Cosmetic Surgery Blog

I know a lot of you have probably heard at least one report on the recent deaths of several children after receiving injections of botulinum toxin. I am sure you have also heard of the adverse reactions other patients have experienced after using botulinum toxin including Botox, Dysport and Myobloc. Although the reports of death mostly involve patients who were undergoing the experimental use of Botox for leg spasticity due to Cerebral Palsy (CP), I am sure the thought has crossed your mind about the safety of Botox for cosmetic reasons in general.

CNN.com reported, “…the consumer advocacy group Public Citizen petitioned the FDA to strengthen warnings to users of Botox and Myobloc — citing 180 reports of U.S. patients suffering fluid in the lungs, difficulty swallowing or pneumonia, including 16 deaths.” However, Allergan’s spokesperson, Caroline Van Hove, commented that the children with CP, “receive far larger doses injected into their leg muscles than the doses given adults seeking wrinkle care.”

The average cosmetic patient receiving treatment for the approved area, the glabella (the frown line between the brows), commonly is injected with no more than 25 units of Botox for this single anatomic area. When a patient like myself gets a treatment for the glabella, forehead and crow’s feet, the common dosage is about 75 units or less—that’s ¾ of the bottle of Botox.

“The children [in the CP study] had a mean age of 8 years and 8 months (SD 4y 8mo; range 1mo–18y 11mo); 106 patients had bilateral spastic CP and six were classified as having unilateral CP. Main indications were leg adductor spasticity (n=59) and pes equinus deformity (n=35). Eighteen children were treated for spasticity of other muscles (e.g. upper limb, M. rectus femoris). The mean treatment period was 14 months (range 3–74mo), with reinjection intervals of 3 to 6 months. The BTX-A dosages were determined according to body weight and size of target muscle. The mean dose per visit was 8.5 units Botox or 24.6 units Dysport per kg body weight.” [Developmental Medicine & Child Neurology 2006, 48: 319–320 319]

The average weight and height for a healthy 8 year old girl with no disorders is 3’ 9” (114.3 cm) and 57.2 lbs (26 kg). The average dose of Botox for an 8 year old of average weight would be 221 units per treatment visit. That’s a lot of Botox in my opinion. However, according to CerebralPalsyTreating.com, “Girl children with cerebral palsy were 2.1 z less than the normal girls as far as weight for age is concerned.” Obviously the dose would be less than the calculation above if this factor were taken into account. So, I did some research on average weights and lengths in children with CP. According to the Kennedy Krieger Institute, the average weight and height for an 8 year old with CP in the 90^th percentile is about 3’ 9” feet and 49.6 lb (22.5 kg). Hence, with these weights and treatment parameters, 191.15 units of Botox would presumably be used for a child with CP in the 90th percentile weight range. That’s still a lot of Botox.

Since the consumer advocacy group, Public Citizen began placing Allergan in their sights, the company has strengthened warnings to patients regarding their product. Whether or not this change was a direct result of Public Citizen’s petition to the FDA is unknown to me. But, PC reports 180 cases submitted to the FDA involving adverse reactions in patients receiving botulism toxin injections. These effects included fluid in the lungs, aspiration pneumonia, muscle weakness, lethargy, and difficulty swallowing, as well as16 deaths. In recent articles it has appeared that Public Citizen may like you to believe that a death occurred from a Cosmetic Injection of Botox, but this has been proven untrue. The patient in 2004 actually died of staphylococcus pneumonia.

Although the reports consist ”only of a handful of patients” who have experienced adverse effects (including death), according to the American Society for Plastic Surgeons (ASPS), there were 4,090,517 anatomic sites injected in 2006—and I was 6 or 7 of them! Still, when reports like this start popping up, you start to go, “hmmmm”. I don’t blame you. But statistically, the adverse reactions are very low and the problems associated with cosmetic use is even lower.

Regardless if you’re Team Botox or not, you as a patient and consumer, must realize there are inherent risks in getting this, or anything else for that matter, injected into your body. All procedures carry some form of risk. With Botox, or Myobloc, the risk is that yes, you can have an adverse reaction, and yes, it may spread to another area. I have been getting Botox for about 4 years and I must say I love it. Yes, I know that Botox is only approved for the glabella but I do get it in other areas such as I mentioned above. Still, do your research, weigh your options, risk versus reward. You don’t have to get it if you don’t want to. But you should do research before undergoing any treatment. I know I’ll be getting my ‘Tox ON when this batch wears off.