Recent media releases that I have read on the use of BOTOX in children with neuromuscular disorders does not accurately represent its safety record in cosmetic applications. To allay potential patient concerns, it is useful to review some of the existing information to clear up any confusion created by these internet and paper reports on this very popular cosmetic treatment. BOTOX® cosmetic (Botulinum Toxin Type A) is produced and sold by the proprietary company, Allergan, based in Irvine California. It was initially approved for the treatment of excessive eyelid twitching 18 years ago and its approval for the treatment of vertical brow lines was 6 years ago. While accurate numbers are impossible to know, tens of millions of cosmetic patients have been treated around the world with the manufacturer reporting more than 13 million doses given since 2002. According to the American Society of Plastic Surgery, BOTOX® cosmetic is the most commonly performed cosmetic procedure performed in the United States with over 3 million doses alone administered in 2006. With over 3,000 published medical reports and a large number of clinical trial subjects studied, a welth of safety information is available. Despite the large amount of doses administered and patients treated, significant adverse reactions to the use of BOTOX® cosmetic is extremely rare.Any true allergies to its use have not been reported. To date, there has never been a single reported death associated with its use either. These cosmetic experiences must be contrasted with the media reports where its use has been in limb spasticity, which is not an FDA-approved application. Substantially larger doses (up to 100 times) are given in these neuromuscular uses compared to what is given for cosmetic wrinkle treatments and are injected in these juvenile patients who are often sickly from their neuromuscular disease. These two patient populations, and their indications, are simply not the same. The FDA appears to recognize these differences and has issued no stoppage of its use for any application to any health care provider at the present time. The accurate portrayal of the safety data on BOTOX® cosmetic should provide great comfort to those patients who regularly receive aesthetic treatments or to those considering it in the near future.
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