Botox is a brand name of a toxin produced by the bacterium Clostridium botulinum. There are other brand names for botulinum, such as Xeomin. In large amounts, this toxin can cause botulism, which you probably associate with food poisoning. Despite the fact that one of the most serious complications of botulism is paralysis, scientists have discovered a way to use it to human advantage. Small, diluted amounts can be directly injected into specific muscles causing controlled weakening of the muscles.


Just like any medical procedure the Botox treatment rarely comes with a few possible side-effects that are temporary. The frequency of complications generally decreases the more knowledge of facial anatomy that your injector possesses and the greater the experience of knowing where and how much to inject.That is not to say that complications can occur in anyones hands but the incidence decreases with greater experience.Allergic reactions to Botox or Dysport is exceedingly rare in my experience.
Botox is a drug made from a neurotoxin produced by the bacterium Clostridium botulinum called botulinum toxin. "It's a poison secreted by the bacteria," plastic surgeon Norman Rowe, M.D., tells SELF. Botulinum toxin has proven to be a successful and valuable therapeutic protein when dosage, frequency of treatment and variety of treated clinical conditions are considered, according to Howard Sobel, M.D., a dermatologist in New York. Basically: when it's done right. When it's done wrong—like, really, really wrong—it can cause "botulism-like symptoms," according to Mayo Clinic, which may include muscle weakness, trouble breathing, speaking or swallowing, bladder control issues, and vision problems. That is "very unlikely," but a more than convincing enough reason not to go bargain hunting for Botox.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Charges can vary from $8 to $20 a unit depending on where you are in the country and the level of dilution, meaning that the price may actually be higher than the quoted price if a clinic dilutes it out instead of preparing full-strength Botox. The cost of the procedure varies as it depends upon the total number of units injected and the number of sites treated.
Though there's still more research to be done on Botox for migraines and doctors aren't yet completely sure why the procedure is effective, they have some ideas. Ravitz tells me, "What [Botox] does is paralyze nerve terminals. Essentially, nerve terminals transmit pain, but they also produce pain substances while they’re doing that, and it completely paralyzes that process." She says that it stops the process of pain patterning and it also relaxes the muscles.

The patient is placed in a somewhat raised position on the exam table, and the areas to be injected are cleansed with a nonalcohol cleanser, such as Hibiclens or Betadine. Some physicians will apply a topical anesthetic, such as EMLA cream or some alternative, at this time. The Botox is then injected into the desired areas. Typical injection patterns include about four or five areas on each side of the forehead and two or three areas on either eye area. More areas can be injected by skilled physicians, depending on the type of wrinkles and the desired effect for the patient. It is common for pressure to be applied if an area seems to be bleeding after the injection. While ice is sometimes applied beforehand for comfort reasons, direct pressure is much more effective than ice for control of bleeding and bruising.

"As we get older, we lose volume in our face and hyaluronic acid filler can be used as a replacement,” explains Wexler. "For younger women, injections can be used to treat areas with acne scarring or hollowness under the eyes." During your ‘20s, when the face is at its fullest and healthiest, it has been argued that a shadowy gaze can even be quite charming. But in other cases, hereditary dark circles can result in a persistently tired look, which is where a few drops of filler under the eyes may be useful. As top dermatologist David Colbert, M.D. is quick to note, however, too much Botox and filler distorts the face and as a result will make you appear older. “When the line is crossed everyone starts looking like they are related," he also cautions of a uniform cookie-cutter appearance that lacks character or individuality. Or worse. “It’s a snowball effect of people liking something, coming back too soon [for even more], and then it gets too heavy,” adds Wexler.
When asked how often he turns people away, Dr. Matarasso says: “I turned someone away today. I had a gentleman come in, he was an appropriate candidate anatomically, he had some deep lines in his forehead, but his expectations were unrealistic. He wanted every line erased, and I said, ‘No, you are going to look a little mask-like.’ I gave him a brochure and said, 'Go home and think about it.'” 

