Botox gained popularity and notoriety as a wrinkle reducer in the late 1990s and early 2000s. But it wasn’t long before researchers recognized the potential of Botox for treating medical conditions, too. Today it’s used to treat problems such as repetitive neck spasms, eye twitching, and overactive bladder. In 2010, the FDA approved Botox as a preventive treatment option for chronic migraines.
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).
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It is not known whether BOTOX® is safe or effective to treat increased stiffness in upper limb muscles other than those in the elbow, wrist, fingers, and thumb, or in lower limb muscles other than those in the ankle and toes. BOTOX® has not been shown to help people perform task-specific functions with upper limbs or increase movement in joints that are permanently fixed in position by stiff muscles. BOTOX® is not meant to replace existing physical therapy or other rehabilitation that may have been prescribed.
Recently, there has been an emerging trend of “BOTOX® Cosmetic parties,” in which several people gather at a physician’s house or another location to have BOTOX® Cosmetic injections at a lower cost. While prices for treatment may be somewhat lower at a BOTOX® Cosmetic party than for treatment administered during a normal office visit, the situation may not be ideal. The American Academy of Dermatology and the American Society of Aesthetic Plastic Surgery have both issued warnings against such “parties,” as they have reservations about the ability of the physician to provide a safe and sterile environment outside of their office.
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There are no data on the presence of BOTOX in human or animal milk, the effects on the breastfed child, or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for BOTOX and any potential adverse effects on the breastfed infant from BOTOX or from the underlying maternal conditions.
Dr. Starling says the FDA approval indicates that the anti-CGRP treatments are ideal for individuals with episodic migraine who have four to 14 headache days per month, and people with chronic migraine who have 15 or more headache days per month. Clinical trials are also being conducted to see if anti-CGRP antibodies are effective for the treatment of cluster headache. “The initial studies have demonstrated that it’s likely effective for cluster headache patients,” Dr. Starling says. The FDA’s approval of these medications has been incredibly meaningful for the migraine community. “The migraine community is feeling like they’re relevant—that they’re being seen, heard and taken seriously,” Dr. Starling says. “There are many people who are working hard to develop more treatment options until we can address every patient who has migraine, and eventually find a cure.”
Unopened vials of BOTOX should be stored in a refrigerator (2° to 8°C) for up to 36 months. Do not use after the expiration d ate on the vial. Administer BOTOX within 24 hours of reconstitution; during this period reconstituted BOTOX should be stored in a refrigerator (2° to 8°C). Reconstituted BOTOX should be clear, colorless, and free of particulate matter.

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Botulinum toxin is one of the most poisonous substances known to man. Scientists have estimated that a single gram could kill as many as 1 million people and a couple of kilograms could kill every human on earth. In high concentrations, botulinum toxin can result in botulism, a severe, life-threatening illness. Botulism, left untreated, may result in respiratory failure and death. Despite botulinum toxin being so toxic, Botox is in huge demand.
The safety and effectiveness of BOTOX® for hyperhidrosis in other body areas have not been established. Weakness of hand muscles and blepharoptosis may occur in patients who receive BOTOX® for palmar hyperhidrosis and facial hyperhidrosis, respectively. Patients should be evaluated for potential causes of secondary hyperhidrosis (eg, hyperthyroidism) to avoid symptomatic treatment of hyperhidrosis without the diagnosis and/or treatment of the underlying disease.
Jump up ^ Dodick DW, Turkel CC, DeGryse RE, Aurora SK, Silberstein SD, Lipton RB, Diener HC, Brin MF (June 2010). "OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program". Headache. 50 (6): 921–36. doi:10.1111/j.1526-4610.2010.01678.x. PMID 20487038.
A randomized, multi-center, double-blind, placebo-controlled study of the treatment of cervical dystonia was conducted. This study enrolled adult patients with cervical dystonia and a history of having received BOTOX in an open label manner with perceived good response and tolerable side effects. Patients were excluded if they had previously received surgical or other denervation tre atment for their symptoms or had a known history of neuromuscular disorder. Subjects participated in an open label enrichment period where they received their previously employed dose of BOTOX. Only patients who were again perceived as showing a response were advanced to the randomized evaluation period. The muscles in which the blinded study agent injections we re to be administered were determined on an individual patient basis.
Absolutely. Botox (and competitors like Dysport and Xeomin, which will be widely available next January) are highly purified toxins that can temporarily erase or reduce horizontal forehead lines, vertical frown lines, and crow's-feet. "The injections slow muscles that contract hundreds of times a day, eventually etching lines in the skin," says New York City plastic surgeon Michael Kane, author of The Botox Book (St. Martin's Press). Botox can also lift the corners of the mouth that sag with age, smooth out the "pin cushion" look in some chins, soften smoker's lines around the mouth, and soften vertical neck cords.

