three to four months but most of my patients want to look natural, so they come in when they need it. Botox is being used for some reasons other than wrinkles, such as prevention of sweating or lessening migraines but such uses are considered "off-label " uses. It must be used with caution in the lower face because since the paralysis it causes cannot be reversed until it naturally wears off, one risks having a droopy mouth! Usually fillers are used lower in the face. The only people who should not use Botox are those people with a genetic history of neuromuscular weaknesses such as myasthenia gravis. Such individuals might be more sensitive to the effects of the drug.