Injectables - Botulinum Toxin

Botox works by weakening the muscles into which it is injected. As facial muscles contract, the loose skin above those muscles wrinkle. By weakening the muscles, the wrinkles are reduced.

Botox is considered very safe overall when injected by experienced medical practitioners with minimal side effects.

The most common side effects are bruising due to numerous blood vessels under the skin as well as erythema or redness at the injection sites. Areas treated should not be rubbed or manipulated for 2-4 hours after the injections. This is to avoid the potentially rare side effect of the eyebrow or eyelid dropping as Botox can be pushed down into wrong muscles. It is also suggested not to exercise or go out in the sun for 24 hours as overheating can metabolize the Botox before diffusion is complete.

The cosmetic use of Botox is FDA-approved only for the frown lines, forehead lines, and crows feet. All other facial injections would be an "off-label" use. The most common areas of the face that are injected with Botox are the frown lines between the eyebrows, the forehead wrinkles, and the crow's feet area around the eyes. It can be injected into any muscle in the face or into other muscles in other parts of the body.

The effects for most people is 3 months. But everyone is different. Some people can metabolize Botox quicker causing it to last less than 3 months. For some it can last longer than 3 months.

As soon as your wrinkles return, you can have Botox again. There is no defined limit to the number of injections one can have. Research has shown that wrinkles are slower to return in many people when injected every 3-4 months.

Botox, itself, is not painful. The pain is associated with the needle-stick. Everyone’s threshold for pain differs. The smaller the needle, the better it is tolerated. You can have the practitioner numb the skin topically prior to injection.

Results will be seen anywhere from 2-4 days. The maximum effect occurs at about 10 to 14 days.

There is no defined limit to the number of injections one can have. However, the body's immune system is capable of developing antibodies to the Botox molecule which can render it ineffective at some point in the future.

As we age the fat pads as well as the underlying bone that support the skin waste away and along with gravity the skin sags. An experienced practitioner may then recommend fillers to add support in adjunct to Botox. The deeper the set wrinkle the less chance to make it “disappear”. It will only soften the appearance of the wrinkles which many still find very satisfactory.

This has been a hot topic of discussion with many believing that as muscles stop being used with regular repeated Botox injections they atrophy or weaken over time. This in turn means that the wrinkles created by such muscle contraction are less noticeable.

Botox takes about 2-4 days to start seeing results with maximum effect occurring days 10-14. As there is a high risk of bruising and swelling with many people taking blood thinners or other contributing factors that thin the blood, it is suggested to give 2 weeks to fully heal.

You can stop anytime you want without consequences. The wrinkles of your forehead will return to their original appearance when the Botox wears off and will not look worse than before you started treatment. You cannot become addicted to Botox, but the reason you may feel like "you can never stop" is because after seeing the disappearance of your wrinkles, you "never want to see the wrinkles" again.

Yes, Botox is frequently given in multiple sites at the same time.

Botox weakens or “puts to sleep” the muscles that moves the skin above them. Dermal fillers are injected directly into the wrinkle to plump up and smooth the skin surface. Fillers can also be injected into a region to add volume, lift, and support. Botox can last up to three months while some fillers can last up to a year.

It all depends on where and how much Botox is injected. Everyone’s forehead is a different size and the muscles can vary in strength and appearance. Many want their foreheads "frozen." Your desired Botox effects should be discussed with your practitioner. Many times you may need an enhancement visit in 2 weeks to put areas further asleep that stand out.

It is not unusual for patients who have had Botox injections in the forehead to experience a temporary headache depending on how many injections they've received.

Remember maximum effect occur days 10-14, so wait until then. Many times areas can still be awake or the lateral eyebrows may elevate as the muscle “recruits” to those areas. Don’t worry, many practitioners highly suggest returning in 2 weeks for an enhancement visit, lasting 10-15 minutes. Only a couple more injections are needed to put the rest of those active muscles asleep. If you still don’t like the results, there is nothing you can do but wait for the Botox to wear off in 3 months.

All drugs/medications, when taken at certain high dosage levels, can produce toxic effects. When used appropriately, Botox should not have a toxic effect on your general health, even after several treatments over several years. The amount required to effectively reduce the wrinkles on your forehead is far below any toxic level of the drug.