Why did this woman almost die from botox?

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Front-page news: Botox injection nearly kills woman. Yesterday’s Hamilton Spectator trumpeted the news.

Does this mean that everyone who decides to smooth out a few wrinkles is risking a brush with death? Not at all.

Let’s look at what happened: Francine Giacomelli, a 25-year old woman who lived confined to a wheelchair because of severe cerebral palsy had botox injections into her thighs, hips and back to improve the function of those muscles and reduce pain.

Botox acts as a mucle relaxant, making a huge difference in conditions of severe muscle spasticity.

In this poor woman’s case, she experienced side effects from the spread of the botox so that it affected the muscles that control the eyelids and her swallowing function. She will gradually regain control of these muscles when the botox wears off but it could take months.

What about botox treatments for wrinkles?

There’s a vast difference between the way botox is used for cosmetic treatments and medical conditions.

Botox for cosmetic use is much more concentrated, meaning that it won’t travel or diffuse any distance from where it is injected. We are targeting tiny facial muscles and we want the botox to stay put.

For medical conditions, particularly those involving large muscles, the botox is diluted so that it will diffuse into the muscle. This is a good way of dealing with large muscles but it carries the risk that the botox will spread beyond the target muscle to other areas.

The dose that we use for a tiny little facial muscle is much smaller than what is needed for a big gluteal or quadriceps muscle.

When I did our Fabulous Five in the 10 Years Younger in Burlington program, the most that I put into any one woman (targeting every single facial muscle that I wanted to) was around 75 units. Not one of these ladies experienced symptoms of the botox spreading to another area.

In contrast, a lot of these medical treatments for severe spasticity start at 100 units and go up from there. I don’t know how many units this woman was given but an estimate for treating 3 large muscle groups, both left and right sides, would be a minimum of 120 units and probably a lot more.

Botox for cosmetic use in the face is very safe. There has never been a report of an allergic reaction or a death with true BOTOX® Cosmetic from Allergan.

Medical botox, on the other hand, carries risks related to the dose required, the size of the patient (the number of units per kilogram body weight is higher in children and small adults) and the part of the body being treated. However if you google botox and cerebral palsy, you will find countless reports of children and adults who experienced huge improvements in their lives, thanks to this new treatment.

I wish Francine a speedy and safe recovery.

By |June 26th, 2009|Categories: botox, wrinkles|3 Comments


  1. Take a better look June 27, 2009 at 7:15 pm - Reply

    What I saw when I googled was dangers of the use. What I would like to know is why Canada is allowing this to be used when the U.S. is not with good reason. Canada needs to step up.

  2. Dr. Rose Jeans July 2, 2009 at 9:59 pm - Reply

    Every treatment in medicine has risks and benefits. Part of the art and science of medicine is determining what is acceptable ratio for a particular condition.

    For some people with CP, the handicap caused by the spasticity is so severe that any hope of benefit is worth a degree of risk.

    I know of many laypeople who have worked hard to set up programs to provide botox for children and adults with muscle spasticity. Those folks would not be happy if the government shut down their programs.

    The benefits of botox can be life-changing for some of the people. I'm sure that Francine's doctors intended this degree of benefit for her. Francine's case made the news because it was unusual; the media doesn't bother to report everyone who has medical botox and gets good results.

    I think the best thing to do at this point is gather all of the data on both successes and failures of medical botox and try to figure out what factors made the treatment succeed or fail.

  3. Take a better look July 3, 2009 at 10:05 pm - Reply

    I believe that one failure is enough to pull the treatment using botox on individuals with cerebral palsy. At the very least patients need to be educated in the risks of using Botox as a form of treatment for C.P.. I am quite sure any parent of an individual with cerebral palsy that is using this form of treatment and could see what happened to Francine would surely agree it is not worth the risk. Francine only lives half the life of an average individual why risk reducing it to less then half.

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