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| |  AAFP: Should Family Doctors Offer Botox Injections? By Mike Fillon NEW ORLEANS, LA -- October 15, 2003 -- One of the most successful stories in modern cosmetic surgery is botulinium toxin A (Botox A). Allergan, maker of the injectable cosmetic product, expects to sell up to $1 billion of Botox in 2003. "Clearly, botulinium toxin injections have become extremely popular," said Mark R. Needham, MD. Dr. Needham and Eileen M. McGrath, MD, conducted a course on the subject at the American Academy of Family Physicians 55th Annual Scientific Assembly. Both doctors are in private practice in Santa Monica, California, United States. Presently, noted Dr. Needham, Allergan's Botox A is the only preparation licensed in the United States, and is used to soften facial lines and wrinkles. He added that Botox A works well for forehead lines, crow's feet, and frown lines. In the procedure, the toxin is injected into the muscle in these areas, and works by weakening the muscle, which in turn lessens the lines of facial expression. The results typically last 4 to 6 months. There can be side effects, however. One in 10 patients will develop a small bruise or haematoma, which will take several weeks to resolve. Also, rare drooping of eyebrow or eyelid can occur. This can last 3 to 6 months but is reversible. Extremely rare double vision has been reported. (This can last 3 to 6 months but is reversible.) As well, sometimes an injection simply does not take Dr. Needham added that doctors with extensive procedural experience might want to offer this cosmetic treatment to their patients, as patients are more comfortable receiving the treatment from their own physician. "It can enhance revenue for the practice," noted Dr. Needham, who added that patients want cosmetic treatments, "whether we want to believe it or not." Before agreeing to perform the procedure, Dr. Needham said a doctor would need to evaluate the patient. Does the patient have realistic expectations? Does he or she have underlying psychopathology? Dr. Needham said some of the clues one should look for to determine whether the patient has unreasonable expectations (and may be unhappy regardless of the outcome) include obsessive and detailed questions, vagueness, secretiveness and suspicion. Dr. Needham said the technique is relatively simple to learn, has minimal complications and contradictions, and usually results in very satisfied patients. "While the effect is temporary and rather expensive to attain," said Dr. Needham, "men who look in the mirror while shaving and see a face without a severe frown often go through the day less grumpy than they normally would. Women who look in the mirror and see a woman with a smooth forehead may feel prettier and more confident." In 2001, Americans spent over $9 billion on cosmetic surgical procedures -- a 40% increase over the previous year.
[Study title: Botulinium Toxin Injections for Family Physicians. Abstract 354]
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