Our Clinic
Skin Cancer Surgery
Cosmetic Surgery
Hair Transplantation
Laser Surgery
Facial Rejuvenation
Other Links
Teaching Website
Cosmetic Surgery Center
Division of Dermatology
Dermatologic Surgery Center
UW Medicine
Daniel Berg, M.D., FRCPC, Director
Clinic Appointments: (206) 598-6647
Botox ®
Dr. Berg provides Botox ® injections at the UW Dermatologic Surgery Center and the UW Cosmetic Surgery Center. Botulinum toxin in dermatologic surgery is useful for treatment of dynamic wrinkles (e.g., frown lines or "crow's feet"). Botox ® has been used for treatment of a variety of medical conditions for many years, and it recently received specific FDA approval for cosmetic use in frown lines. Botulinum toxin is also very successful at reducing sweat, particularly under the arms in people with excess sweating, hyperhidrosis.
What is Botulinum Toxin or Botox ®?
Botox ® is the trade name of Botulinum toxin Type A which is a purified protein produced by a bacterium called Clostridium botulinum. Like many things, excess is a bad thing ... in large doses taken internally, usually from eating contaminated canned foods, it causes a disease called botulism. Used in purified form, in tiny amounts and in specific muscles, injections of Botox ® will relax the action of that specific muscle, achieving desired effects. It is used widely in medicine in several conditions for treatment of excess muscle spasm and to relax muscles around the eyes. In dermatology and cosmetic surgery it is primarily used for treatment of unwanted lines and localized excess sweating (hyperhidrosis).
Treatment of Wrinkles
What causes wrinkles and frown lines?
Frown lines and some wrinkles are caused by the constant action of muscles underneath the skin. In particular, a furrow in the area between our eyebrows may appear and persist because of the repeated, often unconscious action of a muscle called "corrugator". These furrows can produce an angry or frustrated look on our face. Muscles around the eye are responsible for the "crow's feet" wrinkles that appear on the outside aspect of the eyes.
What benefits can I expect?
Botox ® can relax the underlying muscle in which it is injected. By relaxing these muscles, frown lines and certain other lines become less noticeable or deep, especially during day to day activities. Most patients do not find that Botox ® makes them "expressionless", but in fact find that used properly certain targeted areas respond very well.
How is the Botox ® given?
This depends on the muscle being treated. To improve frown lines, the Botox ® is injected directly into the corrugator muscle. This reduces your ability to contract the muscle and the frown line gradually fades away. While the Botox ® is working you will be unable to vigorously draw your eyebrows together when you frown.
Does the injection hurt?
The treatment itself takes only a few minutes and just feels like the minor sting of the needle. Very rarely bruising (visible but usually painless) may occur from the needle.
Is there a danger of botulism from Botox ®?
No. Given by trained physicians in the correct amount there is no danger of botulism from Botox ®. Botulism is caused by very large amounts of the toxin in the system, usually from eating contaminated food. Only a tiny fraction of the toxic dose is used in medical indications. Botox ® has been used since the 1980s (in larger doses than you will receive) for the treatment of muscle diseases (like muscle spasm) and has been shown to be extremely safe in many published medical studies and articles.
Will the treatment be permanent?
No. The Botox ® will begin to work in 2-4 days. Gradually over three to four months the Botox ® effect will fade. When the frown line begins to reappear, a simple repeat injection is all that is necessary to maintain the effect.
What are the side effects?
There is a small sting as the injection occurs. Rarely there can be a bruise at the site. Less than 1% of patients may develop a slight lowering (ptosis) of the eyelid. This may or may not be noticed and is always temporary. Other side effects are rare and can be discussed with your doctor. This may or may not be noticed and is always temporary. Botox ® should not be used if you may be pregnant or if you are taking aminoglycoside antibiotics (you can ask your doctor). It should not be used if you have a history of myasthenia gravis.
Treatment of Hyperhydrosis
What is localized hyperhidrosis?
Hyperhidrosis refers to a condition of abnormally excessive sweating. This can be generalized (all over) or localized to specific areas, most commonly the axilla (armpits) or palms. When severe, localized hyperhidrosis can lead to significant effects on quality of life, necessitating frequent clothing changes and causing significant stress and/or impairment in social or work situations. In most cases localized hyperhidrosis is a condition that occurs without a known cause. In rare cases, it may be related to internal problems. Consultation with a physician is recommended before considering medical treatments for hyperhidrosis for this reason.
What are the treatments for hyperhidrosis?
Options for treatment of localized hyperhidrosis vary depending on the area to be treated. Consultation with a physician (e.g., a dermatologist) who is knowledgeable about this condition is recommended. Use of Aluminum Chloride (Drysol) liquid is effective in some people. This is a medication available through the pharmacy. Devices are available (iontophoresis) which may help block the excess sweating for some people. For the axillae (armpits), surgery has been described to remove the skin in the armpits or even to do liposuction to try and destroy the sweat glands. Surgery to destroy the nerves that supply the sweat glands may also be a very useful permanent solution in some patients. This is called thoracic sympathectomy. Finally, Botox ® has been shown in several medical studies to be a very effective treatment for patients with localized hyperhidrosis, especially in the axilla.
How does Botox ® work for hyperhidrosis?
Botox ® blocks the nervous system stimulation of the sweat glands in the armpits or palms or other localized areas. It is directly injected into the skin in the area that is sweating excessively. After a few days, significant and often dramatic reduction in sweating is seen in many patients. The duration of effect lasts on average 4-6 months, but some patients get up to a year of reduced sweating from an injection. Side effects are minimal in the axilla though transient muscle weakness can occur in the palms.
Further information on Botulinum Toxin Type A (Botox ®) can be found on the website of The American Society for Dermatologic Surgery (ASDS).
Note: Individuals must determine for themselves how to use the information provided on this website. When making medical decisions, a physician should always be consulted first.
University of Washington Medical Center
Roosevelt 1, Fourth Floor
4225 Roosevelt Way NE
Seattle, WA 98105
Clinic appointments or more information:
Monday through Friday
9:00am to 4:30 pm
206-598-6647
Copyright © 2006 Daniel Berg, M.D.
Dermatologic Surgery
Contact the webmaster at:
danberg@u.washington.edu
Website designed by Cathi Carol
Last Updated: October 2, 2006