On point with off-label Botox
Whether they intend to or not, cosmetic surgeons are treating botulinum toxin patients for more than to diminish facial lines.
Beverly Hills facial plastic surgeon Behrooz Torkian, M.D., says lots of his botulinum toxin type A patients come in initially for cosmetic issues. The migraine sufferers among them, however, know the neuromodulator treatment is wearing off when their headaches return.
“I just do the same cosmetic Botox that I do for everybody else, but there happen to be some people that say it works for their migraines, so they’ll come back for that,” Dr. Torkian says.
The cosmetic practice is fertile ground for blossoming botulinum toxin use. Newly released 2016 plastic surgery statistics by the American Society of Plastic Surgeons (ASPS) show Botox [Allergan], Xeomin [Merz Aesthetics] and Dysport [Galderma] treatment were by leaps and bounds the most popular among the minimally invasive procedures member plastic surgeons performed in 2016. Of the 15.5 million minimally invasive procedures that year, botulinum toxin type A treatments exceeded 7 million, according to ASPS.
A Wonder Drug
Possible botulinum toxin type A uses are indeed growing, although some alternatives to traditional cosmetic treatment are not well studied and are used off-label.
“It seems as if every day there is a new use for Botox,” says Miami, Fla., plastic surgeon Jacob Freiman, M.D.
In fact, uses for botulinum toxin type A have a history of morphing. Researchers noted health benefits from the powerful toxin in the 1950s and 1960s. Those were the decades in which Physiologist Vernon Brooks discovered that injecting small amounts of the toxin into hyperactive muscles impacted local nerve endings and resulted in a temporary relaxation of the muscles. Later, in the ‘60s, ophthalmologist Alan B. Scott conducted experiments injecting botulinum toxin type A into monkeys. His theory was that the botulinum’s muscle-relaxing effect might treat strabismus. And he was right. It worked for blepharospasm, too.
Quite by accident, in the early 1990s, Canadian ophthalmologist Jean Carruthers noticed the frown lines on her blepharospasm patients were fading. So started botulinum toxin type A’s cosmetic journey to FDA approval for glabellar lines and more.
It didn’t stop there.
“Botulinum toxin … is FDA approved for treatment of a myriad of pathologies, such hyperidrosis, migraine headaches, urinary incontinence caused by an overactive bladder, muscle spasms in multiple sclerosis, etc.,” Dr. Freiman says. “It is also being used ‘off label’… for many more pathological conditions, such as painful sex, premature ejaculation, relieving tension on cleft lip repairs, Raynaud’s phenomenon and neck spasm, among others. One study even showed a vast improvement in depression. Some are calling Botox a wonder drug.”
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