New wrinkles for Botox

Items on Jeff Wojciechowski's to-do list before a 2010 family vacation to Cancun included renewing his passport, shopping for beach wear, and getting a Botox injection.

The procedure wasn't to smooth out wrinkles. Instead, the injection went into his bladder muscle, to give the 63-year-old Fort Washington man a respite from incontinence that has plagued him since a 2006 construction accident left him paralyzed from mid-chest down.

Though Botox has become synonymous with the temporary elimination of wrinkles, what's less well known is its application across medicine.

In August, the U.S. Food and Drug Administration approved the use of Botox to treat loss of bladder control due to neurological conditions such as Wojciechowski's when oral medications cannot be tolerated. The approval means more patients will now likely receive the procedure because insurance will cover it.

The results typically range from slight improvements to a total elimination of incontinence episodes, said Patrick Shenot, a Thomas Jefferson University Hospital urologist leading an Allergan-sponsored clincal trial that Wojciechowski participates in.

The FDA has also approved Botox for chronic migraines, muscle stiffness in the arm, disorders of the neck and eye muscles, excessive sweating, and - its most recognized use as a cosmetic procedure - relaxing those deep vertical lines between the eyebrows.

Many people now ask for a more "natural" look from Botox, a more subtle relaxing of the muscle. They don't want to eliminate facial expressions as many did in the drug's early days.

Expanded uses have translated into more sales for companies that produce botulinum toxins such as Allergan. Botox and Botox Cosmetic make up 77 percent of the market share for botulinum toxins. Global sales were $125.3 million in 1998, but they topped $1.4 billion last year, split evenly between medical and cosmetic uses.

Botulinum toxin was the top minimally invasive cosmetic procedure - averaging $375 a visit - with 5.4 million treatments in 2010, according to the American Society of Plastic Surgeons. That was a dramatic increase over the 856,000 procedures in 2001.