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Botox and traptox specialist in pittsburgh for headache, neck pain, TMj pain

Botulinum toxin (BOTOX)

Botulinum toxin injections are noted primarily for the ability to reduce the appearance of facial wrinkles. They're also used to treat conditions such as neck spasms (Cervical Dystonia and Thoracic Outlet Syndrome), arm or leg stiffness and contractures (Spasticity), eye muscle twitching (Eye Spasticity), excessive sweating (Hyperhidrosis), Trigeminal Neuralgia, and chronic migraines.

BOTOX injections use a toxin called onobotulinumtoxin A to temporarily prevent a muscle from moving. This toxin is produced by the microbe that causes botulism, a type of food poisoning.

BOTOX was the first drug to use botulinum toxin. Other products now include: abobotulinumtoxin A (Dysport), rimabotulinumtoxin B (Myobloc) and incobotulinumtoxin A (Xeomin), prabotulinumtoxin A (Jeuveau).  Each is a little different, particularly when it comes to dosage units, so they aren't interchangeable.

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Woman Receiving Botox

expert botox treatment for aesthetic and functional restoration

Why Botulinum Toxin

Botulinum toxin injections block certain chemical signals from nerves, mostly signals that cause muscles to contract. The most common use of these injections is for aesthetic purposes to temporarily relax the facial muscles that cause wrinkles in the forehead and around the eyes. 

Therapeutic Botulinum toxin

Botulinum toxin injections are also used to treat conditions that affect how the body functions:

  • Forehead/Eye wrinkles and Frown lines: Our most common use of BOTOX injection is for Aesthetic purposes.
  • Chronic neck or upper back pain (TRAPTOX): If you experience chonic upper back, neck, or scapular pain,  Botox injections may help.
  • Temporomandibular Disorder (TMD) - Pain eminating from the hyperfunctioning of the muscles that control chewing.
  • Chronic Migraine: If you experience migraines more than 15 days a month, Botox injections may help reduce headache frequency.
  • Occipital headaches/neuralgia:  Stabbing pain originating from the inflamed occipital nerves as they pierce the large muscled of the upper back and neck.
  • Trigeminal Neuralgia:  Botox has been shown to have some efficacy in reducing the severity of this disease process.
  • Thoracic Outlet Syndrome: Neck and shoulder pain with numbness or tingling of the fingers, especially with overhead activities, caused by compression of the nerves coming out of the neck, and at times caused by compression of spastic muscles of the neck and shoulder girdle.
  • Muscle contractures: Some neurological conditions, such as stroke or cerebral palsy, can cause your limbs to abnormally bend or contract. In some cases, these contracted muscles can be relaxed with injections.
  • Eye twitching (Eye Spasticity): Botox injections may help relieve spasticity or twitching of muscles around the eye.
  • Hyperhidrosis: In this condition, excessive sweating occurs even when the temperature isn't hot and you're not exerting yourself.
  • Cervical Dystonia: In this painful condition, your neck muscles contract involuntarily causing your head to twist or turn into an uncomfortable position.

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Cosmetic Botulinum Toxin 

Botulinum Toxin relaxes facial muscles, and as a result, it smooths lines and wrinkles.  This can be preventative in younger adults with a smaller dosage delivered.  It can also be used to treat deep lines in the face and neck, and to acheive certain specific cosmetic results such as neck line and facial slimming.

Our In-House Aesthetic Experts will give you a thorough individualized treatment plan, and since facial anatomy is unique, work with every patient to achieve their aesthetic goals.  Although dosage for treatment areas vary widely, this photo outlines a general idea of what to expect with your visit.

  • Treatment is relatively painless, and the results are usually apparent after 10-14 days.  Results last up to 4 months.
  • After treatment there is no downtime.
  • Tell us if you've had any type of Botox injection within the past four months. 
  • Tell us if you take blood thinners, as you may have to stop them a few days before the procedure to reduce the risk of bleeding or bruising.

