Aspirin has caused death from bleeding and allergic reactions. Some people should not take aspirin. Water has caused death by excessive water ingestion called water intoxication. All people should not drink too much water at one time. Now we learn of 16 deaths apparently due to botox. We learn that in most cases this was due to massive doses of botox given to children with cerebral palsy. Some others died because of injections in the neck which caused difficulty in swallowing and/or breathing and led to aspiration.
Most patients receive about 30 units at one treatment session in our practice. The doses used in the reports varied from 600 units to 1000 units. Our migraine headache patients receive up to 100-130 units at one treatment session. That is still 1/6 the dose reported in these studies. Many thousands of children have been treated with doses of 600 units and they did not die or suffer. This speaks to the fact that all drugs must be calculated on a case by case basis. They must be administered in a physician’s office by a physician. OK, OK. So your doctor uses a nurse or nurse practitioner or physician assistant. I wonder why. Could it be to improve patient care? I doubt it. And botox parties. There’s a fun idea! Let’s inject drugs into our faces while drinking alcohol with no medical records and no screening of patients. All of our patients fill out a health history form and all are interviewed by Dr. Rachel or myself before they can receive botox. And while I am naming names, what about the salons that are injecting botox. “Don’t worry,” they say. “We have a medical director.” Of course he happens to be an ER doctor on retainer some 10-20 miles away. When we dumb down the administration of drugs, when we eschew physician competence for convenience and price, when we lump all health care providers as equal then we sow the seeds of incompetence and we reap the consequences. The irony here is that these cases of botox injury were probably administered by physicians who are the best in our profession and even they are still vulnerable to human adverse consequences.
I have said and I maintain that Botox is one of the miracle drugs of the 20th century. I know it treats wrinkles- you say “big deal”. It is the most effective drug for the spasticity of cerebral palsy; it is very effective in both migraine headache patients and tension headache patients; it is the most effective drug for excessive sweating; it is the most effective drug to balance the face and promote normal chewing after bell’s palsy or stroke; and it is the most effective drug we have for severe muscle spasticity. Put yourselves in the shoes of all of these patients whose lives are compromised by their health impairments. And if you are one of those people who needs a minimally invasive face lift and does not want cutting surgery, the botox non-surgical facelift is a relatively painless and effective treatment to buy 5 years or more of non-surgical facial enhancement.
Let us continue our vigilance with adverse drug reactions. But let us not over-react to the reactions. Let’s not have another law-suit induced silicone scare that torments patients and bankrupts companies.
Article by Edward Lack, MD
Past President American Acadamy of Cosmetic Surgery
