What is botox injection

Botox injection also called Botulinum toxin A (onabotulinumtoxinA) injection, is used to treat a number of conditions. Botox injection is in a class of medications called neurotoxins. Botulinum toxin A (onabotulinumtoxinA) is classified as an injectable muscle relaxant. When botox is injected into a muscle, it blocks the nerve signals that cause uncontrollable tightening and movements of the muscle. When botox is injected into a sweat gland, it decreases the activity of the gland to reduce sweating. When botox is injected into the bladder, it decreases bladder contractions and blocks signals that tell the nervous system that the bladder is full.

A topical form of botulinum toxin A is currently under investigation.

Before and after each botox injection, a few simple measures may optimize the safety and improve the results of treatment. To minimize the risk of later bruising, it is recommended that patients discontinue any non-essential medications or dietary supplements that can cause thinning of the blood:

• Aspirin (2 weeks prior)
• Non-steroidal anti-inflammatory medications (ibuprofen, naproxen, etc)
• Fish oil supplements
• Vitamin E
• Gingko and ginseng
• Red wine

Botox injections should be performed by doctors who are experts in the conditions being treated including knowledge of human anatomy. A typical visit usually takes 15 minutes, with a slightly longer visit in the case of a first-time patient for a lengthier discussion that explains the procedure and its side effects. The area is cleaned with alcohol, and the patient is placed in a comfortable position. The doctor takes a syringe containing the medication and injects the skin or underlying muscle with small amounts of fluid. This is repeated until all areas are satisfactorily treated.

For your Safety: Take time to find a reputable practitioner who is properly qualified and practises in a clean, safe and appropriate environment. Ask the practitioner what you should do if something were to go wrong.

Botox injection is a prescription-only medicine that should only be prescribed and given by an appropriately trained healthcare professional, such as a doctor, dentist, pharmacist prescriber, or nurse prescriber.

Legally, the prescriber can delegate the administration of the injections to another person, but they are responsible for ensuring it is given safely.

You shouldn’t have Botox injections if you’re pregnant or breastfeeding, since the effects on the baby aren’t known.

Those who should not have Botox injections are as follows:

Those with allergies or sensitivity to ingredients in the Botox. Patients with certain neuromuscular conditions (eg, myasthenia gravis). Those with infections at the treatment site. Patients taking aminoglycoside antibiotics or captopril.

What to do if I have problems Botox injection?

If you’ve had Botox injections and are not happy with the results or are experiencing problems, take up the matter with your practitioner through the clinic where you were treated.

If there are any complications that require medical attention, it is best that you go back to the practitioner who treated you. If this is not possible, you can go to your doctor or local accident and emergency (A&E) department.

You can also report any side effects directly to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch/default.htm). By reporting side effects, you are helping to provide more information on the safety of this medicine.

Do Botox injections hurt?

Botox injection is almost painless. However in some areas botox injections can quite painful especially if the hands are injected, so local anesthetic may be required.

Can Botox injections relieve arthritis pain?

Botox injections into arthritic joints appear to reduce pain and improve function. Results from several scientific studies have been promising, but larger clinical trials are needed.

So far, participants in various studies have reported improvement in arthritis pain and joint function after Botox injections. Botulinum toxin works by blocking the transmission of certain chemical signals that relay information between nerves and the brain.

These preliminary studies have been small, and many of them didn’t include a control group to see if the botulinum toxin injections work better than placebo. So there’s much left to learn about the possible role of Botox injections in arthritis treatment.

While research continues, proven treatment options — such as exercise, weight loss and medication — remain the focus of most arthritis treatment plans.

How does Botox injection work?

BOTOX®, a registered trade mark of Allergan Inc., and Dysport® (Ipsen’s product) are different forms of purified botulinum toxin A (onabotulinumtoxinA), and are produced by the bacterium Clostridium botulinum, the cause of a dangerous disease called botulism. Botulinum toxin is a neuromuscular blocking agent, which means it causes paralysis of the injected muscle by preventing the release of acetylcholine from motor nerve terminals. Without its nerve supply, the muscle fiber withers away. The muscle strengthens again as the nerves regenerate.

Botulinum toxin reduces sweating by blocking the sympathetic nerve fibers that control sweat glands.

