The myriad ways I use Botox (Which even surprised a Botox scientist!)

There are presently only 3 manufacturers of Botulinum Toxin type A. These are Allergan, Ipsen and Merz.

It is commonly known as Botox, but that is the trade name for the version made by Allergan. That is why Botox is often written with a small trade mark symbol after it. I’ll be referring to Botulinum Toxin as Botox in this article for the sake of simplicity.

The uses for Botox have expanded greatly, and I believe it is used in about 90 medical conditions at the moment. Many of the uses in and around the eye are featured on my website. Eye surgeons were the first clinicians to use Botox.

I was first introduced to it personally in 1989 where it was used to make the upper lid droopy (ptosis) in order to heal a dry or ulcerated eye that couldn\'t blink properly, an application I still use today.

I tend to prescribe injections of Botox during almost all of my clinics. The commonest usage of it for me is in my patients with facial palsy where the good side of the face pulls across the bad side of the face, especially when smiling or laughing.

I inject the Botox into the good side of the face, creating as it were a partial palsy on the good side so that the two sides match. This usually makes the smile more symmetric. Patients are very happy with the treatment, and return for it at regular intervals (usually 4 monthly), even from abroad!

We are presently writing a research paper about the technique as the treatment makes patients more confident in public, and especially when having photographs taken.

Patients with facial palsy also get a watery eye when they eat (this is called crocodile tears), or their eyelids twitch when they are speaking, smiling or eating (this is called aberrant regeneration).

Both of these problems occur because of mis-wiring. The healing nerve goes to the wrong part of the face.

These conditions are both treated with Botox.

I also find Botox useful for patients with inturning eyelids (the eyelashes rub on the front of the eye and cause pain) where the patients are too unwell for surgery. Botox in the lower eyelid turns the eyelid out for four or five months, making the patient\'s eye more comfortable.

There is also the use of Botox for Chronic Migraine as well as improving laughter lines and creases, and I have written about these before.

The reason I mention the above uses of Botox is because last week I was visited by the scientific officer of one of the companies which makes Botox.

When I mentioned the conditions I use it for, he was (pleasantly) surprised as he had not come across those uses of it before! I was equally surprised that he did not know or consider these uses in his daily job - research with Botox!

These uses are termed off-label (except for cosmetic work and chronic migraine)  i.e. not what the drug was initially licensed for. However, as doctors, we can make an argument for using drugs off label if we inform the patient of that.

I am hoping he is going to take up my offer of collaborating in research with me about these extra uses of Botox. Then the uses would then become approved and no longer be off-label!

Image courtesy of: Winnond

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