Botox - Cosmetic and Therapeutic Use

The famous Botox is the trademark and pharmaceutical of botulinum toxin A, a toxic protein originally produced by the bacterium Clostridium botulinum. This toxin is a powerful poison, the same one that causes botulism, a serious food poisoning.

Botox injection
Botox injection

Botulinum toxin is a neurotoxin that prevents muscle contraction, leading to paralysis of the muscles. Botulinum toxin poisoning is a medical emergency because it can cause respiratory muscle paralysis, leading to death due to respiratory failure. This neurotoxin is one of the most powerful poisons known; if aspirated, 1 microgram is sufficient to lead a person to death through diffuse paralysis of the muscles of the body.

Botox for therapeutic use

Recognized initially as a dreaded venom, after understanding its mechanism of action, botulinum toxin was then used in medicine for patients whose controlled paralysis of some muscles was beneficial. However, in order to be administered safely, it was first necessary to isolate and purify the toxin so that it could be synthesized. Botox, the pharmaceutical form of botulinum toxin A. Botox is the most famous brand on the market, with Myobloc, Dysport and Prosigne.

Although it is very famous for its cosmetic use, with applications of Botox in the face to treat wrinkles, this drug was initially used for the treatment of diseases. Because its time of action is long, it can paralyze muscles for up to 6 months, controlled inoculation through a small injection with minimal amounts of the toxin has become a good option in the treatment of neurological / muscular diseases. Among the main indications for the therapeutic use of Botox are:

1) Blepharospasm: a neuromuscular disease that causes involuntary contraction of the muscles around the eyes, causing the patient to blink involuntarily and vigorously.

The application of Botox in the muscles around the eyes paralyzes these muscles, preventing these unwanted contractions for up to 4 months, when it is necessary to re-administer the drug.

2) Strabismus: is the group of diseases where the eyes are not parallel, the popular "eye squint", which occurs by asymmetry in the contraction of the eye muscles. The application of Botox helps to decrease the muscular strength of one of the eyes, managing to align the eyeballs.

3) Cervical dystonia: it is a very painful disease where the muscles of the neck contract involuntarily, causing abrupt movements of the head to the sides, forwards and backwards.

The application of Botox in these neck muscles, 3 to 4 times a year, is the most indicated treatment

4) Hyperhidrosis: excessive sweating, which usually involves armpits, palms and soles of the feet, can also be treated with Botox applications, in this case not to paralyze some muscle, but to inhibit the functioning of the sweat glands.

The use of Botox in the armpits for axillary hyperhidrosis usually has better results than in palmar and plantar hyperhidrosis, where injecting the toxin, in addition to being very painful, can cause muscle weakness in the hands and feet.

5) Migraine: Botox for the treatment of migraine was recently approved by the American FDA. Application of the toxin to the face and neck muscles in the medium term decreases the incidence of migraine, appearing to be a great option for those patients with frequent headaches.

6) Anal fissure: one of the mechanisms that perpetuates the anal fissure is the spasm of the anal sphincter, which ends up cracking the fissure and making it difficult to evacuate. The use of Botox helps to relax this muscle, facilitating the healing process.

Botox for cosmetic use

Since the year 2000 Botox has been approved in Brazil for aesthetic use in the treatment of expression wrinkles. It is important to note that Botox only works for those wrinkles that arise when we use the facial muscles. Wrinkles caused by excessive sun and smoke are not corrected by Botox.

Very careful and technique is required in the application of Botox in some regions of the face, especially around the mouth, so that there is no paralysis in the muscles responsible for speech and chewing. If the doctor is not trained, asymmetries may appear on the face due to a greater paralysis of one side of the face.

The photos below show that after the application of Botox there was disappearance of the wrinkles that appeared when frowning. The goal of cosmetic Botox is to decrease muscle strength without causing total paralysis of the same, thus preventing complications such as falling eyelid and loss of facial expression.

The use of cosmetic Botox usually has maximum effect in the first 2 weeks, requiring a new application every 3 or 4 months.


Contraindications to the application of Botox include allergic reaction after previous exposure, pregnancy, breastfeeding and application to inflamed or infected sites.

Drug interactions

The following medicines may exacerbate the effects of Botox and its concomitant use is not indicated:


The application of Botox is a medical procedure and should always be done in a medical environment. Remember that we are dealing with a very powerful poison that can lead to death if used irresponsibly.

Among the most common complications of Botox are:
  • Pain and bruising at the application site
  • Allergies
  • Local redness
  • Nausea
  • Headache

In some cases the effects of Botox turn out to be larger than desired, causing muscle paralysis. This can lead to falling eyelids and / or absence of facial expression when applied to the forehead; changes in speech and chewing when applied close to the lips; difficulty swallowing and weakness to lift the head when applied to the neck.

If applied properly and by trained professionals, the risk of the toxin spreading through the body is derisory. In rare cases of systemic intoxication, the clinical picture is similar to botulism.

Loss of botox effect

Botox is a toxin and as a result, every time it is applied, it causes an immune response of the body against that harmful foreign body. After repeated applications, our body is able to create antibodies to the botulinum toxin, causing its effect to be neutralized quickly.
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