When we hear the term Botox or see it advertised, it’s usually tied to smoothing out facial wrinkles or keeping them at bay. But while beauty drives most of the market, that’s only part of the story. A range of important medical treatments also rely on Botox — and none of them has anything to do with chasing youth.

In 2024 alone, more than 9 million treatments were performed worldwide — up more than 26 percent since 2021. Close to 85 percent of users were women with an average age of 43. The number of men using Botox is also on the rise and is expected to reach 17 percent in 2025, up from 12.3 percent in 2018.

American ophthalmologist Alan Scott first used botulinum toxin A, a neurotoxin produced by a bacterium called Clostridium botulinum (brand name Botox) as an alternative to surgery, to weaken hyperactive eye muscles by paralyzing muscles and blocking specific nerves.

Scott had no idea how versatile the drug, then called Oculinum, would become in the field of medicine when he sold the rights to Allergan in 1991 for U.S.$4.5 million. At that time, it was used for uncontrollable blinking and misaligned eyes. Now worth billions, Botox is continually proving itself with a growing list of applications.

Like migraines that stop people in their tracks, preventing them from completing even the most basic daily tasks. These headaches impact more than a billion people worldwide every year.

Botox treatment was FDA approved for migraine treatment in 2010.

Injections are strategically placed around the head and neck areas to interrupt the pathway of pain connecting the central nervous system in the brain and spinal cord nerves. The neurotransmitters and molecules released during a migraine are interrupted by the botulinum toxin where the nerves and muscles connect.

This has been proven effective in those who suffer with chronic migraines, which means 15 plus headaches per month for a minimum of three months. It’s not for everyone, though. Users must be 18 years or older. It also doesn’t eliminate the headaches altogether but reduces the frequency by about 50 percent.

Botox is also used in patients with muscle spasticity, which can be the result of neurological disorders like stroke or cerebral palsy that cause damage to the brain, spinal cord or nerves that control muscle movement. Damage to the nervous system causes muscle stiffness or muscles to move involuntarily, because wrong orders are being delivered.

And if you’re a sweaty person, even when you shouldn’t be, Botox could be your new best friend.

Overactive sweat glands, a condition called hyperhidrosis, can cause profuse sweating, creating uncomfortable and often embarrassing scenarios.

Like many of the other conditions mentioned above, there is a surgical option — have those sweaty glands removed — but bodies need sweat to regulate body temperature, just not so much of it.

Botox injections to a localized site can block the signals that activate those overactive glands. This means your body’s sweat glands can continue to operate to cool you, without excess. The treatment takes about two weeks for maximum impact and can offer reduced underarm sweating by up to 90 percent.

This treatment can be applied to those with overactive bladders as well. This doesn’t mean that a little urine escapes when you sneeze — that would be considered stress incontinence. If your bladder is overactive, you might feel a sudden urge to urinate and struggle to control it or experience frequent urination day and night.

Good news: “A urologist can inject Botox into your bladder to treat urge incontinence or overactive bladder. This helps the muscles relax, which will give you more time to get to the bathroom when you feel the need to urinate,” according to the Mayo Clinic. Botox relaxes the bladder muscle to limit contraction.

This treatment can help the 17 percent of women and 3 to 11 percent of men who struggle with urge incontinence.

While these treatments are FDA approved, further uses in other off-label applications are sometimes approved on a case-by-case basis by the regulating body.

One of which is chronic pain.

It was once thought that these injections solely blocked the signals sent by nerves to the muscles, but new research tells us that’s not the only function — they also affect the electrical activity inside the nerves by calming overactive nerves.

Studies show that Botox reduces some nerve-related pain. In conditions like phantom limb pain, nerve damage pain and allodynia (when something that shouldn’t hurt hurts), tiny Botox injections result in the nerves becoming less sensitive.

So those things that shouldn’t hurt did so less, and it took more stimulus for those patients to feel pain.

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A 2024 review published in Toxins discusses future potential applications, and it seems while Botox has come a long way, there’s still a ways to go.

The product is being redesigned by mixing and matching the modules and modifying its parts to create versions that work faster and last longer, don’t cause muscle paralysis and go only to the nerves that cause pain. Researchers are also studying new ways to administer the medication other than an injection.

Smart Botox is en route with products like microneedle patches, slow-release gels, light-activated nanoparticles that can be switched on only when required and gene-delivery approaches that make cells produce tiny amounts of the active Botox part over time.

These applications are only in their infancy and hopefully will be available before we get too wrinkly, but big picture, classic Botox (BoNT/A and BoNT/B) is in the process of becoming more precise, predictable, longer and faster acting, less paralytic and potentially needle-free.

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