BOTOX Cosmetic - The Truth about BOTOX

1.  What is Botox?

2.  What is the difference between Botox and fillers like Juvederm or Radiesse?

3.  How does Botox work?

4.  What causes facial lines and wrinkles?

5.  What are some FDA approved applications for Botox?

6.  Is Botox Cosmetic safe?

7.  Are there side effects to Botox Cosmetic?

8.  How is Botox supplied?

9.  How and where is Botox administered?

10. How much Botox do I need?

11. How long does Botox last?

12. How long does the treatment take to complete?

13. Why choose Dr. Mitchell to perform your Botox?

14. Disclosure.

Does the sight of frown lines between your eyebrows displease you?  Do creases on your forehead or “crow’s feet” around your eyes make you look older than you feel?  Have you been told that you look angry when you’re not?   Facial wrinkles and creases are a sign of facial aging that begin to appear in our late twenties or early thirties.  Genetics, sun exposure, pollution and unhealthy lifestyle habits promote worsening signs of aging.

Well a huge element of the solution to these facial lines, wrinkles and unsatisfactory eyebrow contour can be found in Botox Cosmetic.  Like me, you can eliminate or reduce those scowl lines by using the time-tested, effective and successful Botox remedy.  Millions of people achieve smoother skin, diminishing those unsightly wrinkles and creases by using Botox Cosmetic.  I consider Botox a virtual “Fountain of Youth” for the facial skin.  Since 2003, I have successfully treated hundreds of patients with Botox.  The satisfaction rate is over 99%.

1.  What is Botox?

Botox is NOT the same as Botulism.  Botox does not contain bacteria.  Botox is a STERILE, vacuum-dried PURIFIED botulinum toxin type A. The amount of Botox needed to achieve the desired aesthetic outcome is small. Botox Cosmetic is used to reduce or eliminate the appearance of facial lines and wrinkles.  It is injected under the skin into areas surrounding the eyes, forehead, mouth or neck to smooth crow’s feet, frown and worry lines and lines on the neck.

Botox injections block nerve impulses, weakening muscles to relax wrinkles and give the face a rejuvenated appearance.  Botox is also FDA approved for treatment in migraine headaches, eye twitching (blepharospasm) and facial twitching (hemi facial spasm) and excessive underarm sweating (hyperhidrosis).  Dr. Mitchell is skilled at injecting Botox for all of these purposes.

Botox Cosmetic is a Physician administered, non-surgical, FDA approved treatment for the temporary improvement in the appearance of moderate to severe frown lines associated with muscular activity between the eyebrows.  Other cosmetic uses include treatment of other movement-related facial lines and platysmal bands in the neck.   The most commonly treated areas are the glabella (area between and just above the eyebrows), the forehead and the crow’s feet (area of skin on the temporal side of the eye).  Besides simply smoothing lines and wrinkles, Botox is used to “shape” the brow and eyes.  Botox can raise a droopy eyebrow temporarily in order to obtain a less-tired appearance.

2.  What is the difference between Botox and Fillers like Juvederm or Radiesse?

There is much confusion regarding the difference between Botox and facial fillers.  Botox is a clear liquid injected in very small quantities directly into and around facial muscles.  The effect is neuromodulation or diminishing ability of the muscle to contract (tighten).  The resulting effect is fewer lines and wrinkles.  Facial fillers on the other hand act as plumping or filling material in order to inflate, build or add volume to the target facial area.  Fillers are used to smooth out creases by injecting the material similar to adding air to a flat tire or water into a balloon.  Botox on the other hand works at the cellular level to block chemical messengers between cells in order to reduce or stop the movement of facial muscles.

3.  How does Botox work?

Botox is a neuromodulator (nerve transmission regulator).  Botox works by selectively and temporarