Many complications can be avoided with proper placement of the injection, he added. When surgeons inject Botox in the upper lid, they increase the risk of causing a ptosis.
Improperly placed injections in the lower lid may cause diplopia or ectropion, Dr. Levine said. The technique is not difficult to learn, and many books and articles have been written on how to do it, he said.
Fagien also urged surgeons to read as much as they can on the subject, from studies in medical journals to articles in the lay press. Lipham noted that the risk for complications often depends on where the injection is administered.
Patients with blepharospasm and hemifacial spasm, for instance, require Botox injections along the eyelid crease and are at a greater risk for developing upper eyelid ptosis, he said. Upper eyelid ptosis is caused when Botox diffuses behind the orbital septum and weakens the levator muscle, Dr.
The incidence of upper eyelid ptosis when Botox is injected for cosmetic indications, however, is much lower, and it rarely occurs when the product is administered properly. Patients should not receive Botox if they have a neuromuscular disorder, if they are taking aminoglycoside antibiotics, which cause an increased sensitivity to the drug, or if they are pregnant, trying to conceive or breast-feeding, according to Dr.
In addition, patients with egg allergies may have an increased likelihood of an allergic reaction since the Botox molecule is stabilized by human albumin, a protein that is similar to egg albumin, Dr.
Putterman, who participated in early clinical trials with Botox, said there is no data to suggest that patients should limit the number of injections they undergo.
He said he still treats some of the same patients who started Botox injections 20 years ago, and they have experienced no adverse reactions.
Patients generally return for an injection within 3 to 6 months, surgeons said. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, and trouble swallowing.
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Scott said those results are encouraging and will replace surgery for many patients. Studies in children with strabismus to get just the right dose of bupivacaine and to see long-term effects are just getting under way. Bupivacaine can stimulate eye muscles in a manner that he compares to lifting weights.
In addition to strabismus, Botox has been a godsend to sufferers of benign essential blepharospasm, a neurological condition in which the eyes involuntarily force themselves shut, by stopping the muscles from going into spasm. Blepharospasm affects an estimated 20, to 50, Americans; for some unknown reasons, women are twice as likely to suffer from it as men. Scott remembered how the first blepharospasm patient he treated in had her eyes so tightly clamped that her husband had to guide her into his office.
He injected Botox into the center of her eyelid and was ecstatic to find the next day that the eyelid was wide open — only to discover the day after that that it had re-drooped. That experience taught him to keep the upper eyelid doses at the margins and to the sides of the eyelids and to keep the doses low. These days, Scott is developing a method of treating sufferers of blepharospasm with tiny implanted devices that perform pacemaker-like stimulation of the eyelid muscles to hold the eyes open.
The views expressed are those of the author s and are not necessarily those of Scientific American. Now neurologists are all injecting it. AC: Jean sees botulinum toxin as a generation drug, like penicillin. Q: One of the applications discussed is its use in treating depression. Is the benefit psychological or physiological?
Now is this a direct effect of the toxin? Or an effect of the way people behave toward them? Q: Botox is one of the most deadly toxins. What reassurances do we have about its safety? AC: Botulinum toxin is a peptide, a fragment of a protein. So the tiny amount we inject—typically one-, two- or three-billionths of a gram—is irrelevant.
JC: I did. JC: People are most interested in their calling card—their face, their neck, their hands. Photograph by Brian Howell.
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