Botulinum Toxin

Your physician will utilize very fine needles to inject Botox® into specific facial muscle groups. Botox® is extracted from a bacteria called Clostridia botulinum which paralyzes muscles and had been used until recently for disorders of the eye muscles. Today, primary treatment sites include between the eyebrows, over the forehead, and around the eyelids in order to paralyze the corrugator and procerus muscles, the frontalis muscles, and the orbicularis oculi muscles respectively. Less popular treatment sites include the chin, upper lip, and neck in order to paralyze the depressor anguli oris, orbicularis oculi, and platysma muscles respectively. Typical units of Botox® required per site have been compiled for your convenience below:

Botox® is currently being used to eliminate facial wrinkles by paralyzing certain muscles used for portraying expressions. Most people are eligible for this procedure unless you are unfortunate to have allergies to eggs or to albumin, a protein found in most organisms. Other exclusions include pregnancy or patients with rare muscular disorders. The effects of Botox® are readily visible within several days but may take up to 1 week. Also, bruising may last for up to 2 days, so you may want to avoid any large social events for a few days.

In general, it is beneficial to obtain Botox® injections prior to acquiring static wrinkles. Static wrinkles refer to the stubborn wrinkles that persist even when you are not actively expressing. Once these wrinkles set in, Botox® can only prevent them from getting larger; in contrast, if you start Botox® before the static wrinkles take hold, then you can avoid these wrinkles all together.

Since Botox® injections can result in slight bruising, it is wise to schedule your treatment several days prior to any social events. In addition, it is wise to avoid any blood thinners such as aspirin or herbal products for two weeks prior to treatment. For patients susceptible to migraine headaches it is advisable that they take their prophylactic headache medications to avoid post-injection headaches.

Since Botox® treatment requires only superficial injections, no preparation is required by clients. Most clients tolerate the treatment during their lunch hour and can return to their daily routine without any delays. Following their Botox® treatments patients are advised to avoid lying down for approximately 6 hours and avoid any exercise for one day in order to avoid migration of the Botox® away from the injection site.

Clients can expect a softening and/or elimination of wrinkles caused by certain facial muscles of expression. The most common wrinkles treated include: a) forehead wrinkles created by raising of the brows; b) wrinkles between the eyebrows caused by squinting; and c) wrinkles around the eyes (crows feet) caused by smiling. Most clients observe relaxation of strained muscles and note feeling rested for 6 months.

Since Botox® treatment requires only superficial injections, treatments may be performed in a clinic examination room.

Since Botox® treatment requires only superficial injections, minimal anesthesia is required. Patients are offered either a topical anesthetic cream immediately prior to injections, topical cooling with a blowing coolant device during injection, or no anesthetic at all. Most repeat clients elect to complete their Botox® treatment without any anesthetic.

Immediately following Botox® treatments, clients may note slight bruising of the skin at the injection sites. Fortunately, bruising is easily covered with touch up make up and is temporary. Patients should avoid aspirin products for 1 week prior to injections to avoid bruising.

Most clients tolerate the treatment during their lunch hour and can return to work without any delays. Following their Botox® treatments patients are advised to avoid lying down for approximately 6 hours and avoid any exercise for one day in order to avoid migration of the Botox® away from the injection site.

In general, Botox® is extremely safe and effective but there are a few side effects that clients should be aware of. First, Botox® may not work on you or be effective for only a few months. There are several reasons for this. First, the injector may not fully appreciate muscle physiology and thus inject into the improper layer. Second, Botox® is most effective in a concentrated form. Unfortunately, some clinicians may over-dilute their Botox® stock making it less effective. Finally, Botox® may be outdated if it has been sitting around too long prior to injection. Since Botox® is dispensed in 100 unit bottles and most clients only need 20 to 50 units per session it can be difficult to use up an entire bottle in a single day after it has been reconstituted, i.e. prepared. Typically, Botox® should not be administered after 3 days following preparation.

The most common side effect following Botox® injection is bruising. Although this is a nuisance, bruising is minimal and usually resolves within 2 days. All aspirin containing products should be avoided for one week prior to and following injection to minimize risk of bruising. Another uncommon side effect is a post-injection headache. Fortunately, headaches are manageable with Tylenol administration and resolve within one day.

The most troublesome side effect involves the unintended paralysis of a functional muscle. This is due to the undesired migration of the Botox® from the initial area of injection. If the levator muscle is inadvertently paralyzed, the patient develops a temporary eyelid droop. This complication occurs several days following injection and results in eyelid asymmetry and a patient who looks sleepy. Fortunately, antidote eye drops are available and will counter this effect allowing the levator muscle to regain its strength. Two weeks of eye drop administration is usually sufficient to correct the problem.

Finally, a long-term side effect of frequent Botox® treatments is alteration of facial anatomic landmarks. For example, if the patient starts out with minimal arching, then it is likely that the eyebrow shape will become even flatter after routine Botox® use. Once again, this side effect can be avoided with modification of routine injection sites in an infrabrow site so that an arch is created.

As a patient you should be aware that for any services rendered, physicians are mandated to obtain informed consent. To obtain informed consent, physicians should explain all risks and undesirable effects that might result from the procedure. In general, Botox® is extremely safe and effective but there are few risks associated with Botox®. First, clients may be allergic to Botox®, eggs, or albumin which could result in a hypoallergenic response. Such a reaction could be life threatening if the client is not treated in a medical clinic setting where appropriate measures can be taken to care for the client.

Another risk associated with Botox® treatments is that to a pregnant female. Since Botox is a paralytic agent, it may translocate to the fetus via the blood stream and have harmful effects on the development of the fetus. All clients should be asked a detailed history regarding pregnancy status and menstrual cycles. Finally, Botox® can have detrimental effects on patients who have certain neurological disorders such as ALS, Myasthenia gravis, or Lambert-Eaton syndrome. A similar overdose can be observed in clients who are currently taking aminoglycoside antibiotics. Neurological paralysis can occur requiring emergent therapy and transportation to the hospital emergency room.

Botox® is a registered trademark of Allergan, Inc.