| Category Name | Content |
| Name | Botox (OnabotulinumtoxinA) - Neuromodulator |
| Uses | FDA-approved for treatment of dynamic facial wrinkles (glabellar lines, forehead lines, and crow’s feet), cervical dystonia, chronic migraine prevention, hyperhidrosis, blepharospasm, and strabismus. Off-label uses include masseter reduction (jawline contouring), gummy smile correction, TMJ disorder relief, and excessive salivation (sialorrhea). |
| Route of Administration | Intramuscular (IM) or intradermal injection, depending on indication. |
| Frequency of Use | Maximum every 3 months. Effects last 3–4 months, depending on metabolism and treatment area. |
| Concentration(s) | Standard reconstitution: 100 units per vial, diluted in preservative-free saline. |
| Maximum Dosage | • Aesthetic use: Max 100 units per session. • Hyperhidrosis: Max 50 units per axilla (total 100 units). • Chronic migraine: Max 155 units per treatment cycle. • Other medical uses: Based on clinical judgment. |
| Contraindications | • Pregnancy, breastfeeding, or planning pregnancy. • Allergy to botulinum toxin type A, human serum albumin, or gram-positive bacterial proteins. • History of severe allergic reactions, anaphylaxis, or neuromuscular disorders (e.g., Myasthenia Gravis, Lambert-Eaton Syndrome, ALS). • Active skin infections, acne, or inflammation in the treatment area. • History of bleeding disorders or use of anticoagulants. • Prior embolism, necrosis, or glabellar necrosis from previous aesthetic procedures. • Patients taking cholinesterase inhibitors (e.g., pyridostigmine, donepezil). |
| Possible Side Effects | • Common: Mild bruising, swelling, tenderness, transient headache. • Rare: Eyelid or eyebrow ptosis, dry mouth, flu-like symptoms, asymmetry. • Severe: Dysphagia, respiratory distress, muscle weakness beyond treatment area (botulism-like symptoms requiring medical intervention). |
| Compatibility With Other Treatments/Drugs | • Safe with: Dermal fillers, most skincare treatments. • Avoid with: Recent laser resurfacing, chemical peels, or neuromodulator treatment within the last 3 months. |
| Allergies | Patients allergic to botulinum toxin A, human serum albumin, eggs, cow’s milk protein, or gram-positive bacterial proteins should not receive treatment. |
| Administration Time | Injection procedure takes approximately 15–30 minutes, including consultation and mapping. |
| Dosing/Settings | • Forehead: 10–20 units • Glabellar lines: 15–25 units • Crow’s feet: 6–12 units per side • Masseter reduction: 20–30 units per side • Hyperhidrosis: 50 units per axilla • TMJ disorder: 20–30 units per side • Gummy smile: 2–4 units per side • Platysmal bands: 10–20 units per band |
| What To Do If Adverse Reaction Occurs | • Ptosis: Prescribe apraclonidine (Iopidine) eye drops, instruct patient on proper application. • Anaphylaxis: Administer epinephrine (0.3 mg IM), call 911, provide airway support. • Severe dysphagia or respiratory distress: Refer to emergency care immediately. • Overcorrection: Allow time for natural resolution (3-4 months); if necessary, refer to a specialist for management. |
| Additional Documentation Requirements | • Signed informed consent form. • Pre-treatment photos (frontal and side views). • Medical clearance for patients with history of neuromuscular disorders, autoimmune conditions, or previous complications. • Documentation of past neuromodulator treatments, including product used and dosing history. |
| Post-Treatment Care Instructions | • Avoid lying down or rubbing the treated area for at least 4 hours. • No strenuous exercise, alcohol, or excessive sun exposure for 24 hours. • Monitor for signs of asymmetry or unexpected muscle weakness. • Results typically appear in 3–7 days, with full effect in 14 days. • Follow up in 2 weeks for touch-ups if needed. |