Potential Botox side effects include pain at the injection site, infection, inflammation, swelling, redness, bleeding and bruising. Some of these symptoms may indicate an allergic reaction; other allergy symptoms are itching, wheezing, asthma, a rash, red welts, dizziness and faintness. Tell your doctor immediately if you have any breathing issues or a faint or dizzy feeling.
Once the protein stops functioning at the neuromuscular junction, it is broken down into its harmless components (amino acids) and either recycled for use in other proteins or excreted by the kidneys. "The bigger the muscle, the quicker you'll see motion return," says Rowe. "Likewise, the smaller the muscle, the longer the effect of botox lasts." It doesn't have a tolerance effect, either—your body never gets used to Botox.
The potency Units of BOTOX (onabotulinumtoxinA) for injection are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, units of biological activity of BOTOX cannot be compared to nor converted into units of any other botulinum toxin products assessed with any other specific assay method [see WARNINGS AND PRECAUTIONS and DESCRIPTION] .
If you find that your Botox wears off really fast, speak to the person who gave you the injections to find out why (i.e. if the Botox was too diluted, not enough was injected, the Botox was old, your anatomy requires a different technique, you might be resistant to Botox, etc). A reputable doctor will work with you to figure out how to make the Botox treatments worth your time and money. Keep in mind that for some people, Botox takes time to kick in - approximately 1-2 days to be noticeable and 1-2 weeks to peak.
The idea of a needle going toward your forehead, in between your eyes, or at your eyebrows might be a little daunting, but rest assured, not only is Botox FDA-approved, but it’s a very common (and highly-requested) procedure. It’s commonly used for cosmetic reasons, but it also helps alleviate a slew of other health concerns.”Botox was first approved by the FDA in 1989 to treat blepharospasm of the eyelid, and now can treat hundreds of medical conditions, such as hyperhidrosis (excessive sweating) or chronic migraines,” dermatologist Jill S. Waibel, MD. She also notes that it was only approved for cosmetic purposes in 2002. “Since then, millions of people have had Botox done safely and effectively. It is important to remember that Botox is safest when used by a board certified dermatologist or a plastic surgeon.”
BOTOX is indicated for the treatment of upper limb spasticity in adult patients, to decrease the severity of increased muscle tone in elbow flexors (biceps), wrist flexors (flexor carpi radialis and flexor carpi ulnaris) , finger flexors (flexor digitorum profundus and flexor digitorum sublimis), and thumb flexors (adductor pollicis and flexor pollicis longus).
Postmarketing Experience: The following adverse reactions have been identified during postapproval use of LATISSE®: dry skin of the eyelid and/or periocular area, eye swelling, eyelid edema, hypersensitivity (local allergic reactions), lacrimation increased, madarosis and trichorrhexis (temporary loss of a few eyelashes to loss of sections of eyelashes, and temporary eyelash breakage, respectively), periorbital and lid changes associated with a deepening of the eyelid sulcus, rash (including macular and erythematous), skin discoloration (periorbital), and vision blurred.
I’ve had migraines since I was 12, but in 2015 my attacks got much worse. Without migraine-specific painkillers, my migraines make me queasy and tired, forcing me to go to bed with a freezing wet towel on my head. For the last two years, I’ve tried different medications, switched birth control pills, made lifestyle changes (less stress, more swimming, no alcohol) — to little avail. My migraines would improve for a while, but then they came back, worse than ever. Then this year, I finally discovered a treatment that works — Botox.
BOTOX for migraines is an innovative, FDA-approved procedure. BOTOX is a unique approach to migraine relief that is proving to be highly effective for many patients living with the condition. Rather than reducing the symptoms of an existing headache, BOTOX works to prevent future headaches, and helps avoid the continued use of powerful prescription pain medications.

