A number of recent press reports have raised public awareness about safety of botulinum toxin A or BOTOX. Cosmetic BOTOX is extremely safe. We are using small doses and we are largely treating areas of the face and neck in such a way that there is absolutely no significant likelihood of interference with breathing and swallowing.

The usual kinds of adverse advents with therapeutic BOTOX include muscle weakness around the area injected, such as difficulty swallowing as well as flu like symptoms and headaches. A number of the patients who have had therapeutic BOTOX actually have rather severe underlying neurologic diseases to begin with. A large study of therapeutic indications in 36 randomized controlled trials showed mild to moderate adverse events which were mainly areas of focal weakness in 25% of the patients. Interestingly the therapeutic data suggests the risk of adverse events appears to diminish with repeated injections. The real difficulty with therapeutic BOTOX comes with individuals who are already very disadvantaged by their medical condition. For example in severe cerebral palsy where the children are extremely spastic, small and unwell they may not survive a general anesthetic for release of tight muscle tendons. The physicians involved need to use higher doses of BOTOX than would be used in the cosmetic route in order to have a therapeutic effect.

We have retrospectively analyzed 853 upper face treatment sessions in 50 patients with an average of 6 years of treatment. We had adverse events in 9 of the 853 treatment sessions (1.1%) all of these adverse events were transient and mild to moderate in severity and all settled spontaneously.

Further concern has been raised by physicians using non-approved botulinum neurotoxins as in Florida in 2004 and by researchers using non human approved neurotoxin in rats in 2008. We would encourage readers to make sure that the adverse events that they are reading about are in fact due to BOTOX and not to fake BOTOX as in the ones above.

BOTOX has been used for over 20 years in the cosmetic world. Over 3000 articles have been written about it and it has come out with a reputation of being one of the safest drugs known to humanity.