Botox® is a  procedure using Botulinum Toxin which was developed to treat the visual signs of aging by reducing wrinkles.  The procedure has even less risks than most types of cosmetic surgery or skin resurfacing.  Common areas for Botox® injections include vertical lines between the eyebrows and "crow's feet" around the eyes. 

Reasons for Considering a Botox Treatment:

• Small wrinkles or “crow’s feet” around your eyes
• A vertical “frown line” between your eyebrows
• horizontal forehead wrinkles
• downturned corner of mouth

General Procedure

The procedure works by altering the facial muscles beneath the skin that are related to wrinkles.  A cream with local anesthetic will be placed on your skin prior to treatment.  Typically a small amount of Botox® is injected into the muscle that causes the wrinkle.  Botox® works by blocking the impulses from the nerve to the facial muscles, thereby relaxing them.  The result is the underlying facial muscles relax and the skin begins to smooth out over a period od months.  The  Botox® itself only lasts about three months, but many people can use it to help them break the habit of frowning, and this gives long-lasting results.

Recovery Process

Patients generally return to their normal activities immediately after the procedure.  Patients should avoid engaging in heavy physical exercise, or rubbing the injected area for at least 24 hours.

The following informational article was published to inform other types of doctors about Botox.

Botox^R

Why is Botox^R becoming popular, and how does it achieve improved facial aesthetics? When and how can it be used for the lips, chin, and elsewhere on the face?

We all learned about the protein exotoxin of Clostridium Botulinum in Microbiology. It enters presynaptic cholinergic motor (and other) nerve endings, and it inhibits subsequent release of the neurotransmitter acetylcholine. There are seven distinct toxins produced by Clostridium botulinum (A, B, C, D, E, F, and G). Botox^R is the sterile, lyophilized crystalline form of Botulinum toxin A (BTX). It is produced by Allergan, and it is supplied in frozen vials containing 100 units each. It is reconstituted when the injecting doctor adds sterile non-preserved normal saline. The protein begins to denature when it is reconstituted; it is inactivated more rapidly if it is not reconstituted exactly according to the manufacturer’s instructions. The contents of one vial is below the estimated dose for systemic toxicity for a person weighing over six kilograms. (A 150 lb. adult Is 70 kilograms.) It is almost entirely taken up by local tissues at the site of injection.

I think that the best cosmetic application of BTX is to diminish the vertical “frown lines” that many adults develop between their eyebrows. Many people (including some doctors) have an unconscious habit of furrowing their brow during mental concentration. Unfortunately, the lines created by this habit can give the facial appearance of concern, worry, or even anger. If a person’s mood is misinterpreted pejoratively, it can interfere with optimum communication.

Three to five units of BTX injected into or slightly above each end of the corrugator supercilii muscle results in a paralysis (or paresis) of this muscle complex. The effect peaks about three days after injection, and it lasts approximately three months. In rare cases it can last up to a year. The amount necessary is roughly proportional to the bulk of muscle being treated. During the months of paralysis, the expression lines gradually diminish.

After one or two such sessions there can be an added bonus: the patient may be able to learn to control the frowning habit. When the effects of BTX on the corrugator muscles begin to diminish, the patient will be much more aware of each frowning motion than ever before. Empowered by awareness, many people can now “tell themselves” not to frown.

A few of the people who have vertical lines in their upper and lower lips have a habit of pursing their lips. In these select cases, BTX can be injected subcutaneously in very small doses in several places in each lip in order to diminish this habit. Caution is advised when using BTX near muscles which control lip movements, as unnatural expressions can result. (Naturally, smokers would also have to quit smoking.) I have not had adequate experience with this application to know what percentage of these patients can break their lip-pursing habit. BTX is one of several options for selected patients who have optimum anatomic positioning and contour of their anterior teeth, yet persistence of vertical lip wrinkles.

Small doses of BTX can also be injected in the “crowsfeet” areas lateral (not inferior) to the orbits, to diminish the effects of the lateral orbicularis oculi. This can allow the wrinkles in this area to diminish. And it does not seem to noticeably interfere with natural expression when performed properly. But, since such wrinkling naturally occurs during smiling, the wrinkles reappear when the BTX effect diminishes.

BTX can be used on the forehead to diminish the transverse forehead wrinkles resulting from chronic frontalis muscle activation. Multiple injections are necessary, as its effect will only diffuse a little over a centimeter. Some people habitually raise their eyebrows to compensate for eyelid ptosis or excessive impingement of skin on their eyelids . BTX would make these individuals look worse. Additional caution is necessary laterally, where there is less vertical eyebrow support. A surgical forehead lift is a better long-term solution, but it is a significant surgical procedure.

BTX can be injected into bands of platysma muscle in the neck, but accurate dosing is a problem, and important subjacent musculature can be affected. In addition, individuals with such neck bands usually also have excess skin, which is best removed with a facelift.

Sometimes, a temporary improvement in appearance through the use of BTX (or an injectable filler) is all that is desired. I have helped patients a number of times when they wanted to look better for their daughter’s wedding pictures, for example. BTX would be administered at least two months ahead of time in this circumstance. Even when patients highly appreciate the effects of BTX, it is not realistic to plan BTX treatment every three months indefinitely.

Although the following is not related to cosmesis, it is of interest that some patients who receive BTX for frontalis or corrugator hyperfunction have a significant diminution in recurrent headaches. I have used BTX to attempt to help a number of patients with headaches which have been refractory to medical therapy, but it is only occasionally successful in this group of patients. BTX seems to be more helpful in alleviating common tension headaches. Transient headache can also be a side effect of BTX.

BTX has been used to improve a large number of muscle dystonias and spastic conditions, including abnormal mentalis muscle spasm which can occur with lip pursing (whistling or kissing) in some individuals. People with gustatory sweating (Frey syndrome) are reliably and significantly helped by BTX.

After treatment, patients are encouraged to use the treated muscle (frown, etc.) for several hours, as this seems to increase local uptake. Massage is contraindicated in most situations, as it could spread the BTX into muscles which are not desired to be paralyzed.

It is interesting that BTX is actually relatively safe, and its widespread use has not been associated with many problems. Because it is mixed with saline, which is slightly acidic, it is rather painful to receive the injections. Minor bruising from the 30 gauge needle is not rare, but it clears quickly. Significant allergic reactions are quite unusual, although some patients seem to have diminished effects, related to antibody production, after several injections. Some individuals may have an allergic reaction to the albumin which is crystallized with the BTX. When it is used near the orbit, possible side effects include diplopia or ptosis. Neuromuscular conditions with weakness, such as myasthenia gravis, or the use of drugs which interfere with neuromuscular transmission (aminoglycosides), are among the contraindications to the use of Botox^R. It is not recommended during pregnancy or lactation.

The relative safety and efficacy of this minimally invasive procedure have carved a niche for the use of very small amounts of this well known toxin for aesthetic purposes.