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What is BOTOX® Cosmetic?
BOTOX® Cosmetic is a non-surgical procedure designed to relax the facial muscles that cause wrinkles in the brow, forehead, and around the eyes. BOTOX® Cosmetic injections also can be used to block chemical signals from nerves that stimulate sweat glands.
BOTOX® Cosmetic has become the most commonly performed cosmetic procedure, with over 1 million injections performed last year. BOTOX® should be injected at a physician's office by a trained certified provider with an intimate knowledge and understanding of the muscular anatomy of the face as well as the aesthetic implications of proper placement.
BOTOX® Cosmetic is a form of purified botulinum neurotoxin type A complex, produced from a culture of the A strain of bacteria called Clostridium Botulinum Type A. Although the Clostridium bacterium causes botulism, the BOTOX® Cosmetic extract does not. BOTOX® has been used safely for over 15 years in the treatment of muscle disorders of the eyes and voicebox, headaches, spasticity of the stomach, spasticity associated with cerebral palsy and other neuromuscular disorders, in addition to its cosmetic indications. It is approved by the FDA for the treatment of cosmetic wrinkles (of the brow) and severe axillary hyperhidrosis (excessive sweating of the underarms), as well as for cervical dystonia (muscular spasm of the neck), strabismus (eye muscle instability) and blepharospasm (eyelid ticks and spasms). All other usages that will be discussed are off-label (non-FDA-approved) uses of an FDA approved product.
Who is a candidate?
People with frown lines, forehead lines, neck muscle "bands", crow's feet, and smile lines around their eyes who wish to appear more relaxed, calmer and less tired are good candidates for the injection of BOTOX® Cosmetic. People who suffer from excessive sweating of their underarms may find significant relief by receiving BOTOX® injections.
People who should NOT receive BOTOX® Cosmetic are those with the presence of infection at the proposed injection site(s), those who have neuromuscular junctional disorders (such as myasthenia graves or Lambert-Eaton syndrome), or pregnant women.
What is BOTOX® Cosmetic like?
At your visit the area to be treated will be cleansed and you will be asked to use the target muscle(s): ie, frown, smile and look surprised. Your muscles will be marked with a washable pencil at the point of maximal exertion. This will pinpoint exactly the area that it is best to inject. You will then lay down and receive several small injections.
A very tiny needle is used to minimize discomfort. The vast majority of people find this to be a very tolerable procedure. If you have never had the injections before, a certain amount of anxiety is normal. We have found that people experiencing the procedure for the first time are greatly relieved afterward and find it was far easier than anticipated.
After the treatment you will be asked to make the facial expressions a few times over the next couple of hours, as this increases the uptake in the target muscles. Also, you will be asked to avoid laying down for 4 hours to avoid relaxation of those muscles for a prolonged period of time. Infrequently a small bruise may appear; the chance of this can be reduced by avoiding aspirin, Vitamin E and non-steroidal anti-inflammatory medications (such as ibuprofen) for a week prior to the procedure. Your appearance will look like you have had a few mosquito bites, but this resolves within 30 minutes-2 hours. Makeup may be applied immediately after the procedure and you will be free to go back about your daily routine. The treatment typically takes 10 minutes.
For treatment of hyperhidrosis, both underarms will be marked with a washable pencil to highlight the best injection points. An injection is placed in each mark. A treatment typically takes 20 minutes.
How does BOTOX® Cosmetic work?
BOTOX® Cosmetic blocks the chemical signal that causes certain facial muscles to contract. This causes the muscle to relax and the wrinkles that are caused by certain facial expressions to become smoother. It also is used to block the chemical signal that stimulates the sweat glands, reducing excessive perspiration.
What type of equipment is used?
No specific equipment, other than extremely small and precise needles, is needed and the treatments are performed right in the office.
What desired results can be expected?
The duration of improvement with the BOTOX® Cosmetic varies between patients. Treatment effects typically last 3-4 months for wrinkles and 5-6 months for hyperhidrosis. Repeat treatments need to be performed to maintain the effect. Sometimes after a year or two of regular repeat treatments less frequent injections (such as every 6 months) can maintain the effect. Repeat treatments that are performed too soon (less than 3 months) can lead to the treatment losing its effectiveness.
BOTOX® Cosmetic Before & After Pictures
Are there any negatives?
There is a minor degree of discomfort from the small-gauge needle that is inserted under the skin. There may be a slight burning discomfort as the BOTOX® Cosmetic is injected into the muscle.
There will be some swelling in the injection area for a couple of hours. Bruising occurs uncommonly. If it does, it can take 7-10 days to clear but can be camouflaged with makeup immediately following treatment.
Like any injection technique, an infection may rarely occur (less than 0.5% risk) and can usually be treated with topical or oral antibiotics. This has not occurred in any of our patients to date.
There is usually some asymmetry in everyone's face. Occasionally the BOTOX® Cosmetic accentuates this. This can usually be corrected with a small amount of subsequent BOTOX® Cosmetic.
An abrupt transition from a relaxed area to an active area can lead to "pointy" or "Spock-like" eyebrows. This can be alleviated by changing the technique on subsequent injections.
BOTOX® Cosmetic may migrate into nearby tissues, and may cause functional or esthetically displeasing effects such as brow ptosis (drooping of the brow), eyelid ptosis (drooping of an eyelid), diplopia (double vision), or lagophthalmos (weakness of eye closure). Fortunately, these side-effects are rare (as the BOTOX® Cosmetic effect wears off in a few months). There are also prescription eye drops that can mitigate these effects if they occur.
Occasionally BOTOX® Cosmetic can cause headaches, although it is often used for the treatment of migraine headaches. These are usually transient and occur because other muscles are contracting trying to make up for the ones that have been relaxed. There have been rare reports of severe headaches lasting up to 2 weeks after BOTOX® Cosmetic injections.
It is not recommended that anyone with a significant neurological disease, such as myasthenia gravis, or anyone who has experienced at any time temporary paralysis, loss of vision or double vision have this procedure. It is believed that persons with such conditions may be at increased risks for complications from BOTOX® Cosmetic or worsening of an underlying neurological disorder.
What happens after BOTOX® Cosmetic?
Following a treatment for wrinkles you will be asked to stay erect and not manipulate the area for at least 4 hours. You should use the muscles that were injected for a few hours after a treatment; that is, try to frown, squint, smile and raise your eyebrows. This will help the BOTOX® Cosmetic to be absorbed specifically into the muscles we are trying to affect. Your regular skin care regimen can be resumed immediately following a treatment, and make-up may be applied if desired.
Is there another way to get the same effect?
Alternative forms of treatment for wrinkles of the forehead and eyes include injectable fillers such as Restylane™, brow-lift with resection of the brow muscles or blepharoplasty.
Alternate forms of treatment for hyperhidrosis include prescription strength antiperspirant, anticholinergic oral medications, endoscopic transthoracic sympathectomy, and surgical resection of the sweat glands.
How is this different than other procedures?
BOTOX® Cosmetic works directly on the chemicals that cause muscles to contract (the source of wrinkles caused by muscles of expression) and stimulate sweat glands.
Can this be combined with other treatments?
BOTOX® Cosmetic may be combined with many other cosmetic treatments in our office. Many patients choose to undergo combination treatments in order to achieve the maximum aesthetic result.
What is the cost of BOTOX® Cosmetic?
Treatments depend on the amount of BOTOX® Cosmetic needed, and varies from patient to patient. We charge based on the area to be treated. All potential candidates must first undergo an in-person consultation. After the first BOTOX® Cosmetic treatment session, patients may directly schedule their repeat sessions. Please call our office to schedule a consultation.
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