Botox continues to be highly effective for the treatment of vaginismus, vulvodynia and vestibulodynia. The drug is compatible with all of the usual drugs that are normally taken, including antibiotics that may be needed for illness.

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submitted by Peter T. Pacik, MD, FACS

The use of Botox to treat Raynaud’s disease is an exciting new breakthrough in the treatment of the more severe cases of Raynaud’s. Mild cases of Raynaud’s have problems with the fingers turning pale or blue when exposed to cold weather. More severe cases of Raynaud’s may experience ulceration of the finger tips and severe pain. In the past amputation was done. With Botox amputation can be avoided and healing and reduction of pain are noted. More information can be found by linking to the home page of our web site dealing with Raynaud’s

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Submitted by Dr. Daniel A. Sterling

I suffer from migraine headaches and have read that Botox has been shown to help. How long does it take for the Botox to work? How do I know if I am a candidate?

Certain migraine headaches can be improved with Botox injections.  The people who seem to get the best results are ones who can identify a trigger area somewhere on their face, usually in the forehead starting above the eyebrows (supra-orbital nerve distribution). Another location would be the back of the neck (occipital nerve distribution) extending into the back of the scalp.  If this is the case this area is targeted and significant relief usually ensues within one week after injections.  If it is successful in alleviating your migraines then treatment would be required usually somewhere between every two and four months.

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Some people (mostly women) have considerable muscular activity involving the lips. This often results in lip lines. When pursing the lips (kissing movement) deep furrows are often noted. When we correct lip lines, separate injections of facial filler are first injected into the deep furrows, followed by more superficial injections just beneath the lip lines. Sometimes a chemical peel or dermabrasion is used after the facial filler to get the best result.

Botox helps minimize muscular activity and this helps maintain the facial filler for a longer period of time. Botox is used mostly for frown lines, forehead wrinkles and crow’s feet.  .The combination of Botox and facial filler is very helpful for long term (1-2 years) correction of frown lines.

Botox is used sparingly, if at all, in the lips, because of the undesired effect of changing the facial expressions and smile. Though the combination of Botox and facial filler will last longer than either one alone, it is always important to discuss this with the patient first. If the combination is used, only a small amount is used to get feedback from the patient. If the patient is happy with the combination treatment, this can then be continued in the future.

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 A patient asked why get injections of Botox if she has to use dilators anyway before attempting intercourse.

Vaginismus is a complicated situation that has a combination of emotional overlay and physical spasm both of which make intercourse either impossible or associated with a great deal of pain and fear. Just because a patient has Botox does not mean that they are cured after the Botox takes effect.

Even after the vagina relaxes, there continues to be fear and pain. It is important that the smallest dilator is used for 2-3 days before attempting the next size and so on for about 7-10 days before intercourse. Once you feel ready for intercourse, use the dilator and relax for about 15-30 minutes to allow the vagina to slowly stretch. Lubrication and foreplay are essential, as well as a loving atmosphere. The first several times can be expected to be uncomfortable, but this gets better with time. The photograph to the right represents different size dilators and the handle.

An excellent resource for vaginismus and the purchase of dilators is http://www.vaginismus.com/products/dilator_set. 

It is the COMBINATION of Botox and dilators that work better than either approach alone.

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Vaginismus is a condition of severe vaginal spasm making intercourse impossible or very painful at the least. Patients who have vaginismus develop an intense fear of any form of vaginal penetration which includes a GYN speculum examination, insertion of tampons, finger or penile penetration.

For the past several years we have been treating vaginismus with Botox in the group of patients who are resistant to conservative measures or those patients who want to speed up the process of being able to enjoy pain-free sex. This form of therapy is not well known and there appear to be fewer than 50 case reports in the literature.

We have had excellent success using Botox and repeat injections of Botox has not been necessary. One of our patients developed considerable dryness from the injections. This is related to the Botox and is temporary. We suggest that all of our Botox treated patients for vaginismus use water soluble lubricants especially for the first 3-4 months after injection, until the action of the Botox wears off.

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For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Vaginismus for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

When we speak about Botox, physicians and readers think of the formulation made by Allergan which is FDA approved. Actually other formulations are known and this could be confusing to readers.

Botulinum neurotoxins are produced by various strains of Clostridium Botulinum, of which A and B have been developed for routine clinical use. These various types of toxins have different properties and are used in varying dosage strengths. Only two formulations of Botox have been studied and used for cosmetic and therapeutic indications. The type A is known as the BOTOX® Cosmetic commonly used. The type B is known as Myobloc and is less suitable for cosmetic purposes because of the discomfort of injection and its acidity. Myobloc has a shorter duration of activity and is no longer used by most clinicians.

Another formulation is Dysport which is used in the United Kingdom and is currently undergoing FDA approval. Dysport is more likely to diffuse beyond the targeted muscle which can cause unwanted sequelae, and also has a shorter duration of activity.

Statistics for 2006 (latest available as of May 2008) show that BOTOX® Cosmetic injections continues to be the single most common aesthetic procedure performed in the United States, with nearly 3.2 million BOTOX® Cosmetic procedures performed. It is well recognized as one of the safest procedures available, and has a high level of patient satisfaction.

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For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on BOTOX® Cosmetic for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

The platysma is the neck muscle that causes a grimace when it is contracted. As we age, cords or bands make their appearance. These muscular cords can appear in the lateral (outer) part of the neck, though they are more frequently a sign of aging when they appear below the chin area. One or two platysma cords may be present and asymmetry is common.

Though there are a number of surgical procedures to correct platysma cords, the simplest effective method is to inject Botox into the cord itself. Botox will weaken any overactive muscular area, and the platysma bands are no exception. As with other areas of Botox use such as frown lines, forehead wrinkles, crow’s feet, and now the new use to elevate the corners of the mouth and correct marionette folds, injections of Botox need to be repeated about every 3 months, until the involved muscles are sufficiently weak that the patient can be placed on a maintenance program of Botox with fewer injections. This simple approach to correct platysma bands is often all the patient needs and helps avoid an operation in this area.

I recently read an interesting article on the use of Botox and facial filler for marionette folds. Until recently, there was little that could be done for marionette folds. With the advent of facial fillers such as Radiesse, Restylane and fat grafting, these depressions below the corners of the mouth could be filled in, at the same time elevating the drooping corners of the mouth (oral commissures).

The article, which appeared in the September/October 2006 issue of the Aesthetic Surgery Journal, describes the aging anatomy of the depressor muscles of the corners of the mouth (depressor anguli oris) and the benefits of combining a small amount of Botox (3 to 4 units) and facial filler. It has been our experience, that whenever possible, it is helpful to combine Botox and facial filler in that the two treatments together prolong the effects of improvement. An added benefit for the use of Botox in this area is that the depressor muscles to the corners of the mouth are weakened, allowing the angles of the mouth to move into a more favorable upward position.

"D" in the illustration is the depressor anguli oris responsible for turning down the corners of the mouth and is also implicated in the development of marionette folds.

The following before and after photographs show the benefit of Radiesse facial filler for the correction of marionette folds. More complete correction and longer-lasting results can likely be achieved by combining this treatment with Botox injections.

Probably the most common area for Botox injection is the frown area. Some people have very strong muscles in this area (corrugators) that over time cause creases and actual depressions (furrows). With time, they look like they are scowling.

An easy solution for this is the injection of Botox. The heavier the muscles, the more Botox needed. For deeper furrows, facial fillers can be added at the same time. When facial fillers are used at the same time as Botox, the results can be long lasting as shown in the photos below.

Left Photo: Heavy frown lines -- patient frowning. 8 injections of Botox plus 0.7cc Restylane to frown lines. Right Photo: 6 month follow-up. Patient still unable to frown. Frown lines and furrows are filled in with Restylane facial filler. Botox together with facial filler allows both products to work longer.