Botox or onabotulinumtoxinA is a material that has been known for over a century and used for medical purposes for more than 50 years. Its initial uses were for lazy eye (strabismus), blepharospasm (inability to move the eyelids in certain ways), and wry neck (cervical dystonia).
In 2002, it was approved for improving and relaxing frown lines in the area (the glabella) between the eyes on the forehead and has been used successfully in more than over 11 million patients since that time, based on estimates from data supplied by the Allergan Corporation.
In 2004, it was approved for excessive sweating, and in 2010, it was approved for the treatment of migraine headaches.
A common misconception is that it actually paralyzes the muscles in the face. Although, this can happen with extreme amounts of Botox, most physicians strive to inject just the amount that allows the patient to have some limited activity but not so much that they have overactivity of the areas.
Patients should know that it is not used to keep them from expressing themselves but simply to keep them from making facial grimaces and frowns that have become habits and are unintended.
When done correctly, most people who are not trained cosmetic surgeons will not notice the procedure has been performed but simply that the patient looks more rested or happier.
The results usually start to be noticed within three to 10 days or even sooner. They tend to last in most people for up to three or four months. As time passes, the muscle activity will gradually return to normal. Additionally, other areas may return to activity over time, depending on the amount injected. The interesting thing about Botox is that it tends to work fairly well even up to the third month, as a procedure that might last a very short time at full strength and then go away quickly (filler injections such as Restylane, Perlane, or Juvederm tend to last approximately six to 12 months, depending on the amount used).
Results can vary depending on who is performing the injection on the patient. It is very important to go to a physician who is experienced at this procedure, does it him- or herself (rather than having a nurse, physician's assistant [PA], or other nonphysician do it), and has a good reputation for performing this type of procedure. The manufacturers recommend physicians inject the medication themselves. As with most procedures, the skill of the practitioner is related to how often he or she performs the procedure.