Botox® is a relatively new procedure using Botulinum Toxin which was developed to treat the visual signs of aging by reducing or removing wrinkles.  The procedure is considered a safe, effective way of treating aging skin.  Common areas for Botox® injections include horizontal forehead furrows, vertical lines between the eyebrows and "crow's feet" around the eyes.  Botox® has proven to be the best non-surgical form of facial rejuvenation and is capable of producing phenomenal improvements in your appearance.

Reasons for Considering a Botox Treatment:

• Excessive facial wrinkles.
• Large wrinkles or furrows in your forehead.
• Small wrinkles or “crow’s feet” around your eyes.
• A vertical “frown line” between your eyebrows.

Q & A

What is BOTOX?
BOTOX is a temporary muscle blocker that is produced by bacteria. Modern science has been able to purify and carefully standardize the amount available for injection. It is packaged “freeze-dried” into glass vials that must be kept refrigerated up to the time of its use. Sterile saline solution (actually harmless salt water) is added to the bottle prior to injection. Once mixed, it can be safely stored in the freezer for up to 10-14 days and re-used. Using a small needle the mixture is injected just below the skin surface into a particular facial muscle.

How does it work?
Botox works by temporarily blocking nerve impulses that normally tell our facial muscles to contract or squeeze. The result is that wrinkles caused by the muscle movement can smooth out or disappear altogether as the result of this blocking effect. Not only will wrinkles improve after BOTOX injection, but those that are already present will not grow deeper over time. BOTOX is thus not only a good treatment, it is also good prevention.

Does Botox work on all wrinkles?
Wrinkles on the face result from the normal aging process of the skin. The formation of these wrinkles is accelerated by sun exposure or cigarette smoking. If the wrinkles are present with the face at rest, they are known as static wrinkles. BOTOX alone does not effectively treat these types of wrinkles, but can improve them somewhat. BOTOX is effective on other wrinkles known as dynamic wrinkles. These result from the contraction, or squeezing, of our facial muscles. The wrinkles they typically respond well to BOTOX are the between the eyebrows (frown lines), the sides of the eyes (Crow’s feet), and across the forehead. Long standing wrinkles or deep furrows will only improve slightly with treatment. However treatment can prevent them from becoming worse. BOTOX can be effective in treating string-like muscular bands on the neck also.

How is BOTOX measured?
It is important to understand that BOTOX is measured and administered in units with each vial containing 100 units. Since each office injects a different amount of sterile water to the vial it can be either concentrated or dilute. This means that the volume, or amount of fluid injected, is not the same as the number of units given. By using units as the “measuring stick”, both the patient and practitioner know how much has been given for a particular treatment. In addition, these units should be the basis for a fee quote given to you by your practitioner. Otherwise, you will not know how much BOTOX you are actually paying for. If you doctor charges for each “area” treated, ask how many units he typically uses for each “area”.

How much BOTOX is necessary for treatment?
A typical treatment amount for the area between the eyebrows is about 20-30 units, for the forehead about 30- 40 units and for the Crow’s feet about 10-20 units on each side. In general, women require fewer units than men who have much thicker and stronger muscles. Over time less BOTOX is required to treat a given area since the muscles can atrophy or shrink as a consequence of initial treatment. .

How long does BOTOX last?
The wrinkle smoothing effect usually does not become apparent until 4-5 days following the injection. Since BOTOX acts by blocking the movement of muscles, the most significant improvement will appear in those wrinkles that are most apparent with facial animation. BOTOX is not permanent and its effect will wear off with time. It can last up to 6 months before requiring re-treatment with the average effect lasting 3-4 months. If “follow-up” treatments are administered at the first sign of returning wrinkles, they tend to last significantly longer with each subsequent BOTOX session. In addition, less BOTOX is usually needed with subsequent treatments due to atrophy (shrinking) of the muscle.

Can Patients have an allergic reaction to BOTOX? This is theoretically possible, but has not been reported in the medical literature. Patients who have had repeated injections of BOTOX have circulating antibodies against the foreign protein of the toxin. Again, this does not create problems, but can create a situation in which more BOTOX is needed to obtain the desired effect.

How many times will I have to be stuck by the needle? This depends on the area injected, and who does the injections. At Aesthetic Surgery Associates, we able to limit the number of needle sticks in the frown lines to three at most. The crow’s feet usually require three of four per side, and the forehead frequently needs eight or more. Topical local anesthetic creams can be used to reduce the discomfort, but sometimes do not work well in these areas. Simply cooling the area with ice reduces pain significantly

What are the complications of treatment? The most common complication is bruising due to the needle stick in an area rich with veins and arteries. Bruising typically resolves in days, and can be easily covered with make-up if it occurs. Problems can occur if BOTOX gets into muscles other than those intended. For example, if it diffuses into the muscle that raises the eyelid, the lid can droop and cover the pupil – a condition called lid ptosis. If BOTOX gets into the muscles that control movement of the eyeball, it can cause double-vision. These symptoms can be troublesome, but usually resolve without treatment in two to three weeks. Rarely, the same muscles on opposite sides of the face can respond differently and asymmetry can result with facial movement. Similarly, if the muscles that pull the eyebrows down are paralyzed to improve frown line and crow’s feet, wrinkles across the forehead can appear worse due to unopposed brow elevation resulting from “knocking out” the muscle that depress the eyebrow.

Are there any other desirable effects of BOTOX treatment? With time, our eyebrows tend to descend due to the action of the muscles that cause frown lines and crow’s feet. After BOTOX treatment, many patients note that they have a “softer” and more well-rested look due to elevation of the brow position. This has been termed a “chemical brow lift” in the medical literature. As mentioned above, BOTOX also prevents the progression of wrinkles with time.

Additional information can be found on the following web sites:
plasticsurgery.org

To arrange a consultation, please call Aesthetic Surgery Associates at (254) 526-5106 or toll-free 1-866-232-0469