“Most people in their twenties decide to try Botox simply because they want to enhance their appearance, such as relaxing the muscles in their forehead, or because they want to keep their skin looking fresh and young,” Shah says. “Starting earlier is better than later because as the lines get more and more embedded into the skin, Botox is not as effective in eliminating the lines.”

Allergan PLC (AGN) is a large market cap ($65B) biopharmaceutical company with a pipeline of innovative and generic therapeutics for diseases affecting the eyes, bowel, lungs, skin, urogenital systems and brain. Through the acquisition of Tobira Pharmaceuticals and its assets including cenicriviroc (CVC), Allergan is one of the leaders in the clinical development of anti-NASH therapeutics (the focus of this article).
Allergan Plc engages in the research, development, and manufacture of pharmaceutical products. It operates through the following business segments: US Specialized Therapeutics; US General Medicine, and International. The US Specialized Therapeutics segment includes sales and expenses relating to branded products within the United States. The US General Medicine segment involves Central Nervous System; Gastrointestinal; Women's Health; Anti-Infectives; and Diversified brands. The International segment comprises of products sold outside the United States. The company was founded on in 1984 and is headquartered in Dublin, Ireland.
In the before and after picture of my mom's Botox treatment, my mom paid $350 and was charged per area. She chooses reputable physicians that may be slightly more expensive than average, but have good patient reviews and are well-trained and skilled. To her, it is more worth it to have a doctor who knows how to cater the right technique to her skin issues than to have a doctor who injects her with a certain quantity of Botox but with poor or ineffective technique. This doesn't mean that the more expensive a doctor is, the better he or she will be. It just means that similar to how you would hesitate if the treatment is really expensive, you should also hesitate if the Botox treatment is really inexpensive. Good Botox requires a skilled hand and this is especially important since Botox is a treatment that can definitely be botched.
There have been reports following administration of BOTOX® of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal outcomes. Some of these patients had risk factors including pre-existing cardiovascular disease. Use caution when administering to patients with pre-existing cardiovascular disease.
The frontalis muscle attaches to the skin of the lower forehead and ascends to join the fronto-occipital aponeurosis. The action of the frontalis muscle involves elevation of the eyebrows to produce expressions such as surprise, and can cause deep transverse wrinkles on the forehead. The antagonists for brow depression are the corrugators, procerus, and orbicularis oculi muscles.
In rare cases, Botox toxin can spread to areas beyond the injection site. If this happens, you may experience muscle weakness, vision changes, difficulty swallowing, and drooping eyelids. To reduce your risk of serious side effects and complications, always make sure Botox is prescribed and administered by a trained healthcare professional who has experience in using Botox.
Alternatively, bruising could occur, though is less likely, says Rowe, especially in the hands of an experienced doctor. While he says it's "dumb luck" whether or not one bruises from an injection, he also notes that good technique helps reduce the chances. Sobel says that "if you inject [the needle with Botox] too deep, very often you can hit a blood vessel and bruise." What you do after the injection can also make a difference: Take care not to rub or massage the treated areas, as this can cause the toxin to migrate.
The average price for Botox in the Houston area is $14-15/unit. Most providers nowadays will offer specials. In addition, Botox has a "rewards" program that gives you $25 off each treatment done within 3-6 mos of the last treatment, as long as it's done at the same office. Treatment of the glabella, crow's feet and forehead require 25-50 units, depending on the severity of the lines.
In rare cases, Botox toxin can spread to areas beyond the injection site. If this happens, you may experience muscle weakness, vision changes, difficulty swallowing, and drooping eyelids. To reduce your risk of serious side effects and complications, always make sure Botox is prescribed and administered by a trained healthcare professional who has experience in using Botox.

