Botox has obtained a new indication from the US FDA. It is now FDA approved for use on Crow’s Feet, the Laugh Lines that form at the corners of the eyes. While most of us like them while we are smiling, many dislike them when they refuse to relax.
Smile Lines Are Fine When We Are Smiling
After a certain age, the lines at the outer corners of the eyes stop going away when we stop smiling. Persistent Smile Lines are a natural sign of aging. They stick around long after the smiling stops, when elasticity begins to leave the skin. The process is accelerated by sun exposure and smoking, so you have been warned. While neuromodulators, like Botox and Dysport, do not restore the thicker, more elastic skin of youth, they do relax the resulting wrinkles.
But My Doctor Has Treated My Crow’s Feet With Botox For Years
Technically, until Botox’s approval this Wednesday, treating Crow’s Feet was an “off label” use, just like treating frown lines was before 2002. Botox was originally approved for blepharospasm and strabismus. Blepharospasm is a disabling spasm of the squinting muscles that makes its sufferers functional blind, due to the inability to fully open the eyes. Strabismus is a misalignment of the eyes, due to imbalance of the muscles that move the eyes. The mechanism of action of Botox is that it blocks the nerve impulse that makes the muscle contract. For those with blepharospasm, it is a quick and easy fix. The muscle relaxes in a few days, and the improvement is dramatic as the eyelid is no longer forced shut. For strabismus, double vision is caused when the muscles that move the eye are unbalanced. The stronger muscle pulls the eye to its side. Strabismus is treated by weakening the stronger muscle. This balances the muscles that move the eye and corrects the double vision. Unfortunately, the results are not permanent, and retreatment is required because the nerves will sprout new functional branches that need to be blocked also.
Plastic Surgeons, Ophthalmologists and Dermatologists Have Used Botox for Wrinkles for Decades
Botox is safe and effective. Since Botox’s 1989 FDA approval for treating Blepharospasm, the off label use for cosmetic purposes began. It is only in the last decade that FDA approval was granted for wrinkles, but only for the glabellar region, between the eyebrows. It may seem odd that approval for the injectable is limited by area, but that’s the way the FDA has gone about it. So now, Plastic Surgeons are on label when treating Frown Lines and Crow’s Feet, but we are still off label when treating the forehead.
Botox Has Multiple Indications
Botox may be the drug with the most indications ever. It seems that a drug which blocks neuromuscular junction has multiple beneficial uses. Besides blepharospasm, strabismus, glabellar frown lines, and now crow’s feet, Botox is also approved for the treatment of migraine headaches, excessive armpit sweating, overactive bladder (spastic bladder) and the associated bladder incontinence, arm spasticity (severe arm muscle spasms) in adults and cervical dystonia (severe neck muscle spasms) in adults. It’s also used off label for forehead wrinkles, and some lower facial muscle induced wrinkles, to provide symmetry to the face after strokes, episodic migraines, sweating of the palms and other areas, and muscle spasticity of the arms and legs in children (most commonly in children with cerebral palsy).
Who Can Administer Botox?
On the California Medical Board Website it says, “Physicians may inject Botox, or they may direct registered nurses, licensed vocational nurses, or physician assistants to perform the injection under their supervision. No unlicensed persons, such as medical assistants, may inject Botox.” The definition of “direct” is open to interpretation. My opinion is that with each treatment, you should be seen by a doctor either they should inject you, or after the evaluation, they can direct an RN, LVN or PA to inject you. If you are only seeing a nurse, or a spa owner, the spirit of the law is being violated. On the other hand, I do walk around San Francisco and Walnut Creek, and see this as a way to provide bargain basement Botox. While safe and effective, Botox is not 100% predictable, even in the most experienced hands, so buyer beware.