WHAT IS BOTOX?
Botulinum toxin (Botox) is a neuromodulator, derived from the bacteria Clostridium botulinum. A neuromodulator is a molecule that regulates the activity (signaling) of a nerve. FDA-approved Botox for medical treatments is a sterilized and highly dilute concentration of Botox which can be injected into facial muscles to block nerve activation of muscle fibers and decrease the overall strength of contraction.
The facial muscles have attachments to our skin. When our muscles contract, such as making a frown or raising our eyebrows, the skin is pulled inward to create a fold. Skin has high elasticity when we are young, and springs back to its flat, resting state when the muscles stop contracting. However, as we age and have repeated contraction of the same muscles over years, these folds become permanent wrinkles in our skin.
Botox serves to temporarily weaken the muscles of facial expression to prevent the formation of permanent wrinkles, or soften the appearance of existing wrinkles. When botox is injected into a small area of a muscle, the surrounding muscle fibers are paralyzed. This weakens the muscle as a whole. The effect is seen as early as 2 days after a treatment, and typically lasts 3 to 4 months. The process can be repeated indefinitely, with your injector carefully assessing your response to treatment each time and adjusting dosage as necessary.
COMMONLY TREATED AREAS
Periorbital lines (“crow’s feet”)
Lateral brow lift
Masseter muscle (jaw clenching)
Glabella (frown lines, “11s”)
Nose (“bunny lines”)
Perioral lines (mouth)
WHEN SHOULD I START GETTING BOTOX?
Botox was classically considered an anti-aging treatment for patients who wished to soften wrinkles around their face. However, this treatment is becoming increasingly popular among patients as early as their 20s as a preventative measure for wrinkles. If facial lines and wrinkles is something you wish to minimize as you get older, it is a good idea to consider Botox treatment in your 20s.
FREQUENTLY ASKED QUESTIONS
What is the difference between the different types of Botox?
Currently, there are 5 botulinum toxin products on the market which have FDA approval for use in the face: BOTOX Cosmetic® (Allergan Inc.; multinational), Xeomin® (Merz; Germany); Dysport® (Galderma S.A.; Switzerland) and Jeuveau® (Evolus Inc; USA) and Daxxify® (Revance Aesthetics; USA). All 5 of these products contain botulinum toxin Type A as the primary active ingredient but vary slightly in terms of purification process and complexing proteins which are coupled with the toxin. While there are slight variations in dosing, all Botox products have similar results and duration of effect (3-4 months); Daxxify has been shown to last up to 6-9 months. It is important to go to an injector who is highly experienced in the type of Botox products they offer to patients.
What are the risks of Botox?
Botox has a temporary effect (3 to 4 months). Therefore, the risks of treatment are relatively low. However, it is important to go to a highly experienced injector who understands how to optimize dilution and dosing for specific areas. For example, when injected in high volume or an improper location, Botox has the potential to migrate and affect neighboring muscles which were not intended to be treated. This can result in facial asymmetry affecting your eyes (forehead botox migrating to the levator muscle of your upper eyelid) or smile (mentalis/chin botox migrating to a depressor muscle of your lower lip). Additional risk is unwanted cosmetic outcomes, such as excessive drop in brow height. This is avoided by your injector having an expertise in facial anatomy and recognition of areas of the face not to inject neuromodulator.
Botox is backed by years of clinical trial data outlining the safety profile and recommended dosing. Multiple pharmaceutical companies have received U.S. FDA approval for Botox treatments to different regions of the face, for both cosmetic and functional issues.
What is the recovery process after Botox?
There is essentially no recovery! Botox is a very quick procedure that can be completed in less than 30 minutes. No anesthesia is required, however some patients elect to use a topical numbing cream prior to treatment for comfort. Minor bumps and bruising at injection sites are rare, and typically resolve within 1 day. You can drive yourself home or return to work immediately. We ask all Botox patients to avoid exercise, drinking alcohol or massaging their face for 24 hours after treatment.
What is Baby Botox?
Baby Botox, also called micro-Botox, refers to smaller doses of toxin injected into a particular area. This is commonly performed for patients who are undergoing Botox treatment for the very first time, or for patients in their 20s who are receiving Botox as a preventative measure.
Why is my Botox starting to have less of an effect than it did before?
In a minority of cases, patients can develop antibodies (produced by your own immune system) against a protein in the Botox complex. This causes resistance to Botox, and effectively decreases its effect on your muscles. In these cases, your injector may consider increasing your botox dosage or using a different brand of Botox which you may not have the same resistance to. Alternatively, researchers advise patients to stop Botox for at least 6 months to allow their antibody levels to decrease. Your injector should always have a keen sense of how you are responding to Botox, and should adjust your treatment if and when necessary. Botox is never a cookie-cutter, one-pattern-fits-all approach!