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Vials of BOTOX have a holographic film on the vial label that contains the name “Allergan” within horizontal lines of rainbow color. In order to see the hologram, rotate the vial back and forth between your fin gers under a desk lamp or fluorescent light source. (Note: the holographic film on the label is absent in the date/lot area.) If you do not see the lines of rainbow color or the name “Allergan”, do not use the product and contact Allergan for additional information at 1-800-890-4345 from 7:00 AM to 3:00 PM Pacific Time.
Baby Botox can be used pretty much anywhere on your face, but it's best to create subtle changes or to erase fine lines. "Something like this is especially nice for an area like the crow's feet, which is a very delicate area where a subtle treatment is more effective," explains Smith. "If someone has very deep folds, micro Botox probably isn't going to cut it. I would offer this to someone with moderate to fine lines."

“A younger face has a heart shape, and an older face is a little more bottom-heavy and square,” says Dr. Matarasso. “But if you put toxin in both sides, you are not reducing the movement of the muscle, you are thinning the muscle out a bit. You can restore a youthful look. It’s not as dramatic or quick-acting as other areas, but it can be a nice way to improve the contour of the face.”
Tell your doctor if you have received any other botulinum toxin product in the last 4 months; have received injections of botulinum toxin such as Myobloc®, Dysport®, or Xeomin® in the past (tell your doctor exactly which product you received); have recently received an antibiotic injection; take muscle relaxants; take allergy or cold medicines; take sleep medicine; take aspirin-like products or blood thinners.
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Most doctors who provide cosmetic services such as BOTOX® treatments accept payment by various methods, including cash, personal check, major credit cards, or through arrangements made with an established lending institution. Some practices even offer their own financing plans. Don’t be afraid to inquire about BOTOX® treatment financing during your initial consultation.

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).

There have been spontaneous reports of death, sometimes associated with dysphagia, pneumonia, and/or other significant debility or anaphylaxis, after treatment with botulinum toxin. There have also been reports of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal outcomes. Some of these patients had risk factors including cardiovascular disease. The exact relationship of these events to the botulinum toxin injection has not been established.


Robert Anolik, a board-certified, cosmetic dermatologist explains, "The cost for these types of treatments is widely variable, as every patient needs different amounts and in different areas. It could be a few hundred dollars to a few thousand. For example, a patient may have deepened nasolabial folds (smile lines) requiring multiple syringes of Restylane Defyne. Or a patient could need a subtle lift with a small amount of Restylane-Lyft in the cheeks and mid-face. I find many of my patients will come in consistently for Dysport (Dysport spreads out a bit more, so you're able to get a better global balancing, whereas Botox has a little more of an isolated effect) every three to four months on average, and then we will review what might be needed among the fillers. Often more syringes of filler may be needed at first and then we can maintain over time."
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.
The median duration of response in Study OAB-1 and OAB-2, based on patient qualification for re-treatment, was 19-24 weeks for the BOTOX 100 Unit dose group compared to 13 weeks for placebo. To qualify for re -treatment, at least 12 weeks must have passed since the prior treatment, post-void residual urine volume must have been less than 200 mL and patients must have reported at least 2 urinary incontinence episodes over 3 days.
Two preparations of botulinum antitoxins are available for treatment of botulism. Trivalent (A,B,E) botulinum antitoxin is derived from equine sources using whole antibodies. The second antitoxin is Heptavalent (A,B,C,D,E,F,G) botulinum antitoxin, which is derived from equine antibodies which have been altered to make them less immunogenic. This antitoxin is effective against all known strains of botulism.

There are several medically related BOTOX ® treatments that are usually covered by insurance, including treatment for blepharospasm (uncontrollable eye twitching), excessive sweating, constant pain, and others. Insurance coverage for cosmetic uses of BOTOX® injections is much less common, but you should consult your insurance provider to find out if you have coverage for BOTOX® treatment. Also, Allergan, the maker of BOTOX ®, provides a Reimbursement Hotline at 1-800-530-6680. An Allergan representative can help you determine whether your procedure is covered by insurance.

Most insurance providers now recognize BOTOX as treatment for migraines. Some have specific criteria that patients must meet, or require documentation that you have gone through other treatment protocols before trying BOTOX. It can take several weeks to receive authorization to begin treatment. Check with your insurance provider to make sure you fulfill their requirements, and to begin the approval process.


