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Dear Doctor: Let's talk about Botox

Tuesday, December 24, 2002

Q. I've read a lot about Botox, but have seen little about side effects. Is it safe?

A. Botox is the commercial name for a purified and sterile form of Botulinum toxin. This toxin is produced by the bacteria Clostridia botulinum and is responsible for a type of food poisoning, botulism. Fortunately, modern canning methods have made botulism essentially nonexistent from commercially canned foods in the United States.

The Food and Drug Administration approved Botox in 1989 for the treatment of certain muscle disorders of the eyes and face, i.e., "facial tics." Serendipitously, doctors noticed that facial wrinkles were also smoothed temporarily in the area of treatment. Gradually, doctors began using Botox to specifically soften facial lines and wrinkles. The FDA approved Botox for the treatment of forehead wrinkles between the eyebrows on April 15, 2002.

Those wrinkles between the eyebrows generally give the impression of anger, fatigue or both. The classic patient complaint is "People say I'm tired or angry, but I'm neither. What can be done?" The procedure is done in a doctor's office, and involves several small injections into the forehead. The procedure is not painful and patients can resume normal activities immediately. The wrinkles diminish over a week and the effect lasts about three months. The risks are few with incomplete response and local bruising being the most common.

Before one undergoes this procedure, he or she will be asked to provide a complete medical history. The physician should also advise on the risks and benefits of Botox, as well as alternative treatments before asking the patient to give an informed consent. The treatment should be given by a qualified physician in an appropriate medical setting that is equipped to handle adverse reactions and emergency situations. The patient should be willing to be seen in follow-up and follow-post treatment instruction.

One word of caution: "Botox parties" are not the place to receive Botox injections. Enjoy the party, but get your injections in your doctor's office.

Leo R. McCafferty, M.D.
Plastic surgery

Have a brief question? Write to "Dear Doctor," Allegheny County Medical Society, 713 Ridge Ave., Pittsburgh, PA 15212 or e-mail acms@acms.org. Individual responses will not be provided. This column acts as an overview; see your physician for diagnosis.

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