Botulinum neurotoxin is made from the gram-positive anaerobic bacterium Clostridium botulinum. Eight distinct botulinum neurotoxins exist: A, B, C1, C2, D, E, F, and G. Only seven are associated with paralysis. Types A, B, E, F, and G are connected with human botulism.

botox-injectionsBotulism is a toxin that acts by stopping signal transmission within the peripheral and sympathetic nervous system, while leaving sensory transmission intact.

Botulinum toxins are currently being used in the treatment of several disorders including headaches, pain syndromes, tics, tremor, spasticity, focal dystonias, hemifacial spasms, and strabismus.

Botox (botulinum toxin type A) injections are currently approved by the Food and Drug Administration for cosmetic treatment, which makes up most of these injections.

Cosmetic Use of Botox

Aging is associated with the development of wrinkles and lines caused by muscular action, sleep lines, gravitational effect, and actinic damage. A botox injection can reduce facial lines caused by over functional muscles. It can also be used to re-shape aspects of the face such as the brows.

Injections in the Face

Utilizing botox injections to treat horizontal forehead lines is simple, and the results are usually very satisfying.


Multiple botox injections of minute amounts of toxin create weakness without total paralysis. The cosmetic surgeon will inject three to five sites on both sides of the mid line, using 2 units per site. He will then procede to separate the sites by 1-2 centimeters. He will then choose to begin with a site around 1 centimeter above the eyebrow, directly vertical to the medial canthus.

Additional sites will diverge toward the hairline using a “V” configuration, for a total of 3 sites. Additional sites can be added, depending on the clinical response of the individual. If there are wrinkles present in the temporal region, lateral botox injections can be performed.

Botox injections of the eyeball region and upper face are generally performed while the patient is seated and upright for 2-3 hours, as to prevent the spread of the toxin through the orbital septum.

General Considerations

Botox injection procedures will usually vary over time and amongst practitioners. Individuals will typically notice a clinical effect within one to three days following the procedure. Maximum results can be seen within one to two weeks.

Some diffusion of toxin will happen. A 10-unit botox injection into the frontalis muscle will produce partial paralysis. Adverse effects of botox injection include bruising and the escape of blood into the tissues from ruptured blood vessels.

Patients should avoid aspirin and anti-inflammatory drugs for up to 7-14 days before the botox injection. Benefits will typically last three to six months.