What is Botox® Used For?
Authored by Arash Akhavan, MD, FAAD
Botulinum toxin type A, brand name, Botox® has become a household name synonymous with reducing the appearance of fine lines and wrinkles. As a board-certified cosmetic dermatologist, I frequently receive inquiries about what Botox is, how it works, and its scientific underpinnings. But the most frequent questions I am asked about Botox are are typically centered around what Botox is used for.
In this post we review some background information on this popular treatment, and discuss both the cosmetic and medical uses of Botox.
We also invite you to visit our main Botox treatment page to learn about the procedure at our clinic.
What exactly is Botox anyways?
The Invention of Botox Cosmetic
Botox is a formulation of botulinum toxin type A, a neurotoxic protein produced by the bacterium Clostridium botulinum. The journey of Botox from a deadly toxin to a cosmetic miracle is fascinating. In the late 1970s, ophthalmologist Dr. Alan Scott first utilized botulinum toxin to treat strabismus (crossed eyes). His work paved the way for further research, leading to the discovery that botulinum toxin could also alleviate muscle spasms and, notably, smooth out wrinkles.
In 1989, the FDA approved botulinum toxin type A for treating certain medical conditions. By 2002, Botox Cosmetic received FDA approval for cosmetic use, specifically for temporarily improving the appearance of moderate to severe frown lines between the eyebrows (glabellar lines). Allergan, the company that produces Botox, markets the product under two different names: Botox, for medical uses, and Botox Cosmetic for cosmetic indications.
The Molecular Structure of Botox
Botox Cosmetic's active ingredient is botulinum toxin type A. This neurotoxin is composed of a heavy chain and a light chain connected by a disulfide bond. The heavy chain is responsible for binding to nerve terminals, while the light chain acts as a protease, cleaving specific proteins involved in neurotransmitter release. This molecular action underpins the therapeutic and cosmetic effects of Botox.
Mechanism of Action
The mechanism of action of Botox Cosmetic is both intricate and highly effective. The botulinum toxin works by targeting the neuromuscular junction, the site where nerve endings meet muscle fibers. Upon injection, Botox binds to receptors on the nerve endings and is internalized into the nerve terminal. The light chain of the toxin then cleaves SNAP-25, a protein essential for the release of acetylcholine. This cleavage disrupts synaptic vesicle fusion with the nerve terminal membrane, inhibiting neurotransmitter release and resulting in muscle relaxation.
So essentially, once injected into targeted muscles, Botox blocks the release of acetylcholine, a neurotransmitter responsible for muscle contraction. By preventing acetylcholine from transmitting signals between nerves and muscles, Botox induces temporary muscle paralysis. For example, in cosmetic uses this relaxation of facial muscles reduces the appearance of dynamic wrinkles, such as crow's feet, forehead lines, and frown lines.
Medical Uses of Botox
The cosmetic uses of Botox typically get the most media attention, but Botox was actually approved for medical uses first and has more FDA approved medical indications, as opposed to cosmetic indications.
- Chronic Migraine: Botox is approved for the prevention of chronic migraine in adults who experience 15 or more headache days per month, each lasting 4 hours or more
- Overactive Bladder: Botox is approved for the treatment of overactive bladder symptoms from neurological conditions and detrusor overactivity, such as urinary incontinence, in adults when other medications are not effective
- Upper Limb Spasticity: Botox is approved for the treatment of spasticity in the upper limbs in both adult and pediatric patients aged 2 years and older
- Cervical Dystonia: Botox is approved for the treatment of cervical dystonia, a condition characterized by abnormal head position and neck pain, in adults
- Blepharospasm and Strabismus: The first approval for Botox was for the treatment of blepharospasm (abnormal twitching of the eyelids) and strabismus (crossed eyes) in patients aged 12 years and older
- Primary Axillary Hyperhidrosis: Botox is approved for the treatment of severe primary axillary hyperhidrosis (excessive sweating) that cannot be managed with topical treatments
In addition to these FDA approved indications, Botox is also used off-label for other medical indications such as TMJ (Temporomandibular Joint) Disorder, trapezius tension, pyloric stenosis, and spasmodic dysphonia from spasm of the vocal cords.
Cosmetic Uses of Botox
The FDA cleared cosmetic indications of Botox Cosmetic are more limited, although there are many off-label areas where the product is injected.
- Treatment of Glabellar Lines: Botox Cosmetic was first approved in 2002 for the temporary improvement of moderate to severe frown lines between the eyebrows (glabellar lines) in adults
- Crow's Feet: Botox Cosmetic is also approved for the temporary improvement of crow's feet lines, also called smile lines. These are the wrinkles that occur to the side of the eyes.
- Forehead Lines: Botox Cosmetic is approved for lines on the forehead.
In addition, Botox is used off label to improve vertical neck bands by treating the platysma muscle, it is used to treat gummy smile, and to create a lip flip as an alternative to lip fillers. We have found some of its other cosmetic uses to be less satisfactory.
Botox Cosmetic has garnered immense popularity since its introduction. According to the American Society of Plastic Surgeons (ASPS), over 7 million Botox procedures were performed in the United States in 2020 alone. This makes Botox the most popular cosmetic procedure by a significant margin. In addition, as outlined above, Botox has many FDA cleared medical uses.
Over the years, Botox has proven to be a very safe and effective medication. There are many additional indications in the pipeline for FDA approval for Botox, and the future is bright for this medication.
Arash Akhavan, MD is founder and owner of The Dermatology and Laser Group, one of the top centers for cosmetic procedures in New York City for over a decade. Arash Akhavan, MD, FAAD is a Board Certified Dermatologist and an Associate Professor at The Mount Sinai School of Medicine. Dr. Akhavan is a Castle Connolly Top Doc, New York Magazine Best Doctor, and Super Doctor featured in The New York Times. Dr. Akhavan is a key opinion leader that has been featured on hundreds of media publications including The New York Times, Allure, Marie Claire, Women’s Health, Cosmopolitan, ABC News, Fox News, Fox 5, NY1, WPIX, and more. He has been featured on nationally syndicated television programs such as The Doctors.
Dr. Akhavan serves as an educator and lecturer for multiple aesthetic device and injectable companies. This allows his office access to newer technologies at an earlier date than other offices, as well as a higher level of expertise in the use of these devices. This, in turn, translates to more effective and safer treatments for our patients.
By Arash Akhavan, MD, FAAD | | Categories: Botox
