Botox Dangers

Is Botox Cosmetic a Killer?

In February 2008, the FDA issued a warning that Botox Cosmetic (botulinum toxin type A) and its competitor, Myobloc (toxin type B) have been linked to adverse reactions ranging from botulism symptoms requiring hospitalization to death.

Botulinum Toxin-Related Deaths Due to High Dosages

The FDA review of both drugs is ongoing. The administration's chief of Neurology, Dr. Russell Katz, said the agency is looking at a "handful of cases".

All the deaths were of children being treated for leg spasticity or other muscular disorders.

This is not an FDA-approved use of the drug in the U.S., but is allowed in other countries.

Caroline Van Hove, a spokesperson for Allergan the maker of Botox Cosmetic, explained that the dosages used to treat spastic disorders are much higher than those used to treat wrinkles.

The consumer advocacy group, Public Citizen, has urged the FDA to require a "black-box warning" (the strongest type) and require that patients be given a pamphlet explaining the risk.

The licensed forms of the toxin already carry label warnings about the potential for it to spread beyond the injection site and cause death at high dosage levels.

Botulism Cases in Patients Treated for Wrinkles were Due to Overdoses of Unlicensed Toxins

In November 2006, the Journal of the American Medical Association reported four cases of botulism in cosmetic patients who had facial injections of botulinum toxin. All four survived.

The cause of their botulism symptoms was ascribed to illegal use of a highly concentrated unlicensed toxin product. Post-injection analysis of the patients' blood revealed blood serum levels up to 40 times the estimated lethal human dose.

The Symptoms and Treatment of Botulism

The FDA's Dr. Katz advised that patients should be forewarned to seek immediate care if they experience any symptoms of botulism which include difficulty swallowing or breathing, slurred speech, muscle weakness, or difficulty holding up their head.

Treatment for botulism consists of administration of antitoxin optimally with 12 hours of first symptoms and mechanical breathing support if needed.

Botulinum Toxin Can Migrate Beyond the Injection Site

British researchers presented results of a double-blind study of botulinum toxin migration to the 2006 meeting of the American Academy of Dermatology. They found that Botox has a significantly smaller area of migration to adjacent muscles than Dysport,a brand of type A botulinum toxin available in Europe.

Dr. Sandeep H. Cliff reported, "Our findings suggest that the extent of migration post-injection with botulinum toxin type A appears to be influenced not only by the dose and volume of injection but also by the distinct formulation itself."

The researchers' theorized that the much-smaller molecule size of Dysport accounts for its greater tendency to migrate. The area of migration for Dysport was an average of 77% larger than for Botox. The maximum spread for Botox was one square inch.

Can Botox Migrate to the Brain?

Botulinum toxin has been shown to migrate to the brains of lab rats which were given Botox injections in their whisker muscles. Researchers at the National Research Council's Institute of Neuroscience in Pisa Italy published their findings in the March 2008 Journal of Neuroscience.

Though the rats didn't exhibit botulism symptoms, the toxin was still present in their brains six months after injection.

Allergan, the maker of Botox, called the study inconclusive and contradictory to previous findings.

The company pointed out that the study used a lab preparation of botulinum toxin, not Botox, and added "data suggests that different preparations of botulinum toxin react differently in both the laboratory and in clinical practice."

Preparation and Aftercare for Botox Cosmetic

If you've weighed the risk and would still like to proceed with Botox injections for facial wrinkles, here are a few ways to assure the best results.

Carefully check your doctor's Botox treatment experience and credentials. Ask to see the sealed vial and read its label warning.

Apply an ice pack to the injection sites for at least 10 minutes as soon as possible after injection to minimize swelling and bruising.

Do not rub or massage the area. Do not exercise vigorously for at least 24 hours. Don't lie down for at least four hours.

All these activities would encourage migration of the toxin from its desired site.

Be alert for any symptoms of botulism and seek immediate emergency care should they develop. To repeat, the symptoms of botulism include difficulty swallowing or breathing, slurred speech, muscle weakness, or difficulty holding your head up.

Read more about Botox Dangers.

This article is for informational purposes only. It does not purport to offer medical advice.