Botulinum toxin, or Botox as it's widely known, is famous for its ability to smooth away wrinkles. But hiding our frown lines from the world isn't the reason early scientists started experimenting with this substance.
Author
Philip Crilly
Associate Professor in Pharmacy Practice and Digital Public Health, Kingston University
Botulinum toxin is produced by the bacterium Clostridium botulinum. In its most raw form, it can cause the deadly disease botulism. But in the form in which it's used in cosmetic and medical industries, it's so diluted and processed that this isn't a risk.
Botox was first used medically in the 1970s by an American eye doctor called Alan Scott to help patients with a condition called strabismus (better known as a squint). The doctor noticed that when injected around the eye, not only did it help treat the squint - it also reduced wrinkles and lines.
Given the public fascination with looking younger, there was huge interest in this discovery. Nonetheless, it was not approved for cosmetic use by drug regulators until 2002 in the US, then scores of other countries since then.
This is how it is most commonly used today - there were almost 9 million injections administered to reduce wrinkles globally in 2023. However, it's also still widely used for a variety of medical purposes. Here are some surprising ones:
1. Eye disorders
People who have an eye disorder can benefit from Botox injections. The most common eye disorders treated in this way are strabismus and blepharospasm (eyelid twitching).
When someone has a squint, the muscles that control eye movement are out of sync - meaning each eye looks in a different direction. Botox injections help to relax these muscles, which corrects the misalignment.
Blepharospasm sufferers, on the other hand, experience an involuntary contraction of the muscles around their eyes - leading to eyelid twitching or increased blinking. Botox injections administered around the eye relax the muscles involved in blinking, reducing twitching and discomfort.
The positive effects of Botox in treating blepharospasm appear to last between 12 and 14 weeks. For strabismus, the benefits may last up to six months.
2. Excessive sweating
While sweating is an essential body function that regulates temperature, in excess it can be embarrassing and uncomfortable. This condition, known as hyperhidrosis, can be caused by any number of factors - including diabetes, thyroid disorders or menopause.
Regular antiperspirants have little effect in reducing this excess sweating, so some sufferers turn to Botox injections. These work by numbing the nerves that stimulate sweating, subsequently reducing the amount of sweat produced. Users need repeat injections every four months to a year to see continued benefits.
3. Migraines
Some migraine sufferers experience such debilitating symptoms that they're unable to go about their day-to-day activities. Botox injections can help prevent migraines in those who suffer them regularly (at least eight per month) and for whom other treatments haven't worked. The Botox blocks the brain's pain signals, which dulls or prevents these attacks.
People who have used Botox in this way not only report experiencing around half the number of migraines, but also report experiencing less pain during an attack. Injections are usually needed every 12 weeks.
4. Overactive bladder
An overactive bladder creates a need to urinate much more frequently than normal. This can be extremely embarrassing and can have a big impact on a person's quality of life. While pelvic floor exercises and certain medications can help, these don't always work for everyone.
Botox injections are an alternative. One of the causes of an overactive bladder is the bladder muscles tensing up more than they should. Botox relaxes these muscles, making sufferers' urge to urinate less frequent. These effects can last for between six month to a year - after which repeat injections are needed.
5. No-burp syndrome
While not being able to burp doesn't seem like an obvious issue, it can be distressing for those who experience it. Burping is the body's way of clearing digestive gases. Being unable to clear these gases can lead to bloating and discomfort.
People who can't burp have a rare condition known as retrograde cricopharyngeus dysfunction or "no-burp syndrome". With this condition, the muscles in the neck that allow us to release digestive gases are unable to relax, preventing the body from releasing these bubbles of air. This can lead to increased flatulence, bloating, nausea and even painful hiccups.
Botox is now being used to help people with this condition. Injections in the neck relax the muscles that prevent them from burping. This allows the gases to pass through unobstructed.
6. Depression
Botox could potentially even be used to treat long-term depression in people who have not responded to other treatments.
Numerous studies have indicated that patients with depression who received Botox injections noted an improvement in their mood. While the reason for this isn't entirely clear, some scientists believe it could be related to how our face muscles and facial expressions make us feel. Because Botox numbs these muscles, it's thought this sends certain signals to our brain which improve our mood.
Botox has therefore proven itself to be more than just a one hit wrinkle-smoothing wonder. Not only is it helping sufferers of a variety of medical conditions to live more normal lives, it's also being investigated to treat a variety of other medical issues. These include pain, chronic itching and even managing the side-effects of cancer treatment.
Philip Crilly does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
