What's In It? Exploring the Active Ingredient in Botox® & Other Popular Treatments

Author

Dr. Stephen Cosentino

Many people don’t realize that Botox® received FDA approval decades ago. In those early years, it was a quiet, niche treatment for certain types of muscular disorders. It didn’t gain popularity as a minimally invasive cosmetic treatment until the 2000s.

These days, Botox and other medications that use botulinum toxin as their active ingredient are everywhere. They’re used in millions of injection procedures each year to treat more than a dozen cosmetic complaints and a similar number of musculoskeletal issues, such as chronic migraine and incontinence.

But what exactly is botulinum toxin? It sounds scary — is it safe? What are the risks and alternatives?

For answers to all these questions and more, keep reading.

The Active Ingredient in Botox: What It Is & How It Works

Botulinum toxin type A is a potent neurotoxin derived from a particular strain of bacteria. Fortunately, when formulated in a controlled production facility and injected by a board-certified provider with comprehensive Botox training and certification, it’s safe and effective for treating cosmetic and medical complaints like:

Crow’s feet and other fine lines and wrinkles on the face
Frown lines (between the eyebrows)
Chin dimpling
Platysmal bands
Eye muscle spasms
Chronic migraine
Urinary incontinence
Excessive perspiration

Botulinum toxin is injected via a narrow needle into the muscle just under the lowest layer of skin. When properly injected, it works locally and doesn’t diffuse across larger areas of the body.

Botulinum toxin works by blocking nerve signals to and from the targeted muscles. This helps quiet nerve action and relax the muscles, temporarily alleviating the cosmetic issues or physical symptoms that brought the patient to seek care.

Botulinum toxin is a temporary aesthetic treatment. As the body metabolizes the product over a period of months, these effects lessen and the targeted muscles return to their original state.

What Are the Risks?

Adverse events are rare following botulinum toxin injections, but they do happen.

Some serious reactions are responses to inactive ingredients in the medication, such as cow’s milk protein. Others occur due to improper injection technique, which may result in the wrong muscle being targeted. This can cause problems with facial expressions (frowning, squinting, and smiling) for as long as the medication remains in the body (generally three to six months).

Fortunately, most botulinum toxin side effects are mild and temporary. They may include soreness or redness at the injection site, minor swelling or bleeding, and mild flulike symptoms. Infection can occur in rare cases, necessitating prompt medical attention.

What Are the Alternatives?

Botulinum toxin type A is the only FDA-approved neuromodulator of its kind, so it has no true alternatives in the narrowest sense. However, patients who aren’t well-suited to Botox or want to try something else alongside it do have options.

Dermal fillers: These injectable medications add volume and definition to targeted areas of the skin. They’re not neuromodulators, but they do have risks and potential side effects of their own. Their results tend to last longer than botulinum toxin.

Noninvasive cosmetic skin treatments: Microdermabrasion, laser light treatments, and chemical peels may offer similar results (at least as far as treating fine lines and wrinkles goes) without subcutaneous injection.

Topical skincare products: Prefer an at-home treatment? While they don’t offer dramatic results, topical skincare products have fewer potential side effects and complications.