The FDA approval was based on a large study showing that Botox significantly reduced migraine frequency and severity, as well as headache-related disability, compared to placebo. As just one measure of its effectiveness, many of my patients report that they’ve cut their use of rescue medications in half since starting Botox – a significant benefit for people who previously had to resort to rescue medications 15 or more times every month.
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Botox has not been approved for any pediatric use.[30] It has, however, been used off-label by physicians for several conditions. including spastic conditions in pediatric patients with cerebral palsy, a therapeutic course that has resulted in patient deaths.[30] In the case of treatment of infantile esotropia in patients younger than 12 years of age, several studies have yielded differing results.[21][better source needed]


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Now, thanks in large part to off-label use, Botox--the wrinkle smoother that exploded as a cultural phenomenon and medical triumph--is increasingly being drafted for problems that go far beyond the cosmetic. The depression suffered by Rosenthal's patient is just one example on a list that includes everything from excessive sweating and neck spasms to leaky bladders, premature ejaculation, migraines, cold hands and even the dangerous cardiac condition of atrial fibrillation after heart surgery, among others. The range of conditions for which doctors are now using Botox is dizzying, reflecting the drug's unique characteristics as much as the drug industry's unique strategies for creating a blockbuster.
hello i have been taking botox injections i have had my third series of injections and will not stop, they have hepped so much, i was on so many medicines to help it was unreal, the only problem i have is the neck stiffiness but i had it before i dr gives me injections in my neck to help with it now, so its better, i do love them i didnt even notice the wrinkles gone until the doctor said something about it, which i didnt have much except around my mouth, give them a try,
"There is a difference in pricing based on the duration of the results," says L.A.-based injection specialist Lisa Goodman. (FYI: She's incredible, and I emphatically recommend seeing her if you're in L.A. or Dara Liotta, MD, if you're in NYC.) "The longer-lasting formulas cost more upfront. Shorter-term fillers can last from six to 11 months based on the patient's rate of aging (i.e., smoking, drinking, sun exposure, genetics), while the longer-term fillers last about one to two years."

A placebo-controlled, double-blind post-approval 52 week study with BOTOX 100 Units (Study NDO-3) was conducted in non-catheterizing MS patients with urinary incontinence due to detrusor overactivity associated with a neurologic condition. Catheterization for urinary retention was initiated in 15.2% (10/66) of patients following treatment with BOTOX 100 Units versus 2.6% (2/78) on placebo at any time during the complete treatment cycle. The median duration of post-injection catheterization for those who developed urinary retention was 64 days for BOTOX 100 Units and 2 days for placebo.
Botox injections like other goods and services in New York City are typically more expensive then in the suburbs where the rent and salaries are also less expensive. So it is true that in general Botox cost more in NYC. In one vial of Botox there is 100 units of medicine and each unit costs on average $20. Most patients require between 20 to 60 units.That translates into an average between $400 and $1200.
Yes. The number of men receiving cosmetic treatments overall has risen by 325% over the last 20 years. And the number of men specifically choosing treatments like BOTOX® Cosmetic has also risen fast– in the past three years alone, men have received over one million botulinum toxin treatments. When surveyed, the majority of men say they want to look good and they’re bothered by the changes they see in the mirror. 80% would choose to treat their crow’s feet first, while 74% would prioritize their forehead lines, and 60% would most like to treat their frown lines.†
Botox is best known for smoothing out wrinkles, but since 2010 it’s also been used to prevent migraines. (Scientists aren’t 100 percent sure why Botox works, though it may interfere with the transmission of pain signals to the brain.) Though the 36 injections I get every three months in my forehead, skull, neck, and shoulders are painful, they’ve been a game changer. I went from 16 to 18 migraines a month to about eight. The intensity of the pain has gone down, too. The results are so good that I find myself frustrated that I spent so many years in unnecessary misery.

