Emerging Uses of Botox

Expanding Cosmetic Applications

Although Botox® has been officially approved only for use in the treatment of frown lines, many physicians have used it for a number of other cosmetic areas for years. It has been found effective in smoothing out horizontal lines in the forehead, crow’s feet, mouth frown, dimpled chins, and lines on the neck (Carruthers A 2001). Botox® is now being used in more artistic manners, to lift the brow and shape eyebrows (Huang 2000; Carruthers A 2001; Fagien 2001), widen the eyes to produce a more rounded look (Carruthers J 2001; Flynn 2001), shape the jaw and sides of the face (Park 2003), and to balance asymmetrical features (due to injury or surgery).

In addition, studies have found that the addition of Botox® to traditional cosmetic surgery or other procedures (such as laser resurfacing) enhances the result (Fagien 2001).

Back Pain

Preliminary studies have suggested that, in patients who do not find relief from traditional pain medication, Botox® injections are safe and provide local relief of low back pain without systemic side effects (unlike central nervous system side effects seen with other more traditional pain treatments). In a small randomized trial of 31 adults with low back pain lasting longer than 6 months, 73% of participants who received injections reported significant pain relief after 3 weeks (Foster 2001). More studies—especially larger, randomized trials—are necessary to further evaluate the use of Botox®. Although there was initially concern that large doses repeatedly injected into the spinal muscles could lead to muscle weakness, this occurrence has not been noted in any studies (Difazio 2002; Wheeler 1998).

Migraine and Tension Headaches

Studies in the treatment of migraine have shown a decrease in the incidence and severity of headaches for a period of 3 to 4 months after injection of Botox®, along with a reduction in the use of pain killers (Barrientos 2002; Mauskop 2002). Some people respond well after only a single treatment session, while others improve after repeated injections (Binder 2000; Silberstein 2000; Mathew 2002). Some physicians believe that Botox® may even change or halt the course of headaches (Mathew 2002).

The efficacy of Botox® in the treatment of chronic tension headaches is under debate. Some studies suggest positive benefits (Relja 1998; Schulte-Mattler 1999; Smuts 1999; Freund 2000), while others have shown no effect on pain intensity (Zwart 1994; Göbel 1999). A recent study analyzed the results of 271 patients with chronic daily headaches, tension headaches, or migraines, and found that Botox® injections decreased the frequency of all headaches by more than 50% (Blumenfeld 2003). Overall, 85.6% of study participants claimed their symptoms improved. Temporary eyelid or eyebrow drooping was each reported by three people; other side effects were minimal.

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