Botox for Residuals

In the early ’70s botox was used to relax overactive eye muscles in cross-eyed patients. It has since been approved for many uses, including for spasmodic neck, facial and eyelid muscles. Facial muscles have a tendency to become hypertonic (overactive) after paralysis. Weakening or re-paralyzing the muscles with Botox can temporarily ease the effects of some synkinetic and hypertonic muscles. Spasms can be reduced along with the pain and discomfort associated with them.

Cosmetically, Botox can effectively enhance the appearance. With Botox injected into the eyelid muscles, the squint associated with synkinesis or hypertonicity can be lessened; sometimes significantly. If there is tightness or spasms in the cheek area, the Botox injected in the muscles around the eye may also reduce those spasms. Botox can also be injected into the muscles of the cheek or neck areas directly. The overall result can be a more symmetrical appearance plus increased comfort. Over an extended time period immunity can build up, and the procedure may become less effective. To avoid or postpone antibody formation, the smallest effective dose should be administered, and the interval between injections should be extended as long as possible.

Patients who are using muscle relaxants such as baclofen, dantrolene or diazepam can continue taking these meds for further assistance with muscle spasms or tightness if needed; they will not interact with Botox.

Botox can be combined with neuromuscular retraining to try to maintain improved motion patterns and appearance without continuing injections. While Botox is preventing inappropriate muscle movements, exercises are performed daily to reinforce correct, isolated movements. The exercises are continued after the Botox wears off to further reinforce the new pattern.

Botox is botulinum toxin type A – not live bacteria. It is a genetically engineered protein that weakens or inactivates muscles. After injection Botox enters the nerve ending of a muscle, binds to pre-synaptic receptors and blocks transmittal of nerve impulses at that point. The muscle will not contract because the signal from the nerve has been stopped.

Tiny amounts of Botox are injected into the muscles using a small gauge needle. It will begin to take effect 24 – 72 hours after treatment, and the full effect will build up over a period of time. Gradually new nerve sprouts form and neuromuscular control returns a few months later. It is a temporary solution that works for 3-6 months. After that, the injections must be repeated.

Some neuromuscular diseases

Possible adverse effects
Temporarily weak or heavy feeling eyelid
Droopy eyelid (ptosis)
Blurred vision
Double vision (diplopia)
Inability to close the eye (lagophthalmos)
Sagging mouth
Brow droop
Excessive tearing (epiphora)
Long-term weakness

** The list of adverse effects is provided for your information and to help with questions you may want to ask your doctor. Side effects are not common and are temporary. They should not discourage you from seeking treatment that may help. **