Category Archives: FDA

Medical Botox vs Cosmetic Botox, differences?

BOTOX® Medical and BOTOX® Cosmetic

The BOTOX formulations are the same.  But the uses are different.  As the terms say, BOTOX medical is used for Medical purposes.  And BOTOX Cosmetic is used for cosmetic purposes.  There are many OFF-LABEL FDA uses of BOTOX, but here we explore the ON-LABEL uses for medical problems and cosmetic problems.

Medical uses of BOTOX
Sometimes called BOTOX THERAPEUTIC

More specifically, medical uses of BOTOX which are ON-LABEL FDA:

  • BOTOX for Overactive bladder symptoms
  • BOTOX for Urine Incontinence due to neurological disease
  • BOTOX for Headaches, specifically chronic migraines (15 or more days each month, longer than 4 hours each day)
  • BOTOX for upper limb spasticity
  • BOTOX for cervical dystonia
  • BOTOX for strabismus: an eye muscle problem
  • BOTOX for blepharospasm: an abnormal spasm of eyelids.
  • BOTOX for axillary hyperhidrosis
BOTOX Injection sites for Blepharospasm

The BOTOX injection site picture from Allergan.  BOTOX has been the main blepharospasm treatment since FDA approval in 1989.

BOTOX injection sites for Blepharospasm treatment.  Picture from Allergan.  BOTOX has been the main blepharospasm treatment since FDA approval in 1989.
BOTOX injection sites for Blepharospasm treatment.

Cosmetic uses for BOTOX

  • Glabellar lines = Frown lines between the eyebrows.  Botox was approved for usage for cosmetically reducing the appearance of wrinkles, temporarily between the eyebrows in patients between the age of 18 to 65 years old.  This was approved by the FDA in 2002.
  • Crows feet = Lines on the side of the eyes.  In September 2013, the FDA approved Botox for use in the crows feet area.  Botox for the Crows Feet – a entry in my Modesto Botox Blog

Again all the above mentions are FDA approved – ON LABEL usage.  There are other medical and cosmetic uses of BOTOX but they require a physician to determine the possibility of OFF LABEL-FDA use.

Differences in Dosages in Medical Botox vs. Cosmetic Botox

Usually many more Botox units are needed for medical indications than for cosmetic indications.

Disclaimer for this BOTOX webpage:

Unless you are directly looking at my actual crows feet and my glabellar lines, there is no establishment of a doctor-patient relationship.  Please see your own doctor’s wrinkles in person so that you can get medical advice.  Above is for information only – not to be considered any sort of medical advice.  Furthermore, looking at a picture or video of my crows feet and glabellar wrinkles does not count – it has to be a live and in-person viewing.


What is Botox FDA approved for cosmetically?

Glabella and Crows Feet

As of the writing of this Botox blog which is November, 23, 2014.  Cosmetic Botox on the face is FDA approved for use in the glabellar complex and the crows feet.  The glabellar complex is sometimes known as the “11’s” or the frown lines between the eyes.  It is made up of more than one muscle – thus it’s a complex of muscles.  And the crows feet, sometimes called fish tail, area of the eyes is the lateral wrinkles to the sides of the eyes.

How about other areas of the face for Botox Injections?

These two areas constitute the FDA approved areas for facial Botox in a cosmetic sense.  There are other areas on the face – in fact many other areas – which have not received FDA approval, but these have been commonly done for the past decade.  And Botox injections in these other areas of the face is considered off label FDA for Botox usage.

Getting Botox in Modesto, CA

Please consider visiting your Botox injector for one-on-one discussions.  If you are near us, consider visiting our Botox practice in Modesto, CA.  And if not us (Surgical Artistry), then there are these other places in Modesto to get Botox.  The Botox listing of injectors is not an endorsement; it is just a courtesy listing of other practices in Modesto who offer Botox.