Botox injection uses

Botulinum toxin treatment was originally introduced to treat muscle spasms, including blepharospasm (spasms of the eyelids), strabismus (squint), cervical dystonia (torticollis of the neck) and spasticity due to cerebral palsy or other muscular diseases.

In patients treated for facial spasms it was noted that facial wrinkling decreased over the treated muscle. This experience lead to the development of botulinum toxin for the treatment of many types of facial wrinkles.

People often dislike their central scowl lines (called glabellar lines), which are caused by the corrugator and procerus muscles contracting when concentrating, squinting, or frowning. Botox injections into these muscles weaken them and successfully reduce the prominence of the line.

Botox injection can also be used to lessen crows’ feet, bunny lines, marionette lines and smoker’s lines. The treatment can be combined with implantations such as collagen or hyaluronic acid to further improve the appearance. It can also be used to shape the eyebrows into an arch or flare and to correct facial asymmetry.

Botox injection is also sometimes used to treat other conditions in which abnormal muscle tightening causes pain, abnormal movements, or other symptoms. Botox injection is also sometimes used to treat excessive sweating of the hands and armpits (hyperhidrosis), excessive sweating that occurs during or after eating, tremor (uncontrollable shaking of a part of the body), anal fissures (a split or tear in the tissue near the rectal area), postherpetic neuralgia (shingles pain) and some forms of headache. Botox injection is also sometimes used to improve the ability to move in children with cerebral palsy (condition that causes difficulty with movement and balance) or adults who have had a stroke. Talk to your doctor about the risks of using this medication for your condition.

Botox injection may also prove helpful to reduce flares in those with pompholyx (a form of hand dermatitis) or Hailey-Hailey disease, when these are provoked by sweating.

Botox injection may be prescribed for other uses; ask your doctor or pharmacist for more information.

Botox injection is used to:

• relieve the symptoms of cervical dystonia (spasmodic torticollis; uncontrollable tightening of the neck muscles that may cause neck pain and abnormal head positions) in people 16 years of age and older;
• relieve the symptoms of strabismus (an eye muscle problem that causes the eye to turn inward or outward) and blepharospasm (uncontrollable tightening of the eyelid muscles that may cause blinking, squinting, and abnormal eyelid movements) in people 12 years of age and older;
• prevent headaches in people older than 18 years of age with chronic migraine (severe, throbbing headaches that are sometimes accompanied by nausea and sensitivity to sound or light) who have 15 or more days each month with headaches lasting 4 hours or more;
• treat overactive bladder (a condition in which the bladder muscles contract uncontrollably and cause frequent urination, urgent need to urinate, and inability to control urination) in people 18 years of age and older when other medications do not work well enough or cannot be taken;
• treat incontinence (leakage of urine) in people 18 years of age and older with overactive bladder (condition in which the bladder muscles have uncontrollable spasms) caused by nerve problems such as spinal cord injury or multiple sclerosis (MS;a disease in which the nerves do not function properly and people may experience weakness, numbness, loss of muscle coordination, and problems with vision, speech, and bladder control), who cannot be treated with oral medication;
• treat upper limb spasticity (increased muscle stiffness) in the elbow, wrist, and fingers in people 18 years of age and older;
• treat lower limb spasticity in the ankle and toe muscles in people 18 years of age and older;
• treat severe underarm sweating in people 18 years of age and older who cannot be treated with products applied on the skin;

Botox injection is also used in cosmetic treatment to:

• temporarily smooth frown lines (wrinkles between the eyebrows) in adults 18 years of age and older,
• temporarily smooth crow’s feet lines (wrinkles near the outer corner of the eye) in adults 18 years of age and older,
• temporarily smooth forehead lines in adults 18 years of age and older.
• if you are 65 years and older and will be receiving botox cosmetic injection to temporarily smooth crow’s feet, forehead lines, or frown lines, you should know that this treatment has not worked as well for older adults compared to adults younger than 65 years of age.

How should botox injection be used?