The primary release procedure for BOTOX uses a cell-based potency assay to determine the potency relative to a reference standard. The assay is specific to Allergan's products BOTOX and BOTOX Cosmetic. One Unit of BOTOX corresponds to the calculated median intraperitoneal lethal dose (LD50) in mice. Due to specific details of this assay such as the vehicle, dilution scheme, and laboratory protocols, Units of biological activity of BOTOX cannot be compared to nor converted into Units of any other botulinum toxin or any toxin assessed with any other specific assay method. The specific activity of BOTOX is approximately 20 Units/nanogram of neurotoxin protein complex.
In the mid- to late-1990’s dermatologists were the first to report headache relief to migraineurs who were receiving BOTOX injections to reduce facial (forehead) wrinkles. Initially there was significant controversy about whether BOTOX really did help migraine patients. The use of BOTOX for treatment of tension headaches was studied and found to be no more effective than placebo. With migraines, it was more complex. In 2009 the data showed that BOTOX injected in particular areas of the head and neck in patients who met the International Classification of Headache Disorders criteria for chronic migraine provided sufficient benefit to recommend the treatment modality. In 2010, the FDA approved BOTOX for chronic migraine and recommended the protocol of injections and treatment frequency that had been successful in the studies.
In this study the median total BOTOX dose in patients randomized to receive BOTOX (N=88) was 236 Units, with 25th to 75th percentile ranges of 198 Units to 300 Units. Of these 88 patients, most received injections to 3 or 4 muscles; 38 received in jections to 3 muscles, 28 to 4 muscles, 5 to 5 muscles, and 5 to 2 muscles. The dose was divided amongst the affected muscles in quantities shown in Table 36. The total dose and muscles selected were tailored to meet individual patient needs.
Botox (also known as Vistabel outside the U.S. and the U.K.) is an injection that temporarily relaxes facial muscles to reduce the appearance of fine lines and wrinkles, as well as prevent new lines from forming. Common injection sites include the forehead, the area between the eyebrows, the corners of the eyes, and the sides of the chin. Botox can also be used for a wide variety of other conditions, including migraines, excessive sweating, and psoriasis. LEARN MORE ›
Medicine to help the patient relax may be given in cases where the patient has not handled shots well in the past. If the patient has another procedure coming up, these shots can often be done at this time. Let the Rehabilitation Medicine office (513-636-7480) know if a procedure or surgery will be done in the future or if sedation is being discussed for injections in the clinic setting.
I tell my patients that it is not the total price that is important, but how many units are used. For instance, if a patient goes to a spa and pays $150 per area, that may sound like a great deal. However, when the patient ask how long the treatment is supposed to last, the spa responds "2 months". I have seen that many of those less expensive treatments often consist of around 10 units (and therefore carrying a "non-deal" $15 cost per unit!). So, what initially looks like a great bargain, is in fact just a treatment with an inadequate amount of Botox. Always ask your injector how many units they are using, so you can determine what price/unit you are getting. Experienced injectors know that there is no such thing as a standard amount of units, as everyone's facial anatomy and muscular strengths are variable, even from one side of the face to the other.
Botulinum toxin exerts its effect by cleaving key proteins required for nerve activation. First, the toxin binds specifically to nerves which use the neurotransmitter acetylcholine. Once bound to the nerve terminal, the neuron takes up the toxin into a vesicle. As the vesicle moves farther into the cell, it acidifies, activating a portion of the toxin which triggers it to push across the vesicle membrane and into the cell cytoplasm.[1] Once inside the cytoplasm, the toxin cleaves SNARE proteins preventing the cell from releasing vesicles of neurotransmitter. This stops nerve signaling, leading to paralysis.[1]

Some industry insiders say it's not unusual, if still legally murky, for drug-company representatives and doctors to share information with one another about the different ways an approved drug may be used. If a doctor notices that, say, a treatment for crossed eyes also "takes the lines out," he may mention it to the representative from whom he buys the drugs. That rep may share that with another of his clients, and so on.