Dermal fillers, as we’ve discussed in our previous post, vary on what you’re looking for and how long you’d like to see those results. According to the Plastic Surgeons Portal, the minimum you’ll pay for dermal fillers, like Juvederm and Restylane, is going to $1500, while the maximum you’re looking at is $2,500. It’s a small price to pay for radiance and confidence!
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* LS mean change, treatment difference and p-value are based on an analysis using an ANCOVA model with baseline weekly endpoint as covariate and treatment group, etiology at study entry (spinal cord injury or multiple sclerosis), concurrent anticholinergic therapy at screening, and investigator as factors. LOCF values were used to analyze the primary efficacy variable.
In a recent Facebook Live, our new director Nim Lalvani introduced herself to the migraine community. If you missed our Facebook Live, watch the recording below or read on to learn more about Lalvani’s personal connection to migraine and her plans for the Foundation. [embed]https://www.facebook.com/americanmigrainefoundation/videos/290329171553466/[/embed] In the short time that Lalvani has worked at AMF, she’s been impressed by the strong and vibrant community of doctors, patients and advocates. Lalvani’s background is in public health, and she has dedicated her career to patient engagement. She has worked in the nonprofit and patient advocacy spaces for more than 12 years, helping patients at both the national and international level. “I've specifically focused my career on designing and providing the rights tools and resources for patients at the times that they need it most,” she shared, adding that her goal is to amplify patients’ voices in research and therapeutic development.
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Sunburn alert: The AHA/BHA Exfoliating Cleanser and AHA/BHA Cream in the Lytera® 2.0 Advanced Pigment Correcting System contain an alpha-hydroxy acid (AHA) that may increase the skin’s sensitivity to the sun and particularly the possibility of sunburn. Patients should use a sunscreen, wear protective clothing, and limit sun exposure while using these products (or this system) and for a week following.
Most SkinMedica® products are intended to meet the FDA's definition of a cosmetic product, an article applied to the human body to cleanse, beautify, promote attractiveness, and alter appearances. These SkinMedica® products are not intended to be drug products that diagnose, treat, cure, or prevent any disease or condition. These products have not been approved by the FDA, and the statements have not been evaluated by the FDA.

Some doctors and dermatologists recommend lying down and resting after a treatment, but Ravitz says she doesn't think there's any need for downtime unless a patient experiences pain. It can take about two weeks to work, though some patients start to feel relief from chronic migraines sooner than that. Ravitz tells me, "If it’s going to work for a patient, one round of the treatment typically lasts for around three months." Though everybody metabolizes it at a different rate, getting it done every three months or so has been found to be effective.

Warnings and Precautions: In patients using LUMIGAN® (bimatoprost ophthalmic solution) or other prostaglandin analogs for the treatment of elevated intraocular pressure (IOP), the concomitant use of LATISSE® may interfere with the desired reduction in IOP. Patients using prostaglandin analogs including LUMIGAN® for IOP reduction should only use LATISSE® after consulting with their physician and should be monitored for changes to their intraocular pressure.
“Your doctor still has to be willing to do the work of filing a waiver and they don’t get reimbursed for that work, so they don’t like to do it,” Hoffman says. Plus, there’s a federal law called ERISA that exempts certain types of employer-provided health plans, called self-funded plans, from the requirements of state laws. So, for roughly a quarter of Americans who have these health plans, the state limitations to step therapy don’t apply.

Two double-blind, placebo-controlled, randomized, multi-center, 24-week clinical studies were conducted in patients with OAB with symptoms of urge urinary incontinence, urgency, and frequency (Studies OAB -1 and OAB-2). Patients needed to have at least 3 urinary urgency incontinence episodes and at least 24 micturitions in 3 days to enter the studies. A total of 1105 patients, whose symptoms had not been adequately managed with anticholinergic therapy (inadequate response or intolerable side effects), were randomized to receive either 100 Units of BOTOX (n=557), or placebo (n=548). Patients received 20 injections of study drug (5 units of BOTOX or placebo) spaced approximately 1 cm apart into the detrusor muscle.

“ARMR is a longitudinal study. We’re collecting data over time, which will allow us to study changes in headache patterns, health care resource utilization, diagnostic and management strategies, development of co-morbidities and responses to therapies,” Dr. Schwedt says. The registry is comprised of multiple components: The first component is an online platform in which participants fill out a baseline and follow-up questionnaires and clinicians enter the participants’ headache diagnoses. There is also an ARMR headache diary mobile app in which participants share daily information about their migraine attacks, their level of function and their treatment, if any. The third component is a blood sample, which is processed and stored in the ARMR biobank and will be used for genetic analyses. Brain imaging data are collected in the ARMR Neuroimaging Repository, and electronic health record data are pulled and confidentially entered into a centralized ARMR database. “Oftentimes, research is done in silos,” Dr. Schwedt says. “So a group at one institution is doing their own work, collecting their own data, doing their own analysis. And a group at another institution is doing their own work. That isn’t the most efficient way to move forward in the field. We believe creating and sharing data from this large and comprehensive study is really going to improve the efficiency of research in the field.”


