Who is a candidate?

People with frown lines, forehead lines, crow’s feet, and smile lines around their eyes who wish to appear more relaxed, calmer, and less tired are good candidates for the injections of BOTOX® Cosmetic.  People who suffer from excessive sweating of their underarms, palms, and feet 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 multiple sclerosis, myasthenia gravis, 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 it is best to inject.  You will then receive anywhere from 5-20 injections.

A very tine needle is used along with cold air and/or ice packs 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 that it was far easier than anticipated.  The treatment usually takes 10 minutes.

For treatment of hyperhidrosis, a starch-iodine test will be performed to determine your sweat pattern and then marks will be made with a washable pencil to highlight the best injection points.  An injection is placed in each mark.  Cool air is blown in the area during the treatment to minimize discomfort and postoperative swelling.  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?

We only use FDA approved BOTOX® Cosmetic purchased directly from the manufacturer Allergan.  We use small, fine needled syringes to maximize comfort and precision.

What desired results can be expected?

Results for treatment with BOTOX® Cosmetic depend on the area being treated, but may include the following:  resolve of frown, forehead, and crow’s feet wrinkles; a more relaxed alert looking appearance; as well as a potential lifting of the brow and opening of the eyelid.

The duration of improvement with BOTOX®  Cosmetic varies between patients.  Treatment effects typically last between 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.

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 being injected into the muscle.  There will be some swelling in the injection area for a couple of hours.  Bruising occurs uncommonly and can take up to 7-10 days to clear, but may be camouflaged with makeup immediately following treatment.

Occasionally BOTOX® Cosmetic accentuates the natural asymmetry in most people’s faces or causes an abrupt transition from a relaxed area to an active area leading to pointy looking eyebrows (“Spock-effect”).  Either of these can be correctly with a small amount of additional BOTOX® Cosmetic.

BOTOX® Cosmetic may migrate to nearby tissues, and may cause functional or esthetically displeasing effects such as brow ptosis (drooping of the brow), eyelid ptosis (drooping of the eyelid), diplopia (double vision), or lagopthalmus (weakness of eye closure).  Fortunately these side effects are rare (as the BOTOX® Cosmetic effect wears off in a few months) and temporary.  There are also prescription eye drops that can mitigate these effects if they occur.

Often used successfully for the treatment of headaches, occasionally BOTOX® Cosmetic can cause 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.

Anyone with neurological disease or history of temporary paralysis, loss of vision, or double vision should not have this treatment.  It is believed that these increase the risks of complications with BOTOX® Cosmetic or worsening of an underlying disorder.

What happens after BOTOX® Cosmetic?

Usually you will have a mosquito-bite looking area for 20-60 minutes which resolve without a trace.  Occasionally little red areas at areas of injection appear but resolve within a couple of days.  It may help the BOTOX® Cosmetic to be absorbed more quickly if you make the facial expressions we are trying to relax (ie:  frown, raise the eyebrows, smile/squint) a few times over the couple of hours after the injection.  Try not to fall asleep or relax in a recumbent position as this may rarely lead to some diffusion or spreading of the BOTOX® Cosmetic to adjacent areas.  Your regular skin care regimen can be resumed immediately following a treatment, and makeup may be applied if desired.

Try to avoid aspirin containing products or high-dosage vitamin E supplements for 48 hours unless medically necessary.  Avoidance of these for 10 days prior to the procedure is recommended to avoid bruising.  The vitamin E contained in a typical multi-vitamin is fine to take during this time.

Is there another way to get the same effect?

Alternative forms of treatment for wrinkles of the forehead and eyes include injectable fillers, brow lift with resection of the brow muscles, blephroplasty, laser resurfacing, tissue tightening, topical muscle relaxers, and topical therapy.

Alternative forms of treatment for hyperhidrosis include prescription strength antiperspirant, anticholinergic oral medications, iontophoresis, endoscopic transthoracic sympathectomy, and surgical resection of the sweat gland.

How is this different than other procedures?

BOTOX® Cosmetic works directly on the chemicals that cause the muscles to contract (the source of wrinkles caused by muscle 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 vary from patient to patient.  We charge based on the amount of units that are utilized.  This is individualized for each person (men usually need more than women, because their muscles are larger).  Treatment for hyperhidrosis may be covered by some insurance plans.  Please call our office to schedule a consultation.