Is it against the FDA to inject Botox anywhere that isn’t above the eyes?

Dr. Dean Kane Q & A shutterstock_85596703 Q. I want my “bunny lines” & “pebble chin” injected. Plus i have this thing where when i smile my nose pulls down making it look bigger. The person i made a appointment with told me that she cant inject Botox anywhere below the eyes but she could do my crows feet but thats it. I have never heard of that before and ive googled it and i cant find anything that prohibites it. She said she could loose her liseanse? Where can i go to get this done? A. ​Thanks for this question. Your concern is mirrored by so many patients and healthcare workers as well. The labeling and approval policies of the FDA are to safeguard the health of the American public. When a medicine or device is sent to the FDA for approval, it is an approval to market the drug/devices safety and efficacy for the indications the drug / device company request . ​ ​In other words, the FDA does not impose the use or labeling of the product. It is up to the manufacture to request approval for the unique uses of that drug/device from the FDA prior to its sale. ​ ​Botox is unique in that the manufacturer Allergan requested the FDA to approve it for 2 different on-label criteria; cosmetic and therapeutic. Allergan requested Botox Cosmetic to be used originally for improvement in glabella lines and recently for the crow’s feet or lateral canthal lines. Therapeutically, Botox is used in many places of the face, neck, vocal cords, GI tract, urinary tract, major muscles and elsewhere. ​ ​It is the same molecule and works by weakening the contraction of the muscle it is injected into. ​ ​A skilled and talented MD may use a drug/device for off-label applications if he/she can substantiate a similar safety and efficacy in its use. Therefore, cosmetically, a MD may inject other facial muscles to re-balance the facial expressions and creases or lines developed by the hyperactive result of a muscle on facial wrinkles. ​ ​So, yes, “bunny lines”, “pebble chin”, pulled nasal tip, “gummy smile”, neck bands and many other off-label uses are commonplace. Search carefully for a talented and skillful Board Certified Plastic Surgeon injector to provide you a safe, efficacious and pleasing result. ​ ​I hope this is helpful! All the best!   This information is not meant as medical advice. It is provided solely for education. Our practice would be pleased to discuss your unique circumstances and needs as they relate to these topics.
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