Botox injection comes as a powder to be mixed with a liquid and injected into a muscle, into the skin, or into the wall of the bladder by a doctor. Your doctor will choose the best place to inject the medication in order to treat your condition. If you are receiving botox to treat frown lines, forehead lines, crow’s feet lines, cervical dystonia, blepharospasm, strabismus, upper limb spasticity, urinary incontinence, overactive bladder, or chronic migraine, you may receive additional injections every 3 to 4 months, depending on your condition and on how long the effects of the treatment last. If you are receiving botox injection to treat severe underarm sweating, you may need to receive additional injections once every 6 to 7 months or when your symptoms return.

If you are receiving botox injection to treat severe underarm sweating, your doctor will probably perform a test to find the areas that need to be treated. Your doctor will tell you how to prepare for this test. You will probably be told to shave your underarms and not to use nonprescription deodorants or antiperspirants for 24 hours before the test.

Your doctor may change your dose of botox injection to find the dose that will work best for you.

Your doctor may use an anesthetic cream, or a cold pack, to numb your skin, or eye drops to numb your eyes before injecting onabotulinumtoxinA.

If you are receiving botox injection to treat urinary incontinence, your doctor may prescribe antibiotics for you to take for 1-3 days before your treatment, on the day of your treatment and for 1 to 3 days after your treatment.

One brand or type of botulinum toxin cannot be substituted for another.

Botox injection may help control your condition but will not cure it. It may take a few days or up to several weeks before you feel the full benefit of botox injection. Ask your doctor when you can expect to see improvement, and call your doctor if your symptoms do not improve during the expected time.

How is Botox injection administered?

Tiny quantities of the botulinum toxin are injected directly into the affected muscles. It takes three to five small injections between the eyebrows to treat the frown line. The treated muscles weaken over the following week or so. Most people do not notice anything. They simply become aware that they are no longer able to contract the frown muscles. They can still lift their eyebrows normally and blink without problems.

You can frown as often as you like in the first day or so, but the treated areas should not be touched. Don’t have a facial massage!

To reduce sweating, tiny botox injections are placed in the affected area at about 1 cm intervals; this can be quite painful especially if the hands are injected, so local anesthetic may be required.

The effect of botulinum toxin starts wearing off within a few weeks but retreatment is not usually needed for three to six months. It can be repeated as required. Many people find after three or four treatments to glabellar lines that they don’t need another one for a long time; the muscle has markedly weakened or they have broken the bad habit that led to the frowning or squinting originally.

Botox injection contraindications

Botox injections should not be used in pregnancy or when breast feeding. It is also inadvisable for those with certain neurological conditions such as motor neurone disease or myasthenia gravis.

Caution is necessary for patients on the following medications:

• Aminoglycoside antibiotics (may increase effect of botulinum toxin).
• Chloroquine and hydroxychloroquine (may reduce effect).
• Blood thining agents e.g., warfarin or aspirin (may result in bruising).

Occasionally Botox injection fails to result in the desired muscle weakness. The treatment can be repeated, but to reduce the chance of the development of neutralizing antibodies, it is recommended that the treatment is not given again for two months.

Botox injection special precautions

Before receiving botox injection:

• tell your doctor and pharmacist if you are allergic to onabotulinumtoxinA, abobotulinumtoxinA (Dysport), incobotulinumtoxinA (Xeomin), or rimabotulinumtoxinB (Myobloc). Also, tell your doctor if you are allergic to any other medications or any of the ingredients in onabotulinumtoxinA injection. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: certain antibiotics such as amikacin, clindamycin (Cleocin), colistimethate (Coly-Mycin), gentamicin, kanamycin, lincomycin (Lincocin), neomycin (Neo-Fradin, Neo-Rx), polymyxin, streptomycin, and tobramycin (Tobi); anticoagulants (‘blood thinners’) such as warfarin (Coumadin, Jantoven); antihistamines; aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); cholinesterase inhibitors such as ambenonium (Mytelase), donepezil (Aricept), galantamine (Razadyne), neostigmine (Prostigmin), physostigmine, pyridostigmine (Mestinon, Regonol), rivastigmine (Exelon), and tacrine (Cognex); heparin; ipratropium (Atrovent); magnesium sulfate; medications for allergies, colds, or sleep; medications for glaucoma, inflammatory bowel disease, motion sickness, Parkinson’s disease, ulcers, or urinary problems; muscle relaxants; platelet inhibitors such as clopidogrel (Plavix). dipyridamole (Persantine, in Aggrenox), prasugrel (Effient), and ticlopidine (Ticlid); and quinidine. Also tell your doctor if you have received injections of any botulinum toxin product including abobotulinumtoxinA (Dysport), incobotulinumtoxinA (Xeomin), or rimabotulinumtoxinB (Myobloc) within the past four months. Your doctor may need to change the doses or schedule of your medications or monitor you carefully for side effects.
• tell your doctor if you have swelling or other signs of infection or weakness in the area where botox will be injected. Your doctor will not inject the medication into an area that is infected or weak.
• if you will be receiving botox injection to treat urinary incontinence, tell your doctor if you have a urinary tract infection (UTI), which may include symptoms such as pain or burning when you urinate, frequent urination, or fever; or if you have urinary retention (inability to fully empty the bladder) and do not regularly empty your bladder with a catheter. Your doctor will probably not treat you with botox injection.
• tell your doctor if you have ever had any side effect from any botulinum toxin product, or eye or face surgery, if you have or have ever had bleeding problems; seizures; hyperthyroidism (a condition that occurs when the thyroid gland produces too much thyroid hormone), diabetes, or lung or heart disease.
• if you will be receiving botox injection to treat wrinkles, your doctor will examine you to see if the medication is likely to work for you. Botox injection may not smooth your wrinkles or may cause other problems if you have drooping eyelids; trouble raising your eyebrows; or any other change in the way your face normally looks.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while receiving onabotulinumtoxinA injection, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are receiving botox injection.
• you should know that botox injection may cause loss of strength or muscle weakness all over the body or impaired vision. If you have any of these symptoms, do not drive a car, operate machinery, or do other dangerous activities.

How long do botox injections last?

The effect from Botox injection slowly wears off over a period of 3–4 months. Your body may develop resistance to the treatment if it’s repeated too frequently.

What is Botox treatment cost?

Botox injection cost varies depending on the amount of product used. Botox injection cost can vary greatly according to geographic region and depending on the doctor who performs the procedure. The average Botox injection price ranges from $350 to $500 for each area injected.

Botox injection side effects

Botox injection may cause side effects. Ask your doctor which side effects you are most likely to experience, since some side effects may occur more often in the part of the body where you received the injection.

Tell your doctor if any of these symptoms are severe or do not go away:

• flu-like symptoms – including a headache – for the first 24 hours after treatment
• pain, tenderness, swelling, redness, bleeding, or bruising in the place where you received the injection
• temporary weakness and droopiness of your facial features – for example, eyelids or eyebrows may droop temporarily if the injected medicine moves into these areas
• tiredness
• neck pain
• headache
• drowsiness
• muscle pain, stiffness, tightness, weakness, or spasm
• pain or tightness in the face or neck
• dry mouth
• nausea
• constipation
• anxiety
• dry or irritated eyes
• difficulty falling asleep or staying asleep
• sweating from parts of the body other than the underarms

In rare cases, serious problems can develop in the hours, days or weeks after treatment, including blurred or double vision (if the area around the eyes is injected) and breathing difficulties (if the neck area is injected).

Some side effects can be serious. If you experience any of these symptoms, or those listed in the IMPORTANT WARNING section, at any time during the first several weeks after your treatment, call your doctor immediately or get emergency medical treatment:

• double, blurred, or decreased vision
• urinary tract infection
• eyelid swelling
• vision changes (such as dry eyes, irritation, light sensitivity, or blurred vision)
• dry, irritated, or painful eyes
• difficulty moving the face
• seizures
• irregular heartbeat
• chest pain
• pain in the arms, back, neck, or jaw
• shortness of breath
• fainting
• dizziness
• rash
• hives
• itching
• swelling of the hands, feet, ankles, or lower legs
• cough, coughing up mucus, fever, chills
• inability to empty your bladder on your own
• pain or burning when urinating or frequent urination
• blood in urine
• fever

Symptoms of botox injection overdose usually do not appear right after receiving the injection. If you received too much onabotulinumtoxinA or if you swallowed the medication, tell your doctor right away and also tell your doctor if you experience any of the following symptoms during the next several weeks:

• weakness
• difficulty moving any part of your body
• difficulty breathing
• difficulty swallowing

Botox injection may cause other side effects. Call your doctor if you have any unusual problems while receiving botox injection.