The cost of Botox injections varies widely, with most clinics in the United States charging between $9 and $20 per unit. The variation in cost can be influenced by a number of factors, including the location of the clinic or medspa, and the reputation and expertise of the injector. For example, board-certified plastic surgeons who specialize in administering Botox and dermal fillers are likely to charge more because they generally guarantee better results. That is not to say, however, that injectors charging $10 per unit aren’t capable of delivering excellent results as well, but there is far less risk of any complications arising when you choose an injector who has been board-certified. It is always the smartest, safest way to proceed with any cosmetic enhancement.

In 2010, Allergan pleaded guilty and agreed to pay $600 million to resolve allegations that it unlawfully promoted Botox for conditions--including headaches, pain, spasticity and juvenile cerebral palsy--that at the time were not approved by the FDA. In one of the complaints, prosecutors said that Allergan "illegally, vigorously and without any thought to the possible negative health effects to which it subjected patients, promoted off-label uses of Botox." The U.S. Department of Justice also argued that Allergan exploited on-label uses for cervical dystonia--a disorder characterized by extreme neck-muscle contractions--to "grow off-label pain and headache sales." Prosecutors also argued that Allergan paid doctors to give presentations and trainings to other physicians about Botox uses that at the time were off-label.
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In just over a decade, the number of people in the U.S. receiving cosmetic botulinum toxin type A injections--mostly from Botox but also from another brand called Dysport, which commands less than 10% of the market--exploded. From 2000 to 2015, use of the toxins for wrinkles increased 759%. It became a cultural phenomenon too, spawning Botox parties, Simpsons jokes, even greeting cards. In 2008, Sex and the City character Samantha famously quipped, "I don't really believe in marriage. Now Botox, on the other hand, that works every time."
Allergan PLC (AGN) is a large market cap ($65B) biopharmaceutical company with a pipeline of innovative and generic therapeutics for diseases affecting the eyes, bowel, lungs, skin, urogenital systems and brain. Through the acquisition of Tobira Pharmaceuticals and its assets including cenicriviroc (CVC), Allergan is one of the leaders in the clinical development of anti-NASH therapeutics (the focus of this article).
"Neurotoxins and facial fillers are my most popular injectable treatments," notes Zeichner. "Neurotoxins like Botox and Dysport relax muscles under the skin that can lead to folding and lines, specifically frown lines between the eyebrows. Facial fillers are my favorite cosmetic procedure in the office—there's really an art to it. I exclusively use hyaluronic acid fillers because they are safe and long-lasting."

Therefore, it is important to remember that if a clinic or medical spa states that they are providing Botox at a certain dollar amount per unit, it is quite possible that they are diluting the Botox and actually not providing the agreed-upon amount. This is much like the concept of a watered-down drink at a bar, but the costs are much larger when it comes to Botox or its alternatives, Dysport and Xeomin.
Botulinum toxin injections are one approach to the treatment of muscle spasticity. These injections can be given with ease and have minimal side effects. They can also be used in very focal spasticity problems that involve a few muscle groups. This treatment may not be right for some patients, such as patients with severe, widespread muscle spasticity, and patients with permanent muscle contractures that have become rigid.
With small children, I find that being prepared allows us to function better.  My family food preps for the week with fruits, veggies and snack-size portions. I keep the snacks on a shelf that my children can easily reach, so they can choose a healthy option if they’re hungry and I’m unable to get up. Meals are well-thought-out and prepared ahead of time, in case of a migraine attack. I always have a back-up plan for my children. I have alternative arrangements for them after school if I am unable to care for them or myself. I also have activities planned. I keep crafts around that occupy my children’s time but also keep sound and stress to a minimum. We color, build Legos and play with Play-Doh all while sitting in rooms with strategically placed lights and brightness. I save screen time for when I need a few moments of quiet. We keep a routine and schedule, but also stay flexible. A schedule allows my family to know what to expect for our days and evenings. My children are able to continue their day if I have a migraine attack because they know what needs to be done and in what order. We have strict bedtimes that allow my children’s brains to grow and mine to recover. Along with this, I have taught them that moms don’t always feel well, and we may need to adjust the schedule from time to time to accommodate my migraine. I keep medication that can fight a migraine attack with me for use on the go and safely at home. I see a neurologist on a regular basis who helps me manage my migraine symptoms and medication.
“Most people in their twenties decide to try Botox simply because they want to enhance their appearance, such as relaxing the muscles in their forehead, or because they want to keep their skin looking fresh and young,” Shah says. “Starting earlier is better than later because as the lines get more and more embedded into the skin, Botox is not as effective in eliminating the lines.”
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]
When most people see the results of Botox, they are extremely pleased. Botox’s ability to iron out wrinkles is pretty impressive. The fine lines and wrinkles that were all you could see in the mirror appear much less severe and the overall appearance is refreshed and more relaxed and rejuvenated. Botox results typically last up to six months. Botox also acts as a preventative measure for wrinkles, as it prevents repetitive folding of the skin that come from the frequency of making expressions. By injecting Botox before wrinkles even form, you’re setting the stage for a younger look for years to come.
Study 4 included 170 patients (87 BOTOX and 83 placebo) with upper limb spasticity who were at least 6 months post-stroke. In Study 4, patients received 20 Units of BOTOX into the adductor pollicis and flexor pollicis longus (total BOTOX dose =40 Units in thumb muscles) or placebo (see Table 30). Study 5 included 109 patients with upper limb spasticity who were at least 6 months post-stroke. In Study 5, patients received 15 Units (low dose) or 20 Units (high dose) of BOTOX into the adductor pollicis and flexor pollicis longus under EMG guidance (total BOTOX low dose =30 Units, total BOTOX high dose =40 Units), or placebo (see Table 30). The duration of follow-up in Study 4 and Study 5 was 12 weeks.

