Outer Surface of the Eye
Return to Chapter Index
With the recent nod of approval from the Food and Drug Administration
(FDA), the popularity of Botox injections has surged. Spas, shopping
malls, walk-in clinics and even parties advertise the availability of
this age-defying treatment. Even before FDA approval, the use of Botox
was on the rise, increasing 61% between 2000 and 2001, according to the
American Society of Plastic Surgeons.
Botox, the trade name for botulinum toxin type A, is used to lessen
the telltale signs of aging by softening frown lines on the forehead
and brow, crow’s feet at the corners of the eye, and other wrinkles.
But what is this toxin, how does it work, and who should be administering
Botulinum toxin type A is one of several proteins secreted by the bacterium Clostridium
botulinum. These proteins are neurotoxins; they attack nerve cells
and paralyze the affected muscles. Ingestion of botulinum toxins causes
the infamous food poisoning botulism. But when the purified form of
botulinum toxin type A is injected into the muscles below the skin
in very low doses, the result is a reduction in wrinkling.
As we age, our skin becomes less elastic and wrinkles remain even when
the muscles controlling the skin are relaxed. Botulinum toxin lessens
wrinkles by attaching itself to nerve endings in the muscle and preventing
the release of the neurotransmitter acetylcholine. This blocks the nerve
signals transmitted from the brain to the muscles and paralyzes or weakens
the muscle controlling the wrinkled skin. The result is the smoothing
out of the skin from disuse — if it can’t move, it can’t
Botox injections are done in a quick and easy procedure lasting less
than 30 minutes. The toxin takes effect within a week. The results are
temporary, however, so retreatment is necessary within three to six months.
Botox may be used in conjunction with or as an alternative to other facial
skin rejuvenation procedures such as chemical peels or laser skin resurfacing.
When performed by an experienced physician, the most common adverse side
effects of the procedure include headache, respiratory infection, flu
syndrome, and nausea.
With the potential results and relative ease, it is easy to forget Botox
is a prescription drug and not just an injection. However, the results
of the procedure largely depend on the injector’s knowledge of
the complex muscular anatomy of the face, the effects of the drug, and
the principles of aesthetics. Each face must be treated differently.
An inexperienced or careless injector may introduce the toxin into parts
of the face that result in droopy eyelids or brows. Injections in several
parts of the face at the same time can result in excessive paralysis,
leading to a
"frozen" or unexpressive look that may take a few months to
For the best results, anyone considering this procedure should find
a dermatologist or dermatologic surgeon with training and experience
in the technique. The physician should also spend adequate time with
the patient discussing the desired results and the patient’s medical
history. A patient must understand the risks, benefits, alternatives,
and reasoning for the procedure. The injections should be performed in
an appropriate setting such as a medical office with medical personnel
and equipment ready to deal with potential complications.
The injections are on the pricey side, though, costing an average of
December 2002 Update
Back to Top