It's also not approved by the U.S. Food and Drug Administration (FDA) for depression, not that that stops doctors from prescribing it that way. Such off-label use of Botox, like that of any FDA-approved drug, is legal in the U.S. That's because once a drug has been approved by the FDA for a condition, licensed physicians are legally allowed to prescribe it for any medical issue they think it could benefit, regardless of whether it's been proved to work for that condition.
BTX-A has also been used in the treatment of gummy smiles,[80][81] the material is injected into the hyperactive muscles of upper lip, which causes a reduction in the upward movement of lip thus resulting in a smile with a less exposure of gingiva.[82] Botox is usually injected in the three lip elevator muscles that converge on the lateral side of the ala of the nose; the levator labii superioris (LLS), the levator labii superioris alaeque nasi muscle (LLSAN), and the zygomaticus minor (ZMi).[83][84]
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.
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.
Selecting the correct injection points is critical to the success of the procedure. These points are first scored with a marking pencil. Your doctor will likely select numerous injection points for each location to be treated. (These points are located where the muscle contracts — not necessarily at the wrinkle you are hoping to erase.) The Botox filler is then injected into the marked points beneath the skin.
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.
The recommended dilution is 200 Units/4 mL or 100 Units/2 mL with preservative -free 0.9% Sodium Chloride Injection, USP (see Table 1). The lowest recommended starting dose should be used, and no more than 50 Units p er site should generally be administered. An appropriately sized needle (e.g., 25-30 gauge) may be used for superficial muscles, and a longer 22 gauge needle may be used for deeper musculature. Localization of the involved muscles with techniques such as needle electromyographic guidance or nerve stimulation is recommended.

Costs to consider: immediate out-of-pocket costs, long-term higher cost of insurance, your time, and the pain of injections. Botox for migraine costs approximately $525 per vial (100 units) and a typical migraine dose is 155 units. Depending on what your doctor charges in addition to the Botox itself, it’ll set you back $1500 – $2300 to test it out. And then there’s the needle pain. Don’t make the mistake of going to get a Botox injection if you’re in the midst of an attack, because it’ll be more painful than ever. Better to reschedule.
“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.

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.

Ratings on RealSelf.com (www.RealSelf.com) show a satisfaction rate of 65% for Botox, which is on par with other treatments such as Restylane, Juvederm, and Perlane and slightly higher than Xeomin and Dysport. Longer-term treatments, such as Ultherapy facial tightening and Liposuction/SmartLipo achieve ratings in the 80% and above area, while others such as CoolSculpting (Zeltiq) achieve ratings in the 70% area. This may reflect upon the short-term nature of all botulinum toxins versus the longer-term nature of these other procedures.
Two preparations of botulinum antitoxins are available for treatment of botulism. Trivalent (A,B,E) botulinum antitoxin is derived from equine sources using whole antibodies. The second antitoxin is Heptavalent (A,B,C,D,E,F,G) botulinum antitoxin, which is derived from equine antibodies which have been altered to make them less immunogenic. This antitoxin is effective against all known strains of botulism.
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).

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.


Botox, or onabotulinumtoxinA, is used for three main purposes: muscle spasm control, severe underarm sweating and cosmetic improvement. In this article we concentrate on the third use, achieved with the product called Botox Cosmetic, which contains botulinum toxin type A (the active ingredient), human albumin (a protein found in human blood plasma) and sodium chloride.


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]
Patients with smaller neck muscle mass and patients who require bilateral injections into the sternocleidomastoid muscle for the treatment of cervical dystonia have been reported to be at greater risk for dysphagia. Limiting the dose injected into the sternocleidomastoid muscle may reduce the occurrence of dysphagia. Injections into the levator scapulae may be associated wit h an increased risk of upper respiratory infection and dysphagia.
Most people tolerate the injection discomfort well. But you may want your skin to be numbed beforehand, especially if your palms or soles are being treated for excessive sweating. Your doctor might use one or more of various methods available to numb the area, such as topical anesthesia, ice and vibration anesthesia, which uses massage to reduce discomfort.

BOTOX® increases the incidence of urinary tract infection. Clinical trials for overactive bladder excluded patients with more than 2 UTIs in the past 6 months and those taking antibiotics chronically due to recurrent UTIs. Use of BOTOX® for the treatment of overactive bladder in such patients and in patients with multiple recurrent UTIs during treatment should only be considered when the benefit is likely to outweigh the potential risk.
Getting Botox takes only a few minutes and no anesthesia is required. Botox is injected with a fine needle into specific muscles with only minor discomfort. It generally takes three to seven days to take full effect and it is best to avoid alcohol at least one week prior to treatment. Aspirin and anti-inflammatory medications should be stopped two weeks before treatment as well in order to reduce bruising.