Botox was introduced to the world in the late 1980s by ophthalmologists, who began using it to treat optic muscle disorders. It was approved by the Food and Drug Administration (FDA) for the treatment of moderate to severe frown lines between the eyebrows (glabellar lines) in 2002, and its popularity has soared ever since. Botox is consistently one of the top five nonsurgical cosmetic procedures performed each year.


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).
Sometimes, because of these policies, patients are put on meds that are not approved by the FDA for the treatment of migraines, like the antidepressant amitriptyline and the high blood pressure drug verapamil. “In my experience, [verapamil is] not very effective,” says Elizabeth Loder, chief of the headache division at Brigham and Women’s Hospital in Boston and the former president of the American Headache Society. For the insurance companies, that doesn’t seem to matter. “It’s frustrating to patients, especially when it seems like some of the treatments that they’re required to try have a lot of side effects and haven’t really been tested that carefully for migraines.”
Jump up ^ Arnon SS, Schechter R, Inglesby TV, Henderson DA, Bartlett JG, Ascher MS, Eitzen E, Fine AD, Hauer J, Layton M, Lillibridge S, Osterholm MT, O'Toole T, Parker G, Perl TM, Russell PK, Swerdlow DL, Tonat K (February 2001). "Botulinum toxin as a biological weapon: medical and public health management". JAMA. 285 (8): 1059–70. doi:10.1001/jama.285.8.1059. PMID 11209178.

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Botox comes as a crystalline substance from the manufacturer, which then has to be reconstituted with saline or another liquid. Practitioners add varying amounts of liquid when reconstituting it. Although there is no right or wrong amount of liquid to add, most physicians add about 2 mL-3 mL (about a half a teaspoon) of liquid to each vial. Some add quite a bit more, which can lead patients to think they are getting more Botox when, in reality, they are getting the same or less amount of Botox than samples reconstituted in a stronger way. It is the total dose of medication, not the volume of liquid, that leads to the desired effect.
I had a consult and the doctor quickly realized that I was a candidate for Botox. He ordered an MRI and doppler of my brain to make sure everything else was A-OK, and then the rest was just waiting on my insurance company. With Botox (I’m not sure if it’s all Botox or just prescription), the insurance company orders it from a pharmacy and sends it to the doctor.

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. An antitoxin is available but must be used before symptoms of overdose become apparent. Symptoms of overdose may be delayed, and may include serious muscle weakness, breathing problems and paralysis.
Tell your doctor about all your medical conditions, including if you: have or have had bleeding problems; have plans to have surgery; had surgery on your face; weakness of forehead muscles; trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; have symptoms of a urinary tract infection (UTI) and are being treated for urinary incontinence (symptoms of a urinary tract infection may include pain or burning with urination, frequent urination, or fever); have problems emptying your bladder on your own and are being treated for urinary incontinence; are pregnant or plan to become pregnant (it is not known if BOTOX® or BOTOX® Cosmetic can harm your unborn baby); are breastfeeding or plan to (it is not known if BOTOX® or BOTOX® Cosmetic passes into breast milk).
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