The cost for Botox may range from $125 to $400 per treatment area. Multiple areas may be treated at one time, and repeat treatments are needed every three to four months, on average. When it comes to Botox and other injectables, you get what you pay for. Buyer beware: bargain Botox may increase your risk of complications, including poor cosmetic results. If the cost is prohibitive, ask your doctor about payment plans.
In 2016, the stock price of Tobira Pharmaceuticals stumbled on the release of the top-line data of the Phase 2b CENTAUR study of CVC therapy in NASH because the clinical trial missed its primary clinical outcome of improvement in NASH resolution without worsening of liver fibrosis. However, CVC therapy achieved its secondary clinical outcome of improvement in liver fibrosis without worsening of NASH resolution. The clinical efficacy of CVC on NASH liver fibrosis is currently being further researched in the ongoing Phase 3 AURORA clinical trial.
The primary release procedure for BOTOX uses a cell-based potency assay to determine the potency relative to a reference standard. The assay is specific to Allergan's products BOTOX and BOTOX Cosmetic. One Unit of BOTOX corresponds to the calculated median intraperitoneal lethal dose (LD50) in mice. Due to specific details of this assay such as the vehicle, dilution scheme, and laboratory protocols, Units of biological activity of BOTOX cannot be compared to nor converted into Units of any other botulinum toxin or any toxin assessed with any other specific assay method. The specific activity of BOTOX is approximately 20 Units/nanogram of neurotoxin protein complex.
The co-primary endpoints were the average of the change from baseline in modified Ashworth Scale (MAS) ankle score at Week 4 and Week 6, and the average of the Physician Global Assessment of Response (CGI) at Week 4 and Week 6. The CGI evaluated the response to treatment in terms of how the patient was doing in his/her life using a 9-point scale from -4=very marked worsening to +4=very marked improvement).
Autonomic dysreflexia associated with intradetrusor injections of BOTOX® could occur in patients treated for detrusor overactivity associated with a neurologic condition and may require prompt medical therapy. In clinical trials, the incidence of autonomic dysreflexia was greater in patients treated with BOTOX® 200 Units compared with placebo (1.5% versus 0.4%, respectively).
Lastly, a Botox treatment does not offer permanent results. Botox is most effective when treatments are carried out at regular intervals before the results fully wear off. On average, the results last for three to four months,  although Botox metabolizes at different rates in different individuals. The first ever Botox treatment you receive may not last as long as subsequent treatments, plus you may require touch-ups two weeks after the procedure as your injector determines the right dosage for you. Over time, however, many patients notice that they can wait longer intervals between treatments as their treated facial muscles weaken.
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The last thing I've found to be a little frustrating is that my body tends to metabolize the Botox a bit faster than I can get it. While Ravitz tells me I can't get the treatment any more frequently than every three months, because that's the rate at which the body can develop antibodies against it, I find my migraines amping up in frequency again about two to two and a half months after I get the shots. However, given the fact that with the Botox, my migraines have gone down from about four a week to one or two at most, it's absolutely increased my quality of life, and I'm glad I gave it a shot...or 40.

Botulinum toxin is used to treat certain eye disorders such as crossed eyes (strabismus) and uncontrolled blinking (blepharospasm), to treat muscle stiffness/spasms or movement disorders (such as cervical dystonia, torticollis), and to reduce the cosmetic appearance of wrinkles. It is also used to prevent headaches in people with very frequent migraines. Botulinum toxin relaxes muscle by blocking the release of a chemical called acetylcholine.
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In clinical trials, 30.6% of patients (33/108) who were not using clean intermittent catheterization (CIC) prior to injection, required catheterization for urinary retention following treatment with BOTOX® 200 Units as compared to 6.7% of patients (7/104) treated with placebo. The median duration of post-injection catheterization for these patients treated with BOTOX® 200 Units (n = 33) was 289 days (minimum 1 day to maximum 530 days) as compared to a median duration of 358 days (minimum 2 days to maximum 379 days) for patients receiving placebo (n = 7).
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