Many wrinkles of the face are the result of muscle movement. These so-called “dynamic” lines commonly occur between the eyebrows (frown lines), around the eyes (smile lines), or on the forehead. Many people feel that their frown lines always make them look angry. Botox is commonly used to improve or eliminate these dynamic or muscle related lines.
What is BOTOX?
BOTOX is a therapeutic muscle-relaxing agent composed of sterile, purified botulinum toxin type A that is derived from the bacterium, Clostridium Botulinum. BOTOX is carefully and consistently produced in a controlled laboratory environment. BOTOX has been used medically since the 1980s in the treatment of blepharospasm (uncontrolled twitching or spasm of the eyelid). For the last 10 years, cosmetic surgeons have used BOTOX to reduce wrinkles associated with muscle movement.
How does BOTOX work?
BOTOX works at the junction of a nerve ending and muscle by blocking transmission of the signal from the nerve asking the muscle to contract. Thus, BOTOX eliminates or significantly reduces muscle movement locally where it was injected. There are no effects on muscles away from the site of injection. This relaxation of muscle movement is temporary, with effects lasting about 3 to 4 months. By relaxing or paralyzing the muscles that create facial lines, BOTOX prevents the formation of dynamic or movement-related wrinkles. If a wrinkle is present at rest (i.e. without muscle movement) but deepens with movement, then BOTOX will likely not completely remove that wrinkle; however, it will prevent that line from getting worse and may induce improvement over time as the muscle that creates the line is not used.
How is BOTOX administered?
First, your physician will evaluate your lines and determine which muscles contribute to their formation. Then, very small amounts of the BOTOX are injected into the muscles. Several injections with a very small needle are usually required with each session. The entire procedure takes about 5-10 minutes. After the injections, you may have mild tenderness, swelling, and redness for a short period of time (usually less than a day). Bruising may occur especially when treating around the eyes, or if you have been taking any aspirin or ibuprofen products, and usually resolves in 5 to 7 days. Usually the bruising is limited to small pinpoint bruises where the needle is inserted.
When will I see results?
Effects of BOTOX are seen 7 to 14 days after injections. If you have a deep wrinkle at rest (without muscle contraction), there may be no immediate change at all in that wrinkle; however, if BOTOX is used over time, worsening of the wrinkle is prevented, and gradual softening of the line is seen with maintained BOTOX treatments. Occasionally, touch-up injections of BOTOX are required for incomplete relaxation of the targeted muscle. Touch-up injections are given 10 to 14 days after the initial treatment. The cost of additional Botox injection is not included in the cost of the first session and is based on the amount of units used.
How long do the results last?
The muscle relaxation induced by BOTOX is not permanent. Most patients experience a slight return of muscle function around 3 to 4 months after injection, and this gradually returns to baseline. Some patients find that with repeat treatments (every 3 to 4 months), the treatment interval gradually lengthens with the effect lasting as long as 6 months.
What areas can be treated with BOTOX?
BOTOX is most commonly used to treat dynamic lines around the eyes, between the eyebrows, and on the forehead. BOTOX may also be used to treat lines around the mouth and for wrinkles or banding on the neck. Other uses include the corners of the mouth to create lift, chin wrinkles/dimples and using it to lift the outer portion of the eyebrow.
How will the areas feel after BOTOX injection?
Immediately after injection, the treated areas may feel slightly tender and sore or swollen. This is usually very minor and short-lived (several hours to 1-2 days). Once BOTOX has taken effect (4-7 days after injection), most patients note nothing unusual. There is no loss of feeling in the injected areas; however, when asked to move the treated muscles you will be unable to do so. Some patients report improvement in their headaches after BOTOX treatment to the forehead or between the eyebrows; however, BOTOX is currently not indicated as a treatment for headaches.
What are the alternatives to BOTOX?
BOTOX is the only therapy currently available to inhibit muscle movement. Wrinkles and sun damage of the face may be improved with a variety of cosmetic surgery techniques including laser procedures (ie: Fraxel), Restylane or Hylaform, superficial and deep chemical peels, and face-lifting procedures (rhytidectomy).