Injectables are the fastest-growing segment of the medical cosmetics industry and the most infested with knockoffs, illegal imports, dilutions, and dangerous substitutions. Injectables fall into two categories: paralytics that lessen wrinkles by stopping the muscle action that creates them and fillers that alter contours. Fillers come as semiliquid suspensions that are injected through a needle and as solid but flexible materials that are inserted through tiny holes in the skin. Some filler materials are available in both forms. The advantages of the more solid forms are that they lend themselves more readily to filling larger areas and tend to be longer lasting.
Injectable substances often come in preloaded syringes; patients may be charged by syringe or by volume, and charges vary from a few hundred dollars to well over $1,000 per treatment. Because two or more repeat treatments per year may be necessary, cumulative costs can be significant.
Paralytics: Botox, Dysport, and Myobloc are brand names for purified botulinum toxin, a biological agent that has been adapted for medical use. Botulinum toxin has been used for decades for the treatment of conditions characterized by muscle hyperactivity, such as neck spasms, cranial nerve disorders, eye spasms, and excessive sweating (hyperhidrosis).
Botulinum toxin injected into a hyperactive muscle will temporarily paralyze the muscle and thus temporarily diminish the wrinkling of skin attached to that muscle. Common sites of injection for cosmetic reasons are the forehead and the crow’s-feet area adjacent to the eye. Botox is manufactured by Allergan and is so far the only botulinum toxin product approved for cosmetic use, although others are under FDA review.
Botox injections are performed in an office setting, and patients resume normal activities immediately. The effects of Botox may not be fully evident for two weeks and usually last several months. Patients who want to maintain the effect must undergo repeat injections every three to four months. Some patients will experience no benefit from Botox and others may experience progressively less benefit with each injection.
Despite their expense and temporary effect, Botox injections remain very popular. They have also been widely misused and misrepresented. Even though the manufacturer of Botox keeps close tabs on the sales and delivery of the legitimate product, complications and poor results are frequently seen because of injections of diluted or fake Botox sold at a discount and marketed as the real thing. Fake Botox can be procured as readily as or more so than street drugs in many places. Despite the fact that Botox is a prescription drug, unqualified people regularly dispense Botox in salons, gyms, hotel rooms, home- based offices, and other retail venues.
Complications of medical-grade botulinum toxin injections by qualified physicians are uncommon, and serious complications are rare. In unqualified hands or in compromised settings, however, injections can be extremely risky.
Serious potential complications include impaired vision, difficulty swallowing owing to the migration of the toxin into undesirable areas of the face or neck, infection, or life-threatening complications due to the injection of fake Botox.
The bottom line: Medical-grade botulinum toxin injections can be useful in the temporary reduction of facial wrinkling that is associated with muscle activity. In qualified hands, it is a safe treatment. A patient seeking Botox injections should be sure to get the real thing in a legitimate setting rather than risk becoming a victim of an unethical practitioner using improper technique, inappropriate doses, unsanitary conditions, or fake drugs.
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