The most common side effects of Botox injections are neck pain and stiffness at the injection site. You may develop a headache afterward. You may also experience temporary muscle weakness in your neck and upper shoulders. This can make it hard to keep your head upright. When these side effects occur, they usually resolve on their own within a few days.


Marrying ophthalmology to dermatology, Jean and Alistair Carruthers observed that blepharospasm patients who received injections around the eyes and upper face also enjoyed diminished facial glabellar lines (“frown lines” between the eyebrows), thereby initiating the highly-popular cosmetic use of the toxin.[52] Brin, and a group at Columbia University under Monte Keen made similar reports.[53] In 2002, following clinical trials, the FDA approved Botox Cosmetic, botulinum A toxin to temporarily improve the appearance of moderate-to-severe glabellar lines.[54] The FDA approved a fully in vitro assay for use in the stability and potency testing of Botox in response to increasing public concern that LD50 testing was required for each batch sold in the market.[55][56]
Aesthetician Mary Schook is anti-Botox because she sees the long-term effects on her clients. “Everyone is always like, ‘Look how great this looks,’ and then there is the long-term and they are like, 'Fix me,'” she says. “Allergan [the company that owns Botox] says one in 100 patients gets eyelid-drop, so I always joke, ‘I must meet one in 100 patients, because everyone I see has that drop.'”
When pregnant rats received single intramuscular injections (1, 4, or 16 Units/kg) at three different periods of development (prior to implantation, implantation, or organogenesis), no adverse effects on fetal develop ment were observed. The developmental no-effect level for a single maternal dose in rats (16 Units/kg) is approximately 2 times the human dose of 400 Units, based on Units/k g.
How much is Botox is a frequent question we get in our dermatology offices. The cost of Botox runs typically about $400 – $600 per first treatment area, and up to $300 for each additional area. The most popular areas for Botox treatment are the glabella (those lines in between your eyebrows also known as the “11’s”), the crow’s feet are around the eyes and the horizontal lines on the forehead. When injected by a trained professional who has experience with facial aesthetics, Botox can also give the brows and eye area a mini eye lift. When Botox injections are performed by a trained, licensed and experienced medical expert, the results can be amazing. You will not appear frozen or as though you’ve had work done, when injected properly, Botox makes you look more relaxed, more rejuvenated and just better than before. It’s important to seek out a professional who knows about facial anatomy and can inject you in the exact right places.
In 1820, Justinus Kerner, a small-town German medical officer and romantic poet, gave the first complete description of clinical botulism based on extensive clinical observations of so-called “sausage poisoning”.[37] Following experiments on animals and on himself, he concluded that the toxin acts by interrupting signal transmission in the somatic and autonomic motor systems, without affecting sensory signals or mental functions. He observed that the toxin develops under anaerobic conditions, and can be lethal in minute doses.[38] His prescience in suggesting that the toxin might be used therapeutically earned him recognition as the pioneer of modern botulinum toxin therapy.[39]
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.
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Key secondary endpoints included Physician Global Assessment, finger flexors muscle tone, and thumb flexors tone at Week 6. The Physician Global Assessment evaluated the response to treatment in terms of how the patient was doing in his/her life using a scale from -4 = very marked worsening to +4 = very marked improvement. Study 1 results on the primary endpoint and the key secondary endpoints are shown in Table 26.


The bacterium can also be found in the intestinal tracts of mammals and fish and in the gills and organs of crabs and other shellfish. Such naturally occurring instances of Clostridium botulinum bacteria and spores are generally harmless. Problems only arise when the spores transform into vegetative cells and the cell population increases. At a certain point, the bacteria begin producing botulinum toxin, the deadly neurotoxin responsible for botulism.

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