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Botulinum Toxin

Botulinum toxin (BTX) has been used at Baylor Medicine Movement Disorders Clinic in the treatment of dystonia and related disorders since 1983. Its safety and efficacy has been established, partly as a result of the pioneering work at the Movement Disorders Clinic. The first double-blind, placebo-controlled trial of BTX in cranial-cervical dystonia was conducted at Baylor and the findings were used to obtain the initial approval for BTX by the Food and Drug Administration.

Dystonia is a neurological condition manifested by involuntary contractions (spasms) of muscles producing twisting, squeezing or pulling movements and abnormal postures. In addition to dystonias, BTX has been used also to relieve other focal spasms, such as hemifacial spasms, tremors, tics, spasticity, and other movement disorders. At Baylor's Movement Disorders Clinic, BTX has been also used to treat muscle contraction (tension) and migraine headaches, excessive drooling (sialorrhea), excessive sweating (hyperhidrosis), and other conditions for which BTX has been found to be effective.

BTX is a protein that acts by binding to certain nerve endings thus preventing the release of the neurotransmitter acetylcholine. An injection of BTX into the muscle blocks transmission of impulses from the nerve to the muscle causing local and temporary weakness of the target muscle. This process, called "chemodenervation," provides effective relief of dystonias and other disorders manifested by abnormal and unwanted muscular contractions or abnormal secretions. The onset of improvement is often noted within a few days after injection and the benefits usually wear off after 3 to 6 months at which time a repeat injection is needed. Because BTX acts only locally without spreading into the circulation, it does not usually cause any systemic reactions. Most patients obtain safe and substantial relief, but a few experience side effects after the treatment. Except for occasional temporary feeling of generalized malaise and weakness, nearly all other side effects are confined to the injected body part. Injections into the eyelids, for example, may result in transient local swelling, droopy eyelids, blurring of vision, and tearing. Injections into the neck muscles may cause temporary neck weakness or pain and difficulties with swallowing. Swallowing problems, as well as chewing, speech and voice difficulties, may also result from injections into the jaw and vocal cord muscles. Injections into the arm or hand muscles may cause temporary weakness of fingers and hands. These side effects are usually mild, occur infrequently, and most resolve in a few weeks without any specific treatment. If swallowing problems occur, it is advisable to change to a soft or liquid diet. Any troublesome side effects should be reported to the treating or primary care physician.

BTX treatments do not represent a cure, but they usually provide satisfactory relief of symptoms that can be maintained by repeating treatments when the effects of previous BTX injections begin to wear off. Rarely, some patients become unresponsive to the treatment because they develop blocking antibodies. Such immunoresistance is quite uncommon and occurs only after repeated treatments, usually with relatively high doses or when injected more frequently than every 2-3 months. There are several ways that the presence of immunoresistance can be detected. The simplest and least expensive way is to inject small amounts of BTX into the inner portion of right eyebrow. If the eyebrow is weakened by the injection and one week later the patient is unable to contract the muscle on that side while frowning, this indicates that the patient does not have blocking antibodies – no immunoresistance. Besides this unilateral brow injection (UBI), BTX antibodies can be also detected by a mouse bioassay. This test involves sending a frozen blood serum to Northview Pacific Laboratories, 2800 7th St., Berkeley, CA 94710, (510) 548-8440. When the blood sample is forwarded to the Northview Pacific Laboratories by physicians other than those at Baylor, it is important that you are identified as a patient at Baylor College of Medicine and that the results are forwarded to us.

BTX treatments do not represent a cure, but they usually provide satisfactory relief of symptoms that can be maintained by repeating treatments when the effects of previous BTX injections begin to wear off. Rarely, some patients become unresponsive to the treatment because they develop blocking antibodies. Such immunoresistance is quite uncommon and occurs only after repeated treatments, usually with relatively high doses or when injected more frequently than every 2-3 months. There are several ways that the presence of immunoresistance can be detected. The simplest and least expensive way is to inject small amounts of BTX into the inner portion of right eyebrow. If the eyebrow is weakened by the injection and one week later the patient is unable to contract the muscle on that side while frowning, this indicates that the patient does not have blocking antibodies – no immunoresistance. Besides this unilateral brow injection (UBI), BTX antibodies can be also detected by a mouse bioassay. 

