BOTOX® Cosmetic |
Before and After |
These last few years have seen some amazing advances in the field of facial rejuvenation. These advances have predominantly been in non-invasive techniques that are now available to rejuvenate the face. Women in the prime of their careers are not willing to wait until the age of sixty to have a facelift, but would like to maintain their youthful appearances while they are working and socializing. They wish to have these procedures with minimal down time and, at the same time, have consistently good outcomes. Of all the products that come to my mind, none have revolutionized plastic surgery as BOTOX® Cosmetic (hereafter referred to as BOTOX®) has. Such is the impact of this word that my nine year daughter reminded me that I should not forget to mention BOTOX® when I was preparing to talk about plastic surgery at Edmond Medical Center.
That was five years ago. Since then, BOTOX® has become the most frequently used treatment in the USA, with over two million procedures performed. In the year 2003, there was an increase of approximately 37% in the use of BOTOX® over 2002. In spite of this, I regularly see patients who have a very poor knowledge of what BOTOX® is, how it works, and what the possible complications can be. More importantly, most patients do not realize that BOTOX® is an adjunct treatment which should be used in conjunction with other procedures. Patients should have an evaluation of their face by a physician and discuss their long term goals over the next five years, rather than just use BOTOX® as a single modality to look younger. After all, shouldn’t you be spending more time with your physician about your long-term facial rejuvenation goals than your car dealer when purchasing a new car? I thought it would therefore be prudent to begin my first article informing you about BOTOX®.
How does BOTOX® work?
BOTOX® is essentially a purified protein that has been approved by the FDA for facial rejuvenation. Every nerve stimulates the muscles to contract, by releasing a chemical known as acetylcholine. BOTOX® essentially blocks the release of acetylcholine. This blockage is fortunately, or in some ways unfortunately, temporary and the nerve regenerates its ability to overcome the block. In simple words, BOTOX® temporarily paralyzes the muscles at the location where it is injected. Most wrinkle lines develop due to overactivity of the facial muscles. Therefore, they tend to lie perpendicular to the contracting muscles. BOTOX® temporarily paralyzes the muscles and therefore helps efface the wrinkles.
How long does this effect last?
This varies from person to person, but generally anywhere from 3-4 months.
Does that mean that I need to go for BOTOX® every 3-4 months?
Although you may see some muscle activity return, you need not rush back to your plastic surgeon for more BOTOX®. It is advisable to undergo the treatment twice or thrice a year. It can, for example, be done in October so it lasts through the holiday season, and once again in the spring to make you look rejuvenated during the spring/summer outing season.
Can I get addicted to BOTOX® ? Are there any long term adverse effects?
None of the medical studies have documented any addiction or long-term cumulative adverse effects from BOTOX®. Keep in mind that over 2.2 million BOTOX® related procedures have been performed. That is a staggering number.
Where can BOTOX® help me?
- Between the brows (glabella): this helps eliminate “frowning” by preventing the eyebrows from coming close to each other and depressing the eyebrows.
- Forehead wrinkle lines: This helps erase the horizontal lines on your forehead by paralyzing the frontalis muscles which elevate your eyebrows
- Crow’s feet around your eyes: This helps decrease the lines around the eyes, but not completely eliminating them.
- Around the lips: It can minimize but not completely eliminate the lines around your lips. You can also enhance the shape of your lips by using BOTOX® to make them pout further
- Chin: If you have a multi-dimpled or puckered chin, BOTOX® can make it smoother
- Neck or Platysma bands: BOTOX® can eliminate the bands over your neck, but unfortunately cannot help the loose skin or a double chin.
Can BOTOX® be used to shape my eyebrows?
By selectively paralyzing the muscles that depress the eyebrows and those that raise them, a physician can create an aesthetically pleasing arched shape for the eyebrow. It’s important to use a physician who fully understands the anatomy and the function of the muscles underneath your skin, so you do not have any inadvertent paralysis of muscles resulting in asymmetry.
I have heard that BOTOX® can be used to treat migraine, is that true?
Yes, at least two research studies in the plastic surgery literature have conclusively proven that BOTOX® can minimize the number of migraines and the intensity of these disabling headaches. One of the reasons why migraine develops is due to irritation of the nerves that traverse between the forehead and scalp muscles. By paralyzing the muscles, these nerves are not irritated and do not lead to the initiation of a migraine. The correct location of the migraine and the nerves is essential in treating migraine attacks.
Does BOTOX® make me lose my facial expressions?
No, if correctly administered by a physician with a detailed knowledge of the underlying muscles of animation of the face, forehead or the brow, they are never completely eliminated. You will appear rejuvenated but not paralyzed.
Can anyone be treated with BOTOX® or are there some patients on whom BOTOX® should not be used?
BOTOX® is not recommended if you have an infection at the site of the injection. Those with peripheral motor nerve disorders such as myasthenia gravis (a temporary but progressive paralysis of the muscles), are at an increased risk of complications. Certain antibiotics like gentamycin can interfere with the effect of BOTOX®. Always tell your physician whether you are pregnant or lactating. Make sure your physician takes a history of your medications. You should be asked to sign an informed consent which generally explains the risks and benefits of BOTOX®.
What can I expect at the doctor’s office?
Make sure you have an initial consultation with your physician and discuss your long- term goals. Your physician can fully discuss all the options available to you today and over the next few years. Once you have had a detailed discussion about this, BOTOX® is administered via a fine needle. Generally no topical anesthesia is given, but cooling with ice helps to ease any minor discomfort. The location of the injection is critical, as is the dilution and the dosage at each site. If overdiluted BOTOX® is administered at incorrect locations, desired results may not be achieved. It’s important to ask your physician the dosage injected at each site. Generally, four units are delivered at each injection site. Studies have shown that the effect of BOTOX® is dosage-dependent and less than an optimal dose can lead to early return of function of the muscles.
How soon can I see the result?
It generally takes 4-7 days for BOTOX® to have its full effect.
What are the possible side effects of BOTOX®?
Some patients suffer headaches, although studies have shown that this is unrelated to BOTOX®. One percent of patients develop eyelid drooping due to the effect of BOTOX® on the muscles that elevate the eyelid. This muscle is very close to the brows. Asymmetry of the eyebrows is possible, and if BOTOX® is administered on the forehead too close to the eyebrows, it can lead to both eyebrows sagging, making the eyes look smaller and narrower. This side effect will be temporary and can be corrected by paralyzing the muscles that depress the eyebrows.
Is it appropriate to have BOTOX® at a “BOTOX® party”?
Botox®, like any other procedure, requires an evaluation so that the patient is fully aware of the risks and benefits. An informed consent needs to be obtained from you prior to the injection. If you are under the influence of alcohol you certainly are not in an appropriate position to understand the risks and benefits of the procedure.
Who is the best person to provide you with BOTOX® treatment?
A qualified physician who is trained and certified in providing the BOTOX® treatment is the best person to provide BOTOX® treatment. More importantly, choose a physician who can fully evaluate you, make up a long-term plan customized for you, and educate you about both invasive and non-invasive procedures. It’s important to carefully consider your choice of physician before moving forward with even the first procedure. Your selection should be one of highest trust and comfort, as this should be your personal plastic surgeon for a lifetime of care.
Source: Plastic and Reconstructive Journal Supplement on Consensus Recommendations on the Use of Botulinum in Facial Aesthetics November 2004
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Common locations where BOTOX® is |
Before and After
| Before Pre-Op | After Post-Op |
| (All procedures performed by Dr Panchal. Individual results may vary) | |
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More Before and After photos are available in our office. |
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