Unexpected uses for botulinum toxin

Botulinum toxin is certainly a hardworking drug. Used in medicine for years, many of its benefits are far removed from aesthetics, despite our notable penchant for its wrinkle smoothing properties.

“There are so many uses for botulinum toxin, beyond simply softening frown lines or forehead wrinkles,” begins Cosmetic Doctor, Dr Raquel Amado. “It works by temporarily reducing the release of acetylcholine from nerve endings, so depending on where and how we use it, we can influence muscle activity, sweating and even aspects of skin quality.”

Here are some of its smartest—and perhaps most unexpected—uses that still impress doctors today.

TMJ symptoms 

Whether it’s excessive teeth grinding at night or just general stress and tension, our temporomandibular joint (TMJ) can become sore and tight from overactive muscles. This ultimately comes with its own set of problems, from splitting headaches to dental problems. Luckily, botulinum toxin can step in here.

“In these patients we can place botulinum toxin into the masseter muscles, and sometimes the temporalis muscles as well. These are some of the main muscles involved in chewing and clenching,” explains Dr Amado. “The toxin reduces excessive contraction of the muscle. The important thing is that we aren't trying to completely stop somebody being able to chew, we are reducing the excessive force that the muscle is generating. For the right patient, it can make a very noticeable difference to that feeling of tension and pressure around the jaw.”

Privately, this treatment costs around £300-£500, depending on the dose required and the strength of the muscles in question. It typically lasts three to six months.

Hyperhidrosis

Hyperhidrosis, otherwise known as excessive sweating, can be debilitating to have to cope with. It happens when the body produces more sweat than is necessary for temperature regulation, and usually occurs in the armpits. However, it can also affect areas such as hands, feet, face or elsewhere.

Dr Ahmed El Muntasar, GP and Owner, The Aesthetics Doctor, says that this is one of his favourite examples of using the drug to treat a concern, because “it demonstrates that botulinum toxin doesn’t just work on muscles.”

The doctor explains: “Sweat glands are activated by nerve signals involving acetylcholine. By injecting tiny amounts of botulinum toxin into the affected area, we can temporarily interrupt that signal, so the sweat glands produce significantly less sweat. For the right patient, it can make an enormous difference to quality of life.”

Privately, this typically costs between £400 and £700 (it may also occasionally be covered by the NHS), and lasts around four to six months. 

Twitching

Involuntary twitching in the muscle fibres—medically referred to as fasciculations—in areas of the body like the legs, can impact quality of life. “However, botulinum toxin can be used medically for certain persistent focal spasms and abnormal involuntary muscle activity,” notes Dr El Muntasar.

“It reduces the communication between the nerve and the targeted muscle, reducing unwanted contractions while leaving surrounding muscles functioning normally when appropriately dosed.”

That said, El Muntasar explains that it’s important for someone with unexplained or persistent fasciculations to be medically assessed first, as treatment depends on an underlying diagnosis. 

Cost is highly dependent on diagnosis, area, and whether you access treatment privately or through the NHS. Results last three to four months.

Chronic migraine

Those who suffer continuously with migraines can also benefit from the wonders of botulinum toxin—but things work a little differently, says Cosmetic and A&E Doctor, Dr Christine Hall. “In this case, you’re not simply trying to relax muscles; botulinum toxin also affects the release of certain chemicals involved in pain signalling, which is thought to be part of why it can reduce migraine frequency.”

Explaining how the treatment works, she comments that it “involves multiple small injections across the forehead, temples, scalp, neck and shoulders and is repeated at regular intervals.” It tends to last around 12 weeks  and can cost £500-£800, although some may be eligible through NHS programmes.

Overactive bladder

Perhaps one of the most surprising uses of the drug is for an overactive bladder. “Botulinum toxin can actually be injected into the wall of the bladder by a urology specialist to treat certain patients with an overactive bladder or urinary incontinence,” explains El Muntasar.

“The bladder contains a muscle called the detrusor. In an overactive bladder, this can contract involuntarily, creating urgency, frequency and sometimes leakage. Botulinum toxin temporarily reduces excessive signalling to that muscle, allowing the bladder to relax more effectively and potentially increasing the amount of urine it can hold, before someone feels an urgent need to go.”

This is a specialist procedure, typically performed through the NHS for patients who meet the appropriate criteria. Private appointments are available, but can vary in cost considerably. Results last several months before the bladder needs ‘topping up’.

Traptox

Last but by no means least is ‘Traptox.’ Often referred to on social media, this sees botulinum toxin injected into the upper trapezius muscles (the muscles running from your neck across your shoulders.)

“The thinking is that like masseter botulinum toxin (where a muscle is working excessively), reducing its [said muscle’s] activity may reduce tension and pain,” explains Dr Hall. “It can be revolutionary in terms of reducing shoulder tension and pain.” She says it may also “reduce the size of the upper traps to make the neck and shoulders look more elongated and angular.”

Still a niche treatment—and one only recommended in specific cases—this procedure costs anywhere between £300-£700 privately. It usually works for three to six months at a time.