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Facial wrinkles and lines of expression are the result of repetitive folding and creasing of the skin caused by activity of the muscles of facial expression. In many cases, these muscles may become hyperactive, leading to unwanted lines in the forehead area which may make us appear angry, or producing “crow’s feet” at the corners of the eyes, which may make us appear prematurely aged. In some areas, the preferred treatment may involve the use of an injectable filling material (Juvederm, Radiesse, etc.) to plump up the line; in other cases, elimination of the unwanted muscle activity may result in improvement of the unwanted line.

What is BOTOX®

BOTOX® is a medically-purified form of a natural bacterial protein (Botulinum Toxin ) which has been known for centuries to produce muscle paralysis. The therapeutic use of BOTOX® is a recent development, beginning in approximately 1980 with the use of the medication to treat certain conditions involving the eye muscles. It was discovered that certain wrinkle lines were temporarily eliminated when the BOTOX® treatment spread to involve the muscles which cause the wrinkles. Many surgeons and dermatologists began treating unwanted lines and wrinkles in their patients by injecting BOTOX® into the tiny facial muscles that create wrinkles, producing a temporary cosmetic paralysis of these muscles, which eliminates the ability of these muscles to contract and produce wrinkles. BOTOX® gained FDA approval for use in the treatment of unwanted wrinkles in the glabella (the frown lines between the eyebrows) in April, 2002. It is also commonly used “off-label” (without FDA approval) to treat “crow’s feet” wrinkles at the corners of the eyes, horizontal forehead wrinkles, tight muscle bands in the neck, and has recently received FDA approval to treat migraine headaches.

What should I know about the risks of BOTOX®?

Possible delayed side effects are temporary weakness of nearby muscles; in rare cases, eyelid drooping may occur, or patients may develop headache or flu-like symptoms. Since the wrinkle-reducing muscle paralysis effect of BOTOX® is completely reversible with the passage of time, any side effect is only a temporary condition. Rarely, patients may develop an immunity or tolerance to BOTOX®, and the treatments may become less effective. Your plastic surgeon will explain all potential associated risks at the time of your consultation.

How does BOTOX® work ?

Botulinum Toxin (BOTOX®) works by binding to the nerve endings, preventing the release of the chemical transmitters that activate the muscles. Blockage of these transmitter signals from the nerves to the muscles results in diminished or absent activity in the affected muscles, preventing them from contracting.

What to expect after your BOTOX® Procedure

The wrinkle-reducing action of BOTOX® on the treated areas requires a day or two before fully taking effect. Voluntary and involuntary activation of the muscles in the treated areas will gradually diminish and disappear after a few days to a week, and you will notice that the wrinkle-smoothing effects last for a couple of months or more. Muscular activity in the treated areas will gradually return generally within two to three months. To maintain your result, we recommend a repeat treatment at that time. Second and subsequent injections may have a longer duration of effectiveness. Immediately after the injection, patients may experience slight bruising or temporary pain around the injection area that quickly fades. Normal activities can be resumed immediately after leaving the office.

Am I a good candidate for BOTOX® Treatment?

As with any other medical and cosmetic surgical procedure, careful patient selection is important. You may be a good candidate for BOTOX® treatment if you have any of the following conditions:

* Moderate to deep vertical or oblique lines between the eyebrows
* Moderate to deep transverse or horizontal lines in the forehead
* Deep “crow’s feet” in the lateral eyelid area
* Certain types of muscle tension headaches caused by spasm of the forehead muscles

BOTOX® treatment may not be appropriate for you if you are pregnant or nursing, if you have certain neuromuscular diseases, or if you are taking certain medications (aspirin or anticoagulants, aminoglycoside antibiotics, quinine, or calcium channel blockers). You should understand that the treatments provide temporary effects, and that BOTOX® is not a substitute for surgical facial and forehead rejuvenation.

Your New Look After BOTOX® Treatment

In combination with a program of regular skin care, our patients find BOTOX® treatments to be an effective way to maintain a youthful facial appearance. By eliminating the facial lines we associate with stress and fatigue, BOTOX® treatment is another secret weapon we can employ to ward off the signs of aging.

Your plastic surgeon is committed to helping you to maintain the best possible results of BOTOX® treatment and all other facial rejuvenation and cosmetic surgery procedures, in order to keep you looking your best.

The BOTOX® Procedure

BOTOX® injection is performed without anesthesia because it is virtually painless. The injections are made using an ultra-fine needle placed directly into the muscles responsible for the unwanted expression lines. The wrinkle-reducing effects are not permanent, and injections may need to be repeated three to four times per year to maintain the improvement. Research has suggested, however, that long-term use of the injections leads to a longer duration of effect, although some patients may develop a tolerance or partial immunity to the effects of BOTOX® over time. Patients over the age of 65 may not experience such dramatic results, and, because each patient is unique, the degree or completeness of results may vary. BOTOX® is only useful in treating expression lines and cannot be used to repair sagging skin caused by aging (see FaceliftBrow LiftBlepharoplasty).

Are there alternatives to BOTOX®?

In the forehead area, Brow Lift with surgical division of the procerus and corrugator muscles responsible for the unwanted frown lines may provide permanent correction of the unwanted muscular activity producing these frown lines, eliminating or reducing the need for BOTOX® treatments. Similarly, division of the platysma muscle bands in the neck may relieve the appearance of tight cords in the neck which are sometimes effectively treated with BOTOX®. Other molecular variants of BOTOX® are being developed, in the hope of longer duration of effectiveness, or as alternatives for use in treating patients who may develop resistance to the toxin over time.

Frequently-Asked Questions About BOTOX®

Q: Can I use BOTOX® to treat the lines around my mouth?

A: No. Generally, BOTOX® is used only to treat muscular activity producing unwanted lines of facial expression. Since the lines around the mouth are a natural result of normal activities, such as talking, smiling, laughing, etc., these muscle actions should not be paralyzed.

Q: Can BOTOX® cure my headaches?

A: Certain types of headaches due to excessive forehead and facial muscle tension may be reduced or relieved by BOTOX® treatment. The exact mechanism of action is unknown. FDA approval was granted in October 2010 for treatment of migraine headaches with BOTOX®.

Q: Will my insurance carrier cover my BOTOX® treatments?

A: Except in rare cases, BOTOX® treatments are generally not covered by insurance without documentation of necessity by your neurologist or internist, and even with such documentation, the treatments are frequently denied as cosmetic in nature. If you wish to seek reimbursement from your carrier, our office will provide you with the necessary documentation.

Q: Can BOTOX® be used in other areas?

A: There is some evidence that BOTOX® treatments may provide temporary relief of hyperhidrosis (excessive sweating) in the palm of the hand or armpit areas. Insurance coverage may apply in these cases, if your primary physician can provide appropriate documentation. Treatment of these areas frequently requires larger quantities of the BOTOX® material than does treatment of unwanted wrinkles in the forehead or crow’s foot areas, and the cost of treatment is therefore greater. BOTOX® may also be used in some cases to treat tight muscular bands or cords in the neck area.

Q: Will my lines get worse if I stop using BOTOX®?

A: No. Your lines will gradually return to their appearance before you began treatment.