Cosmetic and Therapeutic Botox Injections

What is Botox®? 

Botox is a trade name for botulinum toxin type A, which is a protein produced by a bacteria. When small amounts of it are injected directly into a muscle, it will paralyze that muscle for about 2 to 4 months. The paralysis takes anywhere from one-half day to 2 weeks to take effect. The drug may slowly leak from the injected area to the surrounding tissues and even into the blood stream but the effects are usually minimal and are well known because thousands of people have been treated with the drug. We have treated hundreds of patients with Botox at the University of Minnesota since 1983, when the drug was being tested.

Why would anyone want to poison a muscle? 

The clinical use of Botox was pioneered by Alan B. Scott, M.D., of San Francisco, CA who studied its use to realign the muscles that control the movements of the eyes. While this was his intended use it has been adopted for only a small proportion of patients with ocular misalignment (strabismus). However, the drug was immediately recognized for its ability to treat abnormal squeezing of the eyelids (blepharospasm). Since then, it has become a drug widely used for all kinds of spasms and dystonias.

What are its cosmetic uses? 

Botox can provide temporary relief for frown lines between and above the eyebrows (glabellar folds) and for the skin lines at the outer angles of the eyelids (crows feet). The frown lines and crows feet are caused by contraction of the muscles deep to the skin. While crows feet can be somewhat eased with laser resurfacing of the eyelid skin and occasionally with surgery, there is no effective surgery for frown lines because the folds are too deep. Botox can relax the muscle for months but the problem will come back.

Are cosmetic uses limited to women? 

No. Many men now feel that aging interferes with their job and social prospects. We encourage men to consider this option or other cosmetic surgical procedures.

What are its therapeutic uses? 

At the University of Minnesota Eye Clinic, we use Botox primarily for patients with eyelid spasms (Blepharospasm). We will sometimes also treat spasm in the muscles of the lower face. Some patients with double vision also receive injections in the muscles adjacent to the eyes for misalignment of the two eyes, particularly if there is a temporary misalignment of the patient's better eye. A head injury or mini-stroke of the vessels to the sixth cranial nerve (abducens nerve) can cause double vision, which might improve symptomatically after such an injection though we caution patients that the direction of the double vision usually reverses and may worsen temporarily after the injection.

How is Botox given? 

For cosmetic uses and for eyelid spasms, the injections are given directly into the eyelid and surrounding tissues with a very small needle. Most patients do not mind the temporary pain that occurs just as the injection is given. Some patients like to apply icepacks to the face prior to the injection. For your information, local anesthetics hurt much more than the Botox solution so we do not inject local anesthetics. Topical anesthetic creams may be used but (in our experience) most patients never bother to use them a second time.

How frequently must Botox be injected? 

For cosmetic purposes patients may request injections at 3 to 6 month intervals. There is a possibility that some patients will become immune to it, so it is not wise to be injected any more frequently than every 2 months.

What are its local side-effects? 

There can be bruising at the injection site and this can take a few days (or longer) to clear. Bruising can be decreased by not using aspirin for 2 weeks prior to injection and by not using ibuprofen for 2 days prior to injection. A few patients may have local irritation or allergic reactions. This is very rare, but would be a reason not to retreat. The injection can travel into nearby muscles causing a temporary weakness such as a drooping of an eyelid or decrease in smile. These effects typically appear (if at all) after 2 weeks and disappear a week or so later.

Are there any systemic side-effects?

We would not expect systemic side effects from the doses used around the eye. Your physician will determine if you are taking any medicine or have any muscle disease that would constitute a serious problem. Please remember to provide this information on your first visit.

How much does it cost?

The actual wholesale cost of Botox now exceeds $1000.00 per vial of 100 units. The vial must be kept frozen and cannot be used more than a few hours after its dilution. As a result we try to group all Botox injections on one day per week so that the cost of the drug can be spread among several patients if they don't need the entire 100 units and we can use the drug for other patients. The cost to the patient varies with their insurance for patients receiving therapeutic injections for eyelid spasms or strabismus. We base our charges for cosmetic injections on the same fee scale. As with all cosmetic procedures, the cost for cosmetic injections must be paid in advance. We will charge our list fee for initial evaluation as a self-referred patient and for 1 face photograph. Thereafter you will be charged our list fee for eyelid injections, a standard clinic use charge, and the proportionate charge for the Botox.

Schedule A Consultation:

The initial examination is scheduled by calling (612) 625-4400 or 800-937-4393 (the Department of Ophthalmology) and asking for the appointment desk to request an appointment with either Andrew R. Harrison, M.D. or Howard D. Pomeranz, M.D., Ph.D.

Andrew R. Harrison, M.D.
Department of Ophthalmology