Clear patient communication, understanding of anatomy key when using botulinum toxin

Key takeaways:

• Clear communication from the first consultation is important to establish the appropriate dose and pattern.
• A good understanding of anatomy is also key.

KOLOA, Hawaii — Proper patient communication is the key to achieving good outcomes when administering botulinum toxin, according to a speaker here.

“That first consult is really important,” Eli L. Chang, MD, said during a presentation at Hawaiian Eye 2025. “You have to explain to them, ‘This is a two-way street. You have to tell me what is happening because I am not going to see you for 3 months.”

Injection locations can differ from patient to patient, and the dose may vary as well, Chang explained. When consulting with the patient, it is important to clearly communicate that it can take multiple visits to find their appropriate dose and pattern, and finding that pattern requires their feedback. This feedback can include videos and photos taken by the patient.

Eli L. Chang

“I will inject you, you can take pictures and videos, and when you come back, tell me which spots you need more or [fewer] injections in,” he said.

A robust understanding of anatomy is also key for successful botulinum injections, Chang said.

“Pull out your medical book and figure out which muscle is going crazy and how you are going to get to it,” he said.

Three common conditions that can be addressed with botulinum toxin are blepharospasm, hemifacial spasm and facial nerve synkinesis following Bell’s palsy, Chang said. Another potential indication for botulinum toxin is treatment of neuropathic pain by inhibiting the secretion of pain mediators in the nerve endings and dorsal root ganglions.

When integrating botulinum into your practice, be sure to have alcohol swabs, bacteriostatic saline, insulin syringes, gauze and EMLA cream 5% (prilocaine and lidocaine, Aspen) on hand, Chang said.

“Our patients are adults: Write down the prescription for the EMLA cream, have them go to the pharmacy, give them their map and tell them, ‘Before you come in, apply this, and by the time you arrive we’ll do the injection and you will be out of here in 5 minutes,’” Chang said.

Published by:

Sources/Disclosures

Collapse

Source:

Chang E. Functional botulinum toxin: “Yes, it’s still used for functional indications.” Presented at: Hawaiian Eye 2025; Jan. 18-24, 2025; Koloa, Hawaii.

Disclosures:
Chang reports no relevant financial disclosures.

Read more about

This post was originally published on this site