Juvederm before and after picture for cheeks

Juvederm and Belotero Before and After
Juvederm ultra plus xc and Belotero injected via Cannula Technique by Dr. Calvin Lee

This is not done with Juvederm Voluma.  As of November 2013, I do not have experience with Juvederm Voluma.  Juvederm Voluma, however, is on it’s way to the office in Modesto, CA and I will soon have experience with this new dermal filler.  [update: I’ve used my first syringe of Juvederm Voluma on 12/24/13.  It was a very satisfying and positive experience.   I look forward to having even more experience with Juvederm Voluma.  I was able to use my 27g 1.5 inch cannula for Juvederm Voluma injections].

To improve my cosmetic dermal filler craft, I’m analyzing my past week. 95% of this result was performed with CANNULAS as an instrument of liquid implant delivery and a whole bunch of other secrets. There’s more that I would like to do with fillers for her, but my instructions were only to work on under eyes (tear troughs) and cheeks.

Background info:

Patient had lost a good deal of weight and it is showing in her face.  Options include face lift.  However, she chose to use Juvederm, Belotero, and Botox.  In the before picture she had Botox and Juvederm expertly done at another plastic surgery practice in our town of Modesto, CA.  I added upon that work to get the 13 day “after” picture using only Belotero and Juvederm.

Info about Brilliant Distinctions in our Modesto Cosmetic Injections practice.

Picture used with permission.  Thank you very much for letting me share this experience.  This is an off Label, FDA usage of Juvederm ultra plus XC for cheek fillers.

BOTOX is now approved by the FDA to treat Crows Feet

It’s official:  Botox approved by FDA for the cosmetic treatment of crows feet

Hot off the press:  Today:  9/11/13.  These are my views as a Botox injector in Modesto, CA.

Botox for Crows Feet? No, crows do not stop walking after treatment, and No, it’s not something that veterinarians can do for your pet bird.

Crows feet are those wrinkles around the corners of the eyes.  Sometimes these are even called “fish tail”.  Medical folks are somewhat inclined to call this area lateral canthal lines.  The original cosmetic approval of Botox was in 2002 for the treatment of glabellar lines which are cause by a complex of muscles involved in frowning between the eyebrow area.  Botox now has FDA approval for effectiveness and safety in the crows feet area after studying over 800 patients.


But haven’t doctors been treating crows feet for awhile?

Yes, doctors have been using Botox to treat crows feet wrinkles for many years.  This is called using it off-label FDA usage of Botox – and based on a doctor’s professional discretion.  FDA website.

How Long does Botox last in the Crows Feet?

Botox typically has an effect in my experience and Modesto based practice from 1 to 6 months.  But the results are usually dose dependent.  Meaning that the higher the dose, the longer it lasts.  But there are some minor factors which depend on Botox injection technique and patient factors – but for the most part it is dependent on the amount of Botox injected.

What’s all this about eyelid swelling after Botox?

There’s the risk of eyelid droop.  Then there’s the well known risk of eyebrow droop.  And there’s another complication of eyelid swelling.  The periorbital muscle is the muscle which causes most of the crows feet.  It has the function of closing the eye shut which also serves to squeeze fluid and edema out of the area.  Theoretically if too much Botox was injected into the periorbital muscle – obicularis oculi, it can hamper this mechanical function of squeezing out excess fluid and thus swelling can dwell in the eye area.  However, this is not to be confused with a temporary (few minutes) swelling that appears with the injection site of Botox.  These are small temporary blebs/bulges in the skin which appears as the Botox is injected in a liquid under the skin.  Confusing?  Yes, but these risks are unusual and injectors worry about them so the patients don’t have to worry about them as much.

How about competitors to Botox?  Do they have Crows Feet Approval?

Not yet, the other neuromodulators, which are Xeomin and Dysport do not yet have approval for crows feet.  It is up to the manufacturers whether they want to obtain this type of approval from the FDA.

How will this new FDA approval change my Botox practice?

  1. I think it gives the patients a greater feeling of safety for this product.  Thus I think it is useful.
  2. It becomes easier to pick a product which is FDA approved for the desired effect.  ie.  When deciding between the different neuromodulators available to the Modesto, CA, USA market:  Dysport, Xeomin and Dysport.
  3. I think we would see more advertisements coming from the Allergan company regarding crows feet Botox.  Allergan has historically been very good at advertising directly to the public.


Other Botox related links