Patients became desperate, as supplies of Botox were gradually consumed, forcing him to abandon patients who would have been due for their next injection. For a period of four months, American blepharospasm patients had to arrange to have their injections performed by participating doctors at Canadian eye centers until the liability issues could be resolved.In December 1989, Botox was approved by the U.S. FDA for the treatment of strabismus, blepharospasm, and hemifacial spasm in patients over 12 years old.Botox has not been approved for any pediatric use. It has, however, been used off-label by physicians for several conditions, including spastic conditions in pediatric patients with cerebral palsy, a therapeutic course that has resulted in patient deaths. In the case of treatment of infantile esotropia in patients younger than 12 years of age, several studies have yielded differing results. Cosmetic
The effect of BTX-A on reducing and eliminating forehead wrinkles was first described and published by Richard Clark, MD a plastic surgeon from Sacramento, California. In 1987 Clark was challenged with eliminating the disfigurement caused by only the right side of the forehead muscles functioning after the left side of the forehead was paralyzed during a facelift procedure. This patient had desired to look better from her facelift, but was experiencing bizarre unilateral right forehead eyebrow elevation while the left eyebrow drooped and she emoted with deep expressive right forehead wrinkles while the left side was perfectly smooth due to the paralysis.
Atrophic rhinitis is also associated with similar atrophic changes in the pharynx or larynx, producing symptoms pertaining to these structures. Hearing impairment can occur due to Eustachian tube blockage causing middle ear effusion. Etiology
Causes can be remembered by the mnemonic HERNIA:

Hereditary factors: the disease runs in  families
Endocrine imbalance: the disease tends to start at puberty and mostly involves females
Racial factors: white people are more susceptible than natives of equatorial Africa
Nutritional deficiency: vitamins A or D, or iron
Infection: Klebsiella ozaenae, diphtheroids, Proteus vulgaris, E. coli, etc. Autoimmune factors: viral infection or some other unidentified insult may trigger antigenicity of the nasal mucosa. Secondary atrophic rhinitis
Specific infections, such as syphilis, leprosy and rhinoscleroma, may cause destruction of the nasal structures leading to atrophic changes. Atrophic rhinitis can also result from long-standing purulent sinusitis or radiotherapy of the nose, or as a complication of surgery of the turbinates. The United Kingdom National Health Service has stated that "Most cases of atrophic rhinitis in the UK occur when the turbinates are damaged or removed during surgery". Some authors refer to as Atrophic rhinitis secondary to sinus surgery as the empty nose syndrome. Unilateral atrophic rhinitis
Extreme deviation of nasal septum may be accompanied by atrophic rhinitis on the wider side. Pathology
The ciliated columnar epithelium of the nasal mucosa is replaced by stratified squamous epithelium. Atrophy of mucosa, turbinal bones and seromucinous glands tends to occur, due to obliterative endarteritis and periarteritis causing decreased blood supply, hence the supplying area atrophies. Arrested development of paranasal sinuses.