You could argue that Botox has become a dirty word. When people hear it, most likely think of celebrities with too-tight faces and unnaturally smooth skin, or people called out in the tabloids who’ve “had work done.” While Botox may be most commonly known for its usefulness as a cosmetic anti-aging treatment, what’s not nearly as well-known is that cosmetics were not the original intention of the substance. Dig a little deeper and you might be surprised to find out just how many uses the substance has in other areas of medicine.
In The Beginning
The first thing to know about Botox is that it always does the same thing no matter where it’s used. The substance is derived from a bacterium called Clostridium botulinum, which, believe it or not, is the most potent toxin known to man. One of the bacterium’s main effects is to cause paralysis, and that property is harnessed for medical purposes in the manufacture of Botox. The substance is injected into the body, where it blocks nerve endings from absorbing certain molecules they need to work properly. The diversity of its uses comes not from the substance itself, but in how different fields use its properties to a patient’s advantage.
Crossed Eyes and Eyelid Spasms
Botox was originally intended for people with crossed eyes, and case studies soon followed that showed it also had great benefits for stopping muscle spasms, specifically on the face.
“Patients who had uncontrolled blinking or had narrowed or closing eyelids were among the first to see the benefits of this treatment,” said Albert D'Angelantonio, DPM, FACFAS, chief of Podiatry/Foot and Ankle Surgery in Plastic Surgery. “The cosmetic uses of the treatment came afterward.”
Botox is the most popular cosmetic procedure in America, with about 7.23 million procedures performed in 2017, a figure that’s up two percent from 2016, according to the America Society of Plastic Surgeons. But as the cosmetic uses ramped up over the past 40 years, doctors began to report other effects of the injections. Crossed eyes and eyelid spasms are just two of the seven uses of Botox approved by the U.S. Food and Drug Administration, and that doesn’t take into account the off-label uses that have become commonplace.
One FDA-approved use of Botox is for the treatment of migraines. As doctors were administering Botox treatments to patients for crossed eyes and eyelid spasms, they noticed those patients also started to report fewer headaches. Research followed, and the results were compelling enough that the FDA signed off on the application in 2010. Patients can receive injections once every three months, and studies have shown it can cut the number of days people experience migraines in half.
“The idea is that Botox prevents nerve signals from firing that would normally be the root cause of these headaches, helping chronic migraine sufferers by stopping the pain before it starts,” said Raymond Price, MD, an associate professor of Neurology. “I’ve been thrilled with how many patients have seen dramatic reduction in their headache frequency.”
Similar observations led to the FDA approval of Botox to help patients who sweat excessively.
Another surprising and practical use of Botox involves injections in the feet to prevent pain. Normally as we walk, our weight is distributed evenly over our feet, but that’s not the case for people who wear certain types of shoes like high heels, or those who may put more wear and tear on their feet, like athletes.
“Botox can be used to treat a variety of conditions in the feet and lower extremities such as overactive sweating of the feet or tight muscle and tendon contracture of the calves, which can arise from wearing high heels or from other acquired conditions,” D’Angelantonio said.
In a way, Botox can be thought of like an orthopedic pad, only it’s injected into your foot instead of placed in your shoe. Studies have shown it’s more effective than using a steroid.
About 33 million Americans suffer from overactive bladder each year, essentially meaning they constantly feel like they have to go to the bathroom and often wet themselves or have incontinence because they can’t get to the toilet fast enough. Nerve signals are telling the brain that the bladder has got to go urgently, and causing the bladder to spasm and leak. Botox’s paralytic properties can help here, as well, with some studies showing as many as 90 percent of patients see improvement.
“The injection allows the bladder to relax and fill up more before needing to go. It can also give patients greater control by restoring continence, which provides symptom relief,” said Ariana L. Smith, MD, an associate professor of Urology and director of Pelvic Medicine and Reconstructive Surgery.
The FDA approved Botox for this use in 2013.
An overactive bladder isn’t the only urological use for Botox. The injections can also be useful in treating patients who have trouble passing food from their stomach into their intestines. The stomach is connected to the small intestine at the duodenum, and that junction involves a muscle called the pyloric sphincter. An injection of Botox can relax the muscle and let food pass more easily. Essentially, it turns the valve into the “on” position. This has proven especially useful for patients who experience these symptoms after surgery for esophageal cancer.
There are plenty of other uses still being tested for Botox, including treatment for everything from depression to premature ejaculation, and painful sex to abnormal heartbeats. Even the cosmetic uses go beyond what most people envision.
“We can use injections before surgery to prevent scarring, since Botox will keep the muscle still during the healing process,” D’Angelantonio said.
The treatment is also useful for patients with Bell’s palsy who experience facial drooping.
Leave it to the Pros
Anyone who has seen the tabloid examples of bad Botox mentioned above knows it takes a professional to administer the treatment properly, and poor cosmetic appearance is only one of the dangers involved in harnessing a substance that can be so toxic in other forms. While Botox is versatile and does far more than its reputation suggests, D’Angelantonio cautions that patients still need to seek out an expert for care.