Botox

Botox (botulinum toxin) is FDA approved for use on the area between and around the eyes to decrease the lines caused by frowning and crow’s feet. It may also be used on lines on the sides of the nose (bunny lines) and lines around the lips. It is a chemical which temporarily paralyzes the muscles into which it is injected. The effect lasts from 2-4 months. It is relatively painless and rarely causes bruising. It is injected with a very small (30gauge) needle and the medication does not sting or burn. It takes 1 to 2 weeks to achieve its full effect. Botox works best on people whose creases are present predominantly with movement and resolve when at rest. These are called dynamic rhytids (wrinkles.) If the wrinkles are present both at rest and with movement, there will be less of an improvement. It is one of the first cosmetic procedures many people try since it is very effective and has a great safety profile, when injected properly by an experienced injector. The most common side effects are headache, respiratory infection, flu syndrome, temporary eyelid droop, and nausea. Botox should not be used if there is an infection at the injection site.

Botox is not suitable for injection anywhere in the face since paralyzing certain muscles can result in adverse reactions such as eyelid drooping, eyebrow drop, or drooling. An experienced injector is aware of areas where botox should not be injected and will avoid them. Oftentimes botox must be injected in multiple areas to achieve a natural effect.

Even with an experienced injector some undesired effects may occur temporarily, but can be fixed. Many people are aware of a “Mr. Spock eyebrow” which gives people a surprised look after a botox injection. This can occur because paralyzing the downward pulling muscles between the eyebrows to get rid of a frown, results in an unopposed upward lift by the forehead muscles. In most people this results in a nice arch to the eyebrow. In people with very strong forehead muscles it can result in eyebrows which are raised too much. This is easily corrected with the addition of very little botox above the eyebrows.

If botox is used only across the forehead and not between the eyes , there may be a scowling look since the muscles between the eyes pull downward, while the upward pull of the forehead muscles is paralyzed. For this reason, even if the forehead creases are the main problem, it may be necessary to inject some botox between the eyes to prevent an undesired scowl. Typically, after someone’s first injection, we have people return in two weeks to assure that they have an optimal result and do a touch up if necessary.