Ask Dr. Weiss

Dear Dr. Weiss, there has recently been a great deal of press regarding the dangers of Botox. Should I be concerned?

Public Citizen, a leading advocacy group for public health and safety is petitioning the Food and Drug Administration to increase the warnings on Botox™. They have expressed concern over severe reactions, including deaths, that have been linked to the product. According to the petition, there have been 180 reports of adverse effects in the United States, including 16 deaths, with four children among the fatalities. European regulators have already strengthened warnings about the side effects of Botox last year.

Botox works by blocking nerve impulses to muscles, causing them to relax. It is approved for the cosmetic correction of wrinkles between the eyes as well as cervical dystonia, or uncontrolled muscle contractions of the neck and shoulder muscles. However, researchers at Public Citizen have uncovered several instances where the toxin has spread to other parts of the body, resulting in problems including paralysis of respiratory muscles and difficulty swallowing.  This has the potential to result in food or liquids entering the lungs and causing aspiration pneumonia, a life threatening complication.

The enhanced warnings that the group seeks would make people aware of the possibility of side effects, so they could seek emergency medical help if they experienced early symptoms such as dry mouth, difficulty swallowing, difficulty breathing, slurred speech, drooping eyelids and muscle weakness.

Increasing the awareness of the possible complications of Botox is a valuable public service. Primarily it raises awareness among those seeking both medical and cosmetic therapy with the drug that in fact there are side effects and that individuals should be careful about where and by whom they have this service performed. Unfortunately, the notion that Botox is indeed a medical procedure, with the possibility of significant complications, has been minimized as it has become more popularized. This is especially true as its use in spas and salons by non-physician providers and continues to expand, coupled with the proliferation of stories of Botox parties both in the popular press and in television and movies. It should never be forgotten that Botox is a toxin and injection with this product, be it for cosmetic or medical reasons, should still be performed by an expert in the field who has had extensive training in cutaneous physiology.  This is not a procedure to be performed by someone who simply attended a weekend course.

Over 3 million cosmetic injections of Botox were performed in 2006, with very few reported adverse events. When performed by trained physicians, the procedure is effective and safe. Public Citizen is reminding us that indeed it remains a medical procedure, and failure to treat it as such can result in significant risk.

www.weissskininstitute.com

Stefan C. Weiss, MD, FAAD, is a board-certified dermatologist. For more information, visit www.weissskininstitute.com. Weiss Skin Institute, 9980 Central Park Blvd, North, Suite 124 Boca Raton, FL 33428; 561-372-SKIN .