Botox injections for the treatment of facial muscle spasms have been used for over fifteen years. About 90% of patients find this treatment useful. When injected into a facial muscle in extremely small quantities, the drug causes TEMPORARY weakness in the abnormally acting muscle. Usually four injections through a tiny needle are given into each eyelid. One or two are given into the brow if brow spasm is bothersome. The injection is not particularly painful or irritating and normal activities can be resumed straight away. Bruising is uncommon. The effect takes 1-2 days to begin, reaching its maximum effect over 7-10 days, and slowly wears off over several weeks or months when the injections are repeated. Injections can be repeated many times.
Individuals differ in their response to this treatment and the exact dosage required at different sites for a particular patient may be a matter of trial and error, and may change over time.
SIDE EFFECTS are not common and nearly always recover completely. They include drooping of the upper eyelid, dryness of the eye due to weakness of the lower lid (helped by lubricants), difficultly in closing the upper lid, and light sensitivity. Double vision is rare (3% of patients).
In most patients, symptoms don't change very much from when they are first seen, Botox stays effective, and the patient turns up every few months forever for Botox injections.
A small number of patients (probably less than 10%) get better as the years go by. It is not clear if this is due to the Botox or if this is due to the underlying problem getting better.