Beyond Wrinkles: The Many Uses of Functional Botox

When most people think of Botox, they think of reducing the appearance of wrinkles. While accurate, Botox is also used to treat a variety of non-cosmetic conditions ranging from overactive bladder to depression.

What Is Botox?

First used in the 1970s to treat misaligned eyes (strabismus), Botox is a purified form of botulinum toxin. Other branded formulations, including Dysport, Daxxify and Xeomin, all work similarly. When injected into a muscle, Botox temporarily reduces the muscle’s ability to contract.

“When a muscle can’t contract, it’s unable to pull on the skin above it, hence the wrinkle-defying capabilities of Botox,” says Saikrishna Gourishetti, MD, a facial plastic surgeon with the University Hospitals Department of Otolaryngology - Head and Neck Surgery. “By limiting muscle contraction, Botox can also shrink and relax muscles, which makes it useful for many other medical conditions.”

Non-Cosmetic Uses of Botox

Since becoming commercially available, Botox has earned FDA approval for an increasing number of non-cosmetic treatments. Here are some of the FDA-approved medical or therapeutic uses for Botox.

Overactive Bladder

Frequent and uncontrollable urges to urinate can negatively affect quality of life. Botox injections can help relax bladder muscles to reduce leakage and improve bladder control.

Chronic Migraines

Botox can offer great relief to those suffering from frequent, debilitating migraine headaches. Botox injections into specific muscles in the head and neck can help prevent the onset of migraine symptoms by decreasing muscle tension and the release of pain-inducing chemicals.

Muscle Spasms

Botox injections can cause overactive muscles to relax, reducing spasticity and pain associated with conditions such as cervical dystonia (a disorder that causes involuntary muscle contractions in the neck) and hemifacial spasms (involuntary facial tics). Botox can also relieve arm and leg spasticity associated with multiple sclerosis, cerebral palsy and other neurological disorders.

Eyelid Spasms (Blepharospasm)

Persistent, involuntary blinking can be bothersome and impair a person’s vision. Botox injections can help relieve uncontrollable eyelid spasms to improve symptoms.

Strabismus

Strabismus, a condition where the eyes are misaligned, can occur in both children and adults. By weakening certain eye muscles, Botox injections can help improve eye coordination, allowing them to align properly.

Off-Label Non-Cosmetic Uses of Botox

“Some of the most popular uses for Botox are off-label,” says Dr. Gourishetti, “meaning they’re not yet approved by the FDA but are still frequently employed by doctors because of their proven effectiveness as supported by strong evidence in peer-reviewed medical literature.”

The growing list of non-cosmetic uses for Botox that aren’t FDA approved includes:

• Facial synkinesis (involuntary twitching and spasms caused by voluntary facial movements)
• Esophagus disorders
• Laryngeal dystonia (a voice disorder characterized by spasms of the voice box)
• TMJ dysfunction and pain
• Bruxism (teeth grinding)
• Chronic back pain
• Neuropathic pain (pain caused by health conditions that affect the nerve pathways to the brain)
• Drooling
• Scarring
• Premature ejaculation

Dr. Gourishetti uses Botox to treat Bell’s palsy patients who experience facial paralysis and synkinesis. Targeted use of Botox in these patients can restore facial symmetry and improve facial function. “Botox plays a crucial role in the recovery of these patients, aiding their ability to communicate and express emotions while enhancing their overall quality of life,” says Dr. Gourishetti.

Botox is also being used to address mental health issues. Research suggests that using Botox injections to limit a person’s ability to frown could disrupt the feedback loop associated with negative emotions, improving the mood and emotional well-being of people with depression and anxiety.

“In the future, you can expect both the use of Botox to increase as clinical research continues to explore its use in chronic pain management, scarring management, mental health and other areas of healthcare,” says Dr. Gourishetti.

Cosmetic Uses of Botox

Cosmetically, Botox has a variety of uses for reducing the appearance of facial wrinkles and creases. On-label uses for Botox approved by the FDA include softening the appearance of:

• Glabellar lines: the wrinkles between the eyebrows, also called frown lines or elevens.
• Crow’s feet: the wrinkles around the eyes.
• Horizontal creases in the forehead.

Off-label cosmetic uses for Botox include:

• Slimming the jawline and temples.
• Reducing the appearance of chin dimples.
• Lifting the eyebrows (brow lift).
• Lifting the tip of the nose (nose lift).
• Making the lips appear fuller (lip flip).
• Reducing the appearance of bunny lines (the small, diagonal wrinkles that appear on the bridge of the nose and move towards the cheeks).
• Minimizing the appearance of bands, fine lines and wrinkles on the neck.
• Correcting “gummy smiles” (when the upper lip rests high on the gums when a person smiles).

Sometimes Botox is used to achieve cosmetic and non-cosmetic benefits, such as injections to the masseter muscles.

“We were already using masseter muscle Botox injections to treat temporo-mandibular joint (TMJ) dysfunction and pain,” Dr. Gourishetti explains. “But in shrinking those muscles, those same injections are highly effective at slimming and contouring the jawline. In fact, some patients get masseter Botox injections for both the cosmetic and TMJ benefits.”

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University Hospitals has a team of fellowship-trained surgeons who specialize in performing state-of-the-art plastic, cosmetic and reconstructive surgeries and related procedures.