Dear Doctor Column, July 28, 2003

Question:

I've been invited to a Botox party at my regular salon where all the attendees will be able to get facial Botox injections for about half the normal price. This is tempting, but is it safe?

Answer:

Botox® (botulinum toxin) is a safe and effective treatment that has enjoyed immense popularity since its April 2002 approval by the Food and Drug Administration for the temporary treatment of frown lines. Last year, more than 1.1 million people received Botox treatments, which currently ranks as the top cosmetic procedure sought by American women, according to statistics compiled by the American Society of Plastic Surgeons.

Nevertheless, the American Academy of Dermatology (AAD) stresses that botulinum toxin treatments being performed in casual social settings rather than in a controlled medical environment contradicts the seriousness of this medical procedure. And, as with any medical procedure, the possibility of adverse effects occurring from a botulinum toxin injection is always a possibility.

Although "Botox parties," where people gather for botulinum toxin injections at someone's house, a hotel banquet room, or a salon or spa in a social atmosphere with alcoholic beverages may sound like fun, this medical procedure should be performed only by a board-certified dermatologist or an appropriately trained surgeon, who regularly performs cosmetic surgery procedures in a professional setting.

Botulinum toxin is a purified form of one of the most potent toxins in the world. In high doses, it can cause the clinical disease botulism. However, when carefully injected by dermatologists and appropriately trained surgeons in very low doses, botulinum toxin is a modern tool that can reduce the signs of aging.

Botulinum toxin blocks nerve signals transmitted from the brain to the muscle, causing paralysis of the injected muscle. It works locally by inhibiting the release of acetylcholine, a neurotransmitter, from the nerve. After injection, the muscle relaxes, creating a smooth surface. Within a week after being injected with botulinum toxin, the affected wrinkles and creases soften from the disuse of the muscle. Since botulinum toxin decreases the individual's ability to frown or squint, it also safely and effectively prevents the progressive worsening of these lines over time.

Aside from treating fine line and wrinkles, botulinum toxin has other medical applications, including successful treatment of excessive sweating, or hyperhydrosis. The ability to selectively weaken overactive muscles has had a tremendous application in the medical fields of ophthalmology and neurology, as well.

Before undergoing Botox injections at a party, or anywhere else, UAB dermatologists say to make sure you can answer "Yes" to the following questions:

1. Have you been asked to provide a complete medical history? You should not undergo Botox treatment without having provided details of your medical history that may be necessary in the event of an emergency or adverse reaction to the toxin. In addition, Botox treatment is not recommended for anyone who is or may be pregnant.
2. Have you been advised on alternative treatments? Part of the purpose of a pretreatment consultation is the thorough evaluation of each patient for whatever treatment is being proposed. Although Botox has proven to be an effective treatment for wrinkles, it is only one of the many safe and effective procedures for treating aging skin. No one should undergo Botox treatment without personal evaluation by a qualified physician.
3. Have you been advised of the risks and given your informed consent? A discussion of both the benefits and risks of a procedure is required for informed consent. Such informed consent should be documented in the medical record. A person giving informed consent must not be under the influence of alcohol or other substances that may impair judgment.
4. Is a qualified physician administering the treatment? While Botox treatment is both safe and effective, every medical procedure has risks and possible complications. It is imperative that Botox be administered by an experienced physician who understands facial anatomy and proper Botox injection techniques.
5. Is the physical setting appropriate for administering medical treatment, including handling emergency situations? Any medical procedure requires sanitary conditions. In addition, drugs or equipment that might be necessary to handle an emergency situation must be readily accessible.
6. Are you willing and able to follow post-treatment instructions? Botox treatment requires that the patient restrict physical activity for a period following the injections. Failure to follow post-treatment instructions can lead to complications. In a party atmosphere, people may tend to forget such restrictions, particularly if alcohol is being served.
7. Will you receive adequate follow-up care? Botox is a temporary treatment, and results usually last only a few months. Nevertheless, follow-up care is an important part of the doctor-patient relationship, and should not be overlooked, even when treatment is administered outside of the usual medical setting.

"Botox parties" may offer some benefit to patients by reducing the cost of their individual treatment. However, unless proper measures are in place to ensure both safety and effectiveness of treatments, get your Botox injections in the doctor's office.