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Woman Receiving Botox

traptox and cosmetic botox specialist in pittsburgh

How Much Will it Cost

For Aesthetic Purposes (Forehead/Eye wrinkles and Frown lines, etc):  Common areas of interest include: Forehead lines 10-30 units, Glabellar (Frown) lines 10-25 units, Bunny/Nasalis lines 5-10 units, Lateral canthal lines (Crows feet) 5-15 units, Dimpled chin 2-6 units.  Aesthetic pricing upon request.

No definitive serious adverse event reports of distant spread of toxin effect have been reported as associated with the use of botulinum toxin at the labeled doses.

For Therapeutic Botox (TMJ Spasticity, TRAPTOX = Neck/Back/Scapula Pain, Thoracic Outlet Syndrome, Chronic Migraine, Hyperhidrosis, etc.):  We can submit for Insurance authorization, prior to scheduling your injection.  

For those interested in paying out of pocket, here is our pricing for Therapeutic Botox:

  • Chronic Neck/Upper Back pain (TRAPTOX) - $600 (50 units)
  • Temporomandibular Joint Disorder (TMD) - $600 (25-50 units)
  • Occipital Neuralgia/Headache - $600 (50 units)
  • Chronic Migraine - $600-$1200 (50-100 units)
  • Trigeminal Neuralgia - $600 (50 units)

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Botulinum toxin injections are relatively safe, but possible side effects and complications can occur, including:

  • Pain, swelling or bruising at the injection site
  • Headache or flu-like symptoms
  • Droopy eyelid or cockeyed eyebrows
  • Crooked smile or drooling
  • Eye dryness or excessive tearing

Although very unlikely, it's possible for the toxin in the injection to spread in your body. Call your doctor right away if you notice any of these effects hours to weeks after receiving Botulinum toxin:

  • Muscle weakness
  • Vision problems
  • Trouble speaking or swallowing
  • Breathing problems
  • Loss of bladder control

Doctors generally recommend against using Botulinum toxin when you're pregnant or breast-feeding. And Botulinum toxin should not be used in people who are allergic to cow's milk protein.

Select your Doctor Carefully

Botulinum toxin must be used only under a doctor's care. It's important that injections be placed precisely in order to avoid side effects. Botox therapy can be dangerous if it's administered incorrectly. A skilled and properly certified doctor, like Dr. Spiess, can advise you on the procedure and help determine if it best suits your needs and health.

How you Prepare

Tell us if you've had any type of Botox injection within the past four months. Also tell us if you take muscle relaxants, sleeping aids or allergy medications. If you take blood thinners, you may need to stop taking them several days before your injection to reduce your risk of bleeding or bruising.

What you can Expect

  • Before the procedure
    Most people don't feel much discomfort during the procedure. But you may want your skin numbed beforehand, especially if your palms or soles are being treated for excessive sweating. We use a topical anesthesia to numb the area, and reduce discomfort.
  • During the procedure
    Botox injections are performed in the office. A thin needle is used to inject tiny amounts of botulinum toxin into your skin or muscles. The number of injections needed depends on many factors, including the extent of the area being treated.
  • After the procedure
    Do not rub or massage the treated areas for 24 hours. This may help prevent the toxin from spreading to a different area. You can return to your normal activities right after the procedure.
  • Results
    Botox injections usually begin working one to three days after treatment.  Depending on the problem being treated, the effect may last three months or longer.  To maintain the effect, you will need follow-up injections. 


Botulinum toxin may cause serious side effects that can be life threatening. Call our office or get medical help immediately (Emergency Room) if you have any of these problems any time (hours to weeks) after injection of Botulinum toxin:

  • Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life. You are at the highest risk if these problems are pre-existing before injection. Swallowing problems may last for several months
  • Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, and trouble swallowing 
  • Botulinum toxin may cause loss of strength or general muscle weakness, vision problems, or dizziness within hours to weeks of taking Botulinum toxin. If this happens, do not drive a car, operate machinery, or do other dangerous activities.

If you’re ready to explore whether you are a good candidate for Botulinum toxin therapy, reach out to Dr. Spiess’s office and schedule your first consultation today.

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