By Dr. Scott W. Mosser
Botox® is a highly purified form of botulinum toxin Type A, which is produced by the bacteria clostridium botulinum. It was developed in the 1970’s by a San Francisco doctor searching for ways to correct strabismus, or crossed eyes. He discovered that a purified form of this potentially lethal poison (a toxin once commonly produced by bacteria in improperly processed food) when injected in the appropriate overactive muscles caused a temporary relaxation or paralysis which allowed other eye muscles to take over normal eye function.
Allergan, Inc., small drug company specializing in products for use in the fields of ophthalmology and dermatology, purchased the rights to the discovery in 1987, and the toxin was marketed for use in correcting eye muscle disorders such as blepharospasm (uncontrollable blinking) and strabismus (crossed eyes). This form of botulinum toxin A was licensed by Allergan, Inc. in 1989.
Over the following decade, doctors found additional uses for botulinum toxin Type A, including the treatment of cervical dystonia, a disorder that causes severe neck and shoulder contractions, as well as reducing the stiffness and tremors that often follow a stroke.
“Fountain of Youth” Treatment Causes a Media Blitz
In the mid 1990’s, word of mouth among ophthalmologists and dermatologists in the U.S. and Canada spread the fame of the exciting cosmetic side effects observed after injecting the purified toxin – reduction of forehead wrinkles, facial creases and crow’s feet, resulting in a fresher, more youthful facial contour.
When the FDA approved the use of Botox® for cosmetic purposes in 2002, it triggered wide media coverage and catapulted the demand for Botox® injections specifically for cosmetic effect onto the world stage.
This huge demand led to a period of misuse of Botox® injections by non-medically trained cosmeticians, or in back-door treatments under non-medical condition, which resulted in reports of ineffectiveness or unpleasant side effects. It was only as the public became more informed and Board-Certified Plastic Surgeons and dermatologists began adding Botox® injection procedures to their non-surgical facial cosmetic programs that the full benefits became apparent and the safety and efficacy of Botox® injection therapy became mainstream.
The use of Botox® treatments to relax or eradicate wrinkles and frown lines on the forehead and around the eyes is currently the most popular non-cosmetic procedure in the United States, Europe and many other countries. When injected directly into overactive facial muscles, Botox® inhibits the release of acetylcholine, a neurotransmitter that causes muscles to contract. The result is inhibition, or relaxation, of the muscles, an effect that can last up to several months.
According to Allergan, almost 3.3 billion Botox® Cosmetic procedures were performed in 2005 alone.
A Continuing Popularity
The huge popularity of Botox® injections is likely due to its non-surgical nature (leaving no scars), little or no recovery time, its effectiveness, and its relatively low cost compared to surgical face lifts or other procedures. Its safety is also an important factor. Botox® has been widely used for more than a dozen years and there have been no documented systemic complications associated with Botox® injections when administered by qualified medical personnel in accordance with the recommended dosage and guidelines.
The United States Food and Drug Administration (US FDA) cautions that Botox® is a prescription drug that should be administered by a qualified physician in an appropriate medical setting. Any other venue runs the risks of improper technique, inappropriate dosages and unsanitary conditions. The FDA also recommends that Botox® Cosmetic be injected no more frequently than once every three months, and that the lowest effective dose should be used.
The continuing popularity of Botox® cosmetic treatments among men and women in every walk of life (from the glamour industry to the housewife to executives) and the familiarity with which the term is used, has perhaps somewhat obscured the history of the toxin and its original uses. However, physicians and medical researcher have not forgotten and recent developments of new medical uses for Botox are causing renewed excitement.
A New Wrinkle for an Anti-wrinkle Treatment
This unusual substance, which started life as a life-threatening toxin, was later purified for use in treating eye disorders, and then met fame and fortune as an anti-wrinkle treatment, has in the past few years been found to have exciting new health applications: most notably, in the treatment of migraine headaches.
Again, plastic surgeons using Botox® injections on patients who were incidentally migraine headache sufferers began to notice that in addition to a smoother, more youthful facial contour, patients were reporting a lessening in the strength and frequency of migraine attacks.
San Francisco Plastic Surgery Expands the Use of Botox Therapy
The first medical uses of botulinum toxin Type A took place in San Francisco. Since then San Francisco has also become famous as a center of excellence in advanced plastic surgery.
As a Board-Certified Plastic Surgeon practicing in San Francisco, I administer countless Botox® Cosmetic injections to new and regular patients. Every patient has a unique facial structure and skin type, and I tailor treatments to achieve individual satisfaction with realistic expectations.
I also have a special interest in the use of Botox® injection therapy to alleviate migraine pain. During my training I had the opportunity of participating in the groundbreaking research* which is now leading to pain relief for migraine sufferers around the U.S.
I administer Botox® injections in the muscles adjacent to the very specific nerve areas that supply sensation to the skin around the forehead, eyes and scalp that may also play a role in the pain component experienced during a migraine attack.
These three important nerve areas are:
- the supratrochlear and supraorbital nerves, located in the inner upper eye area, which supply sensation to the central, right and left forehead areas;
- the zygomaticotemporal nerve, located just in front of the hairline outside the brow, which supplies sensation to the temple area; and
- the greater occipital nerve, located in the back of the neck, which supplies sensation to the back of the scalp.
What these nerves share in common is that the intense pain migraine patients experience may be distributed along some or all of these nerves in the same manner as the normal sensory distribution of such nerves.
Botox® acts on these muscles in the same way as when used for a cosmetic effect; by inhibiting the release of acetylcholine, a neurotransmitter that causes muscles to contract. The resulting effect that can last up to several months greatly lessens, or in some cases, eliminates migraine pain.
Botox is not effective in every type of migraine disorder, and a consultation and full review of your medical history and previous migraine treatments would be required to determine whether you could benefit by Botox® injection therapy. Dramatic relief has been accomplished in many types of migraine, and I welcome the opportunity to explore the possibilities with any patient.
*Mosser, SW, Guyuron, B, Janis, J, Rohrich, R. The Anatomy of the Greater Occipital Nerve: Implications on the Etiology of Migraine Headaches. Plast. Recon. Surg 113(2):693-7.
Copyright © 2006 by Dr. Scott W. Mosser. This article may not be copied or reproduced in any form without the written permission of Dr. Scott Mosser. Internet links to the www.drmosser.com sub-page containing this article are permitted.