Patients who have become immunoresistant as a result of BTX antibodies no longer respond to subsequent injections with the same type of BTX-A, but may respond to other types of BTX. The procedure requires specialized skills and, therefore, only some centers are performing this treatment. The actual cost of the medication and procedure depends on the total dose and sites required to treat the specific condition and will be determined at the time of the visit. To cover the cost of the medication and our overhead, we require that all charges for the medication and for the procedure must be paid or documentation of pre-approval is presented before the treatment visit.

Botox Aftercare

Botox (onabotulinumtoxinA) is a brand-name injectable drug for medical and aesthetic treatments. Aftercare instructions typically aim to help minimize your risk of bruising and prevent Botox from spreading to the surrounding muscles.

Botox is a brand-name injectable medication that paralyzes muscles temporarily. It contains the neurotoxin onabotulinumtoxinA, which comes from the bacterial strain Clostridium botulinum. Botox injections are safe, as only a diluted volume of toxin is necessary to work.

Doctors prescribe Botox to help manage health conditions such as:

Small doses of Botox are a common aesthetic treatment to reduce the appearance of facial wrinkles.

While Botox does not require any recovery time, consider avoiding certain actions after receiving it.

This article explains the best practices for Botox aftercare. This includes how long you must avoid exercise and whether you can drink alcohol.

If you receive facial injections of Botox, the practitioner will apply an aseptic technique throughout the procedure. This may include wearing a set of sterile gloves or gown. This helps minimize the risk of infection at the injection sites. They will clean your face with a sterilizing solution before and after the injections.

Post-procedure, you should avoid touching your face, including washing it, to allow the injection sites to heal fully. This typically takes at least 6 hours. If you need to wash your face within 24 hours of the procedure, use only clean hands and sterile water.

If you arrive at the procedure wearing makeup, the practitioner will remove it before giving the injections.

Afterward, it is important to follow the instructions of the practitioner. They typically recommend avoiding makeup for 24 hours after the procedure. If you apply makeup after facial injections before the injection sites have healed, it increases your risk of developing an infection.

The practitioner giving the Botox injection may also provide a sterile SPF 50 sunscreen to protect your healing skin from harmful UV light. Sunscreen helps reduce your risk of developing:

Exercising increases blood flow to your skin. While it benefits your cardiovascular system, exercising too soon after Botox injections can place you at risk of complications.

Increasing blood flow around newly injected Botox can cause it to migrate from the original injection site. This can lead to paralysis of surrounding, non-target muscles.

Exercise also increases your blood pressure, which can lead to bruising and swelling at injection sites.

Research is not adequate to establish a link between alcohol consumption and Botox treatment. But, your healthcare professional may recommend you to avoid drinking alcohol for 24 to 48 hours after the procedure.

The effects of drinking alcohol after a Botox treatment will vary between individuals. So, it is safer to avoid alcohol after the procedure. Talk with a healthcare professional to know more.

You may also want to avoid drinking alcohol for 24 hours before the procedure. This is because alcohol thins the blood, which can increase your risk of bruising after the treatment.

Botox (botulinum toxin) is a brand-name prescription injectable treatment for certain health conditions, such as hyperhidrosis and chronic migraine. It is also a common aesthetic treatment for reducing the appearance of wrinkles and fine facial lines.

It is important to follow the instructions of the medical professional giving your treatment. They typically recommend not touching the injection sites and waiting for at least 24 hours to apply makeup.

Your practitioner may advise you to avoid any activity that will increase your risk of Botox migrating from the target muscle to the surrounding muscles for a certain amount of time. This includes activities such as strenuous exercise and lying down.

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