So far, we’ve discussed the discovery and history of Botox and Dysport in addition to their typical cosmetic uses compared to other treatment options. In the final chapter in our three-part series, our focus will be off-label treatment options that are available using both Botox and Dysport.
With injectable medications like these, a thorough understanding of the procedures required to administer the products is essential to positive patient outcomes. Before undergoing off-label treatment with these medications, it’s extremely important that you seek out a healthcare provider who is experienced in these types of procedures.
Using Botox and Dysport in an off-label capacity requires advanced techniques that only skilled providers understand. Such healthcare professionals can be found in reputable facilities where procedures can be performed safety and with minimal risks. These treatments are available at Azura Skin Care Center, but it’s still vitally important to discuss all options with your healthcare provider to find the best treatment plan for you.
The Difference Between On and Off-Label Treatments
As we discussed in the last blog post, the FDA has a process by which companies must prove that a medication is safe for use: that is, the benefits of using the drug or product outweigh the risks of doing so. Drugs are usually approved by the FDA for certain uses – these specific uses are then termed “on-label”. Many medications are used in ways that haven’t been approved by the FDA, and healthcare providers often prescribe products for unapproved uses if it’s medically appropriate for the patient. This is termed “off-label” use (1).
There are many reasons (2) a healthcare provider would prescribe a drug for an off-label use. There may be no approved treatment options currently available for a patient’s specific medical condition. A drug might not have been sufficiently studied in a specific population (like children or the elderly) to warrant approval for those types of people. Also, several drugs might belong to the same class of medications: they might all work similarly, if not exactly the same way. Providers might use one drug from one class in an unapproved manner for the same reasons they would use another drug from the class that actually has an on-label, approved use.
Cosmetic Off-Label Uses of Botox and Dysport
Both Botox and Dysport have both been used in off-label treatments for a variety of medical conditions. In our discussion, we’ll focus on only the off-label cosmetic applications of both products, which are both used for many of the same medical conditions. In our discussion, remember that when Botox is referenced, Dysport can generally be used in the same way. Also, it is important to keep in mind that the dosage, location and number of injection sites for these particular problems are determined by the healthcare provider and may vary between patients.
One of the most common off-label uses of Botox is in the treatment of forehead lines. These lines commonly appear as the result of scowling and looking surprised. They’re usually horizontal across the forehead. To treat forehead lines, Botox is injected at several points into the frontalis muscle (3), a large, thin muscle that’s closely attached to the skin of the forehead and located above the eyebrows. Injections administered on both sides of the forehead, starting at least one centimeter above an imaginary line drawn horizontally above the eyebrows. This is to prevent eyebrow sagging or drooping. Some providers choose to massage the product into the forehead, but not all do. If this massage is performed, it’s directed up and away from the eyes.
Nose and Upper Lip
Both products can also be used around the nose to help with fine lines and wrinkles… The nasalis (6) muscle is found in the nose and, over time, its movement is responsible for the formation of so-called bunny lines. These are fine lines and wrinkles that appear on the bridge of the nose under the skin below the eyebrows.To treat these lines, Botox or Dysport is injected high up on the nose (7), right under the skin on either side. It then diffuses down into the nasalis muscle.
Some people have so-called “gummy smiles”- they show an excessive amount of gum tissue when they smile. The muscle responsible is the risorius muscle (10), a large facial muscle that’s located on both sides of the mouth. This muscle helps to create our many facial expressions, both expanding and contracting in an upward and outward motion. Botox or Dysport can be injected into this muscle near the lower nose and upper lip, as a minimally invasive, temporary treatment option to reduce the muscle’s activity and lessen the amount of gum that’s shown when smiling.
Mouth and Jaw
In the lower part of the face, the depressor anguli oris (DAO) muscle (8) extends from the ring-like muscle surrounding the lips, the orbicularis oris, to the mandible, or lower jaw. This muscle works to pull the edges of the lips downward, forming a frown. Botox or Dysport can be injected into the muscle on each side of the face to lessen the muscle’s activity.
Also connected to the mandible is the massater muscle (9), which connects the lower jaw to the cheekbone. Chewing solid foods would not be possible without our massater muscles. The hinge where the jawbone meets the skull is called the temporomandibular joint (TMJ), and if it is overworked by the massater muscle, severe pain and headaches can be experienced. As a treatment for TMJ, Botox is injected into the massater muscle, and most patients experience a noticeable improvement within a week.
Interestingly, Botox can also be injected into the massater muscle to help slim down a patients’ face. People that benefit from this procedure usually have more of a squared jaw. Botox is used to weaken the massater muscle over time, which causes it to shrink. Patients typically see a natural and subtle improvement to the area after treatment.
Another common problem area is the chin. Many people have chin dimpling, which is often referred to as “orange peel chin”. Dimples result from repetitive movements of the underlying mentalis muscle over time, and Botox is very effective in relaxing this muscle and smoothing the skin. Most patients see improvement soon after treatment, and the results can last up to six months.
From the Neck Down
The use of Botox and Dysport isn’t just limited to the face. In fact, these medications can be injected at several points below the head. Many people experience wrinkling of the neck, and so-called “necklace lines” are a common problem for people as a result of aging, weight gain, sun damage and poor posture. Still more people have problems with platysmal bands (11), sagging strips of skin that is the result of weakened platysma muscles that start at the base of the neck and run up the front, on both sides, to the jaw. The platysma works together with the DAO muscle in order to pull both corners of the mouth downward. Botox or Dysport can be directly injected into these bands in order to raise the corners of the mouth and the platysma muscles themselves, producing a smoother looking appearance in the skin and a more well-defined neck profile.
While we all know that frequent sun exposure damages skin, many people forget that sun damage can affect more than just the face. Many women develop wrinkling on the chest – cleavage lines frequently appear between the breasts and on the upper chest. These lines are caused by sun damage over time, as we’ve already mentioned, and by the loss of collagen that happens naturally as we age. Fortunately, Botox has been shown to be an effective non-surgical treatment for these troublesome lines.
Finally, Botox has been used in the treatment of hyperhidrosis (12) since the early 2000s. In 2004, it was approved for on-label use in patients with excessive sweating under their arms. More recently, it’s been discovered that Botox has multiple off-label uses to decrease sweating in other areas of the body. The product can be injected into the scalp, forehead, hands, feet, and under the breasts. It’s important to note that Dysport can also be used as a treatment option for hyperhidrosis, but that treatment for this condition using Dysport is strictly off-label use, no matter where it’s injected.
I hope that you have enjoyed learning more about Botox and Dysport! From the early discovery of the botulism toxin, researchers and healthcare providers have recognized it’s potential in cosmetic and other treatment applications. While these products have a variety of on-label, FDA approved uses, they are also utilized in many off-label treatments. Before any treatment with either product begins, it is important to have a conversation with your healthcare provider about the benefits, risks and expected outcomes, so that your experience can be as positive as possible.
Sarah Handzel, BSN, RN
Registered Nurse and Freelance Copywriter
Owner, Catbird Writing Solutions, LLC