Botox injections are used for a variety of medical and aesthetic reasons. If you or a family member are considering them, here are five things you should know about the procedure.

1. What it is and how it works
Botox is the brand name for injectable botulinum toxin type A, a protein created by the bacterium Clostridium botulinum. This bacterium can be found in some spoiled food and releases a potent neurotoxin that can be fatal if consumed. However, injecting the synthesized protein into muscles weakens them only temporarily.

2. Common uses
The muscle-weakening action of Botox can smooth facial wrinkles and treat movement disorders of the eye and head, spasticity, migraines and excessive underarm sweating.

3. Crossed eyes, migraines, cerebral palsy and other medical uses
Injecting Botox directly into muscles that control the eyelids reduces spasms in patients who suffer from blepharospasm, or rapid, uncontrollable blinking. When the condition is severe, patients can become functionally blind because their eyes never stay open long enough for them to see. In one small study of 14 such patients, 73 per cent of the treated eyelids returned to normal after Botox injections.

Bulging eyes caused by overcontraction of eyelid muscles as a result of Graves' disease respond well to Botox injections. Strabismus -- crossed eyes or otherwise misaligned eyes -- has been successfully normalized with Botox injections as well. Botox is also used to control involuntary head- and neck-muscle contractions (focal dystonias) by reducing not only movement but also neck pain caused by constant head twisting.

The same injections also help reduce spasticity and improve gait, range of motion and appearance in children with cerebral palsy and adults with spasticity problems. Some doctors, including Dr. Alastair Carruthers, a clinical professor at the University of British Columbia (UBC) in Vancouver, have found that Botox injections help prevent migraines in patients with frequent migraines. Because Botox can disconnect nerves from sweat glands, says Carruthers, it is also approved for the treatment of excessive sweating, which is thought to be triggered by overactive nerves.

Botox is also successful in its cosmetic uses; namely, reducing facial lines and wrinkles. As skin loses its elasticity with age, "people smile, and wrinkles remain where they are, whereas the skin bounces back when people are young," explains Carruthers. By relaxing the muscles that cause lines to form, botulinum toxin corrects the underlying cause of wrinkles and furrows.

The injections themselves are usually not painful: they are often likened to the sensation of a pinprick. No anesthesia is required prior to receiving an injection, though physicians may numb the skin first with a cold pack or anesthetic cream.

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4. Cons
The effects of botulinum toxin fade after about three months. When it's used to treat eye movement disorders, some patients develop a droopy eyelid, while patients with neuromuscular disorders can have trouble swallowing.

The cosmetic use of Botox has been associated with minimal side effects, according to a review that Carruthers and his wife, Dr. Jean Carruthers, clinical professor of ophthalmology at UBC, did of 50 of their Botox patients. The subjects had received at least 10 cosmetic treatments -- most of them in two or more areas -- and no adverse events were observed in 99 per cent of the sessions. Of the few that did occur, none were serious. The risk of adverse events also did not increase with the number of treatments.

5. Where to get it and at what cost
Plastic and aesthetic surgeons and dermatologists trained in cosmetic procedures are best qualified to offer cosmetic Botox injections. (To find Canadian physicians trained in the cosmetic use of Botox, visit www.trueexpressions.ca.) Other specialists, such as neurologists, who treat movement disorders, spasticity and excessive sweating may have training in its use as well. "As physicians get more experience with Botox, their results improve, and as each specialty gets this material, the number of things that are treated with it will increase," predicts Carruthers.

Botulinum toxin is expensive to produce, so the treatment cost depends on how much Botox the physician uses. A small cosmetic procedure might cost as little as $200, but if multiple sites are injected, the price is likely to be closer to $1,000. When Botox is used to correct medical conditions, the cost may be covered by a health-care plan.

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