Botox   Botox    
Botox is the registered trademark name of the botulism toxin produced by Allergan. This is a natural protein produced by bacteria which has the physiologic effect of blocking nerve impulses to muscle, thereby blocking muscular contractions. It is currently the only muscle relaxant approved by the Federal Drug and Food Administration (FDA) for cosmetic use. The protein has been used for many years by many hunting tribes who recognized the benefits of paralyzing their prey by dipping the tip of their hunting arrows in this substance, also known as curare. Botox has been in use for medical purposes for approximately twenty years. Initially it was used in the fields of ophthalmology, for the treatment of blepharospam (tremor of the eyelids), neurology for the treatment of neuromuscular diseases, and in otolaryngology, for the treatment of
facial nerve disorders. It was during its use for facial nerve conditions, that physicians first realized that Botox improved the appearance of certain facial wrinkles. During this time is has proven to be an extremely safe product for both cosmetic and non-cosmetic purposes. To date, there have been no systemic reactions or allergies to Botox. Please take a look of our video


A discussion of Botox would be incomplete without an introduction to facial wrinkles. There are two types of facial wrinkles, dynamic and static wrinkles. Static wrinkles are those caused by a combination of gravity and loss of skin elasticity and are typically located in the lower third of the face. Examples of these types of wrinkles include the nasolabial folds (those that go from the nose to the corner of the lips) and marionette lines (those that go from the corner of the lips to chin). These wrinkles are not treated by Botox. Instead, they should be treated with "fillers". These are other types of injections that 'fill-in" the valleys caused by the wrinkles. The filler injections will be discussed in another chapter.

Dynamic wrinkles are those wrinkles caused by the activity of the facial muscles. Typically, these wrinkles are located in the upper third of the face and include the forehead wrinkles, the wrinkles in between the eyebrows, those around the eyes (otherwise known as "crows feet"). These wrinkles are best treated with Botox, which acts to relax the muscles that produce these wrinkles. Additionally, the vertical lines in the neck that run from the chin to the clavicle (platysma bands) can sometimes be treated with Botox, as they are also caused by muscular action of a neck muscle called the Platysma.

The typical patient who uses Botox is a middle aged woman or man who becomes concerned about the appearance of facial wrinkles in the forehead, the area between the eyebrow, and the lateral aspect of the eyes, especially with facial animation. The easy application of the substance via injection causes the disappearance or at least improvement of these wrinkles. Botox is considered a minimally invasive procedure for facial rejuvenation. As such it is a relatively simple outpatient procedure for the patient. There are no absolute contraindications to the use of Botox.

The single relative contraindication is the use of blood thinners, as this may allow for small hematomas (small blood clot) to form at the injection site. Botox can be combined with other cosmetic procedures for an improved appearance. The use of botox does not preclude surgical procedures, such facelift or eyelid surgery. In fact, the application of Botox after these procures will help to enhance the appearance. This is because those surgical procedures do not typically treat the wrinkles amenable to Botox.


Typically, Botox is an injection that is administered using small needles that are as thin as a hair. This allows for a relatively fast and painless injection. After the injection, the skin area is cooled with a small packet of ice to help reduce local swelling. The swollen area typically returns to normal in two hours. Rarely, a small hematoma (blood clot) may form. Application of cold compresses for the first twenty four to forty eight hours, followed by heat will allow for the
resolution in three to four days. These hematomas are more commonly seen in the "crows feet" area just to the side of the eyes, as this area has many small veins that can be inadvertently injured or "nicked" during the injection.

Usually, several injections are needed per area to be treated. Although the Botox injections are considered painless by most patients, there are certain techniques that some doctors use to minimize the discomfort even further. Some of these techniques include the application of a topical local anesthetic on the area that is to be injected. This is typically done for 30-60 minutes prior to the injections and it has the effect of numbing the skin, thereby reducing the discomfort of the injection.

Risks associated with Botox include a small skin reaction or blood clot (hematoma) at the injection site. Injection in an incorrect muscle can relax the wrong muscle and cause certain problems, such as a droopy upper eyelid, asymmetric elevation of the brows, or an asymmetry during smiling. The fact that Botox is not permanent is a great advantage when dealing with complications from the direct effects of the medication, as the complication will disappear as soon as the effects of the Botox wear-off.

It is therefore important that with all cosmetic-medical procedures, the physician have the correct training and experience to perform the procedure. Dermatologists, plastic surgeons, and facial plastic surgeons are all qualified to perform Botox injections. Equally important is the use of authentic Allergan-produced Botox. In the past there have been instances of practitioners using laboratory-grade botulism toxin for facial injections. The consequences were catastrophic. Patients should not be embarrassed to ask to see the bottle and confirm with the physician that he or she is using authentic Botox.

Patients typically can return to normal activity, such as work on the same day. However, patients are asked to refrain from exercise the same day. The effects of Botox start to become apparent in five to seven days. Occasionally small touch ups may have to applied in the second week to perfect the appearance.

Botox usually lasts about four to five months. As the patient continues to use Botox, the time between the treatments may some time increase. This may be because the patient subconsciously learns not to use the specific muscle treated. This in turn leads to improvement of the wrinkles with less Botox. This is also theoretically due to the muscle atrophy that eventually develops when these muscles of facial expression are not used for a prolonged period of time.

Besides the direct effect of Botox on certain muscles of facial expression, there are some secondary effects that have been noted. A secondary benefit of Botox when applied to the forehead is the elevation of the lateral aspect of the eyebrow by the unopposed action of the muscles on this area of the forehead (medical browlift). Although this effect is subtle and much less pronounced that when done surgically, the combination of the elimination of the forehead wrinkles and the elevation of the lateral aspect of the eyebrow can have a significant effect in the rejuvenation of the upper face.


Just a few days after your Botox treatment, you can expect to look much more refreshed and youthful. Whether targeting a single or several areas of concern, Botox treatments are a simple and effective way of accomplishing your goals of a more youthfull, rested and vibrant look. It is strictly up to you whether to repeat the treatment every several months to maintain the look, or whether to use Botox occasionally just prior to significant life events, when looking your optimal best is top priority.
The information provided above is for educational purposes only.  Individual results may vary.  A personal consultation with your plastic surgeon is the best way to gain information about your particular complaint, and about potential treatment options to address the same


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