BOTOX® is a formulation of botulinum toxin type A. It is derived from the bacterium Clostridium botulinum. This bacterium produces a protein that blocks the release of acetylcholine and relaxes muscles. Type A is just one of seven different types of botulinum toxin (A, B, C1, D, E, F, and G), and each has different properties and actions. No two of these botulinum toxins are alike.

More than 100 years of research have expanded our knowledge of botulinum toxin type A from the identification of the bacterium Clostridium botulinum to the commercialization of botulinum toxin type A as BOTOX®.

In the 1960s, the muscle-relaxing properties of botulinum toxin type A were tapped for investigational use in realigning crossed eyes. These early studies paved the way for treating other conditions caused by overactive muscles with botulinum toxin type A.

BOTOX® is indicated for the treatment of cervical dystonia in adults to decrease the severity of abnormal head position and neck pain associated with cervical dystonia. BOTOX® is indicated for the treatment of strabismus and blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorders in patients 12 years of age and above.

BOTOX® has been used for more than 15 years to help patients worldwide, and it is approved by the health ministries of at least 70 countries.

Normally, your brain sends electrochemical messages to your muscles to make them contract and move. These messages are transmitted from a nerve to the muscle by a substance called acetylcholine. When too much acetylcholine is released, muscles become overly active and spasm or tense up.

BOTOX® blocks the nerve from releasing acetylcholine. As a result, the muscle spasms stop or are greatly reduced, providing relief from symptoms. Your healthcare provider will know how much BOTOX® is needed to treat you effectively.

It's important to remember that botulinum toxin treatment is not a cure. For many people, however, its effects have been dramatic. With BOTOX®, the nerve will take about 3 months to recover and begin to release acetylcholine, and the muscles may become overactive again. At that point, another injection will be needed to provide relief, as long as no allergic reactions or other significant side effects occurred and clinical response was obtained.

Consultations with our Doctors and Medical Esthetician are FREE. We can help you decide if BOTOX® is right for you. In order to make the right treatment decision, you should discuss the following with them:

• Clinical experience with the drug
• Effectiveness and side effects

Make sure we know if you are pregnant, nursing, or taking any medications before receiving BOTOX® injections. Additionally, you should not receive BOTOX® if you have an infection at the injection site.

BOTOX® should be used with caution if you have other neurological diseases or disorders, or if you are taking aminoglycoside antibiotics or other drugs that interfere with neuromuscular transmission. Be sure to tell your healthcare provider about any prescription or over-the-counter medications you are taking before receiving BOTOX®.

Each treatment typically lasts up to 3 months and can be repeated as long as your condition responds to BOTOX® and you do not have any serious allergic reactions or other significant side effects. BOTOX® has been used for more than 15 years to help patients worldwide, and although formal, long-term clinical evaluations have not been conducted, its safety in long-term use has been well established.

Although most people continue to respond to BOTOX® injections, some people have experienced a diminished response over time. There may be several explanations for this:

• Changes in your condition - If the pattern of your muscle activity changes, your healthcare provider may need to inject new muscles and/or change your dose. Identifying and injecting the affected muscle can be difficult, complicated by the changing pattern of muscle involvement and progression of the disorder.
• Setting appropriate expectations - You may believe your first BOTOX® injection was more helpful than subsequent injections. That's because your condition was perhaps quite severe when you had your first injection. Subsequent injections are usually given before your condition becomes that severe again. Therefore, the relief you experienced with subsequent injections may not have been as dramatic as the first time.
• Antibody formation - When foreign proteins, like botulinum toxins, enter your body, antibodies may form. If antibodies to botulinum toxin develop, you may no longer respond to treatment.

Because botulinum toxins are usually used to treat chronic conditions, it's important to preserve responsiveness to therapy.

While the critical factors for neutralizing antibody formation have not been well characterized, you may be able to help maintain your response to BOTOX® by minimizing your total exposure. The potential for antibody formation may be minimized by injecting with the lowest effective dose given at the longest feasible intervals between injections.

BOTOX® is injected into the affected muscle(s). Our doctors will determine which muscles need to be treated.

Some people report discomfort from the injection. BOTOX® is reconstituted with sterile, preservative-free, normal saline for injection. The neutral pH of the injected solution, in combination with the fine-gauge needle your doctor will use, can help to minimize any injection-related pain.

If you're receiving BOTOX® you'll usually see the effects within 2 weeks of the injection, often you may see effects within 3 days.

BOTOX® offers sustained relief, dose after dose. The relief you'll feel from 1 treatment of BOTOX® will normally last for up to 3 months. Treatments can be continued as long as your condition responds to BOTOX®, and you do not have any serious allergic reactions or other significant side effects. When the relief begins to fade, you'll return to your doctor for your next treatment.

Usually, BOTOX® treatment is required approximately 4 times per year. Because symptoms can change over time, the amount and duration of relief you'll experience can vary. Consult your doctor, who can determine how to achieve the best possible results with BOTOX®.

The most frequently reported adverse reactions in patients receiving BOTOX® for the treatment of cervical dystonia are dysphagia (difficulty swallowing, 19%), upper respiratory infection (such as a cold or flu,12%), neck pain (11%), and headache (11%). Dysphagia is a commonly reported adverse event following treatment of cervical dystonia patients. In these patients, there are reports of rare cases of dysphagia serious enough to require the insertion of a gastric feeding tube (a tube for introducing nutritious, high-calorie fluids into the stomach).

The most frequently reported treatment-related adverse reactions in patients receiving BOTOX® for the treatment of blepharospasm are: ptosis (droopy eyelids, 21%), superficial punctuate keratitis (inflammation of the cornea characterized by small erosions of the tissue covering the cornea, 6%), and eye dryness (6%). Reduced blinking from BOTOX® injection of the orbicularis muscle can lead to corneal exposure, persistent epithelial defect (a defect in the corneal covering), and corneal ulceration (a hollowed-out cavity in the cornea), especially in patients with VII nerve disorders.

Please contact us immediately and seek medical attention if swallowing, speech, or respiratory (breathing) disorders arise.

All in all, BOTOX® prices vary. The cost of BOTOX® injections depends both on the number of units used. The average cost per session is $280 USD. Areas that require more than a single injection, such as the area beside the eyes where so-called "crow's feet" tend to form, can range from $350 to $900 USD. Larger surface areas such as the forehead can cost as little as $500 and as much as $950 USD.