Bronchitis was reported more frequently as an adverse reaction in patients treated for upper limb spasticity with BOTOX® (3% at 251 Units to 360 Units total dose) compared to placebo (1%). In patients with reduced lung function treated for upper limb spasticity, upper respiratory tract infections were also reported more frequently as adverse reactions in patients treated with BOTOX® (11% at 360 Units total dose; 8% at 240 Units total dose) compared to placebo (6%). In adult patients treated for lower limb spasticity, upper respiratory tract infections were reported more frequently as an adverse event in patients treated with BOTOX® (2% at 300 Units to 400 Units total dose), compared to placebo (1%).


In addition to glabellar lines, Botox is used to eradicate crow’s feet, frown lines, and lines and furrows in the forehead. Whereas treating crow's feet and forehead lines with Botox was for many years an off-label use, the toxin has since received FDA approval for both uses. Botox is also approved to treat a variety of medical conditions, including ocular muscle spasms, problems with eye coordination, severe armpit perspiration, migraine headaches, overactive bladder, urinary incontinence related to nerve damage from conditions such as multiple sclerosis and spine injury. Botox is being studied to determine if it might be useful in treating conditions such as knee and hip osteoarthritis, temporomandibular joint disorder (TMJ) and benign prostatic hyperplasia (BPH).
The efficacy and safety of BOTOX for the treatment of lower limb spasticity was evaluated in Study 6, a randomized, multi-center, double-blind, placebo-controlled study. Study 6 included 468 post-stroke patients (233 BOTOX and 235 placebo) with ankle spasticity (modified Ashworth Scale ankle score of at least 3) who were at least 3 months post-stroke. A total dose of 300 Units of BOTOX or placebo were injected intramuscularly and divided between the gastrocnemius, soleus, and tibialis posterior, with optional injection into the flexor hallucis longus, flexor digitorum longus, flexor digitorum brevis, extensor hallucis, and rectus femoris (see Table 33) with up to an additional 100 Units (400 Units total dose). The use of electromyographic guidance or nerve stimulation was required to assist in proper muscle localization for injections. Patients were followed for 12 weeks.

Besides the three primary U.S. manufacturers, there are numerous other botulinum toxin producers. Xeomin, manufactured in Germany by Merz, is also available for both therapeutic and cosmetic use in the U.S.[67] Lanzhou Institute of Biological Products in China manufactures a BTX-A product; as of 2014 it was the only BTX-A approved in China.[67] BTX-A is also sold as Lantox and Prosigne on the global market.[68] Neuronox, a BTX-A product, was introduced by Medy-Tox Inc. of South Korea in 2009;[69]

Are you ready to put your best face forward, but fear that Botox and other “lunchtime facelifts” are out of your budget? Are you wondering, “How much does Botox cost?” You may be pleasantly surprised to learn that some of the most popular and effective cosmetic treatments available are well within reach. A quick word of warning, though: If the prices seem too good to be true, they probably are. The products may be diluted or the treatment provider inexperienced. It’s worth spending a little extra time and money to get the results that you’re dreaming about!
“We don’t believe Botox is expensive when you look at the value that we provide,” says Marc Forth, senior vice president of US marketing at Allergan, the maker of Botox. Botox halves migraine days in 50 percent of patients who get the injections, Forth says. “We believe that value is worth the tradeoff.” Allergan doesn’t have a say on step therapy policies. Insurers “ultimately make that call on their own,” Forth says.
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.
Prior to injection, reconstitute each vacuum-dried vial of BOTOX with only sterile, preservative-free 0.9% Sodium Chloride Injection USP. Draw up the proper amount of diluent in the appropriate size syringe (see Table 1, or for specific instructions for detr usor overactivity associated with a neurologic condition see Section 2.3), and slowly inject the diluent into the vial. Discard the vial if a vacuum does not pull the diluent into the vial. Gently mix BOTOX with the saline by rotating the vial. Record the date and time of reconstitution on the space on the label. BOTOX should be administered within 24 hours after reconstitution. During this time period, reconstituted BOTOX should be stored in a refrigerator (2° to 8°C).
I would caution against shopping around for cheap Botox. There are practitioners than offer bargain prices that are not sustainable from a business standpoint. They may be diluting their Botox or injecting less units than advertised.  Also, some practitioners charge less per unit of Botox but inject significantly more Botox than is required to achieve the optimal outcome. For instance, 60 units of Botox at $10/unit is more expensive than 45 well placed units at $12/unit. 
Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, trouble swallowing.
Botox prevents migraine headaches before they start, but takes time to work. “I look to the second and third treatments to maximize effects,” says Dr. Andrew Blumenfeld. “Patients see increasing benefit with an increase in the number of treatment cycles.” One treatment lasts for 10-12 weeks, and patients reported that two Botox treatments reduced the number of headache days by approximately 50%.
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.
This imbalance can affect a joint in varied ways such as at the ankle with foot position (always points toes or up on toes when walking) or at the wrist with hand position (hand in flexion with problems grasping). After a contracture occurs (not able to bring the joint through its full range of motion, even with forceful / prolonged stretching) it can be hard to re-establish full range of motion at that joint without surgery.
That Groupon offer might be tempting, but Dr. Tutela recommends doing a thorough vetting of your practitioner’s history and methods before signing up for treatment. “I think it is important to ask any provider if they perform that procedure frequently, to gauge their experience,” he says. He also suggests to ask if they’ve experienced any major complications and to check their online reviews. “You can get a sense of how you will be treated and what kind of experience other patients have had,” Dr. Tutela says. “Many of those low-cost, high-volume practices are loaded with horrible reviews from disappointed patients.”
Botox costs can vary anywhere from $200 to $400 or more depending on the physician, location, units purchased, desired profit margin, ongoing promotions, etc. Many doctor's offices price Botox based on cost per unit, but others price Botox injections based on the area of the injection. Whether Botox is charged by the unit or by the area might not matter that much if the Botox treatment is effective, but if you want to know exactly how much you are paying for your treatment, you need to know the number of units of Botox per treatment and the cost per unit. (An honest practice will not hesitate to give you this information if you ask.)
Serious adverse reactions, including excessive weakness, dysphagia, and aspiration pneumonia, with some adverse reactions associated with fatal outcomes, have been reported in patients who received BOTOX injections for unapproved uses. In these cases, the adverse reactions were not necessarily related to distant spread of toxin, but may have resulted from the administration of BOTOX to the site of injection and/or adjacent structures. In several of the cases, patients had pre-existing dysphagia or other significant disabilities. There is insufficient information to identify factors associated with an increased risk for adverse reactions a ssociated with the unapproved uses of BOTOX. The safety and effectiveness of BOTOX for unapproved uses have not been established.

Treatment with BOTOX® and other botulinum toxin products can result in swallowing or breathing difficulties. Patients with pre-existing swallowing or breathing difficulties may be more susceptible to these complications. In most cases, this is a consequence of weakening of muscles in the area of injection that are involved in breathing or oropharyngeal muscles that control swallowing or breathing (see Boxed Warning).
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).

Chronic migraines are what were formerly known as “transformed” migraines. These are near daily headaches, sometimes with migraine features but otherwise with frequent features of tension headaches. This may sound trivial but the treatment for tension headaches, typically with analgesics, would only make this syndrome worse. We learned that treating these with migraine preventive medications proved mostly effective. The current International Classification of Headache Disorders defines chronic migraine as a recurrent headache that has been ongoing for the past 3 months, occurs on at least 15 days per month, lasts at least 4 hours per day, and has 8 or more days per month when the headache has features of a migraine or responds to a typical migraine medication.
First of all, for those who aren't familiar with migraines, they're different from headaches. Headaches are unpleasant, too, but are typically less severe than migraines and don't usually present with other symptoms besides the pressure and aching in the head. Migraines, on the other hand, can be much more intense and often come with nausea, seeing spots, vomiting, extreme fatigue, sensitivity to light and sound, and more.

The efficacy of BOTOX for the treatment of upper limb spasticity was evaluated in three randomized, multi-center, double-blind, placebo-controlled studies (Studies 1, 2, and 3). Two additional randomized, multi-center, double-blind, placebo-controlled studies for upper limb spasticity in adults also included the evaluation of the efficacy of BOTOX for the treatment of thumb spasticity (Studies 4 and 5).

For most of our guests, the effects of the treatment can last anywhere from 3-6 months. Many factors can influence how long the effects last. As the product wears off, muscle action returns gradually, & the previously treated lines & wrinkles may begin to reappear, and need to be treated again. With repeated treatment, the lines and wrinkles often appear less severe than before, as the muscles are being trained to relax.Some of these factors that may shorten or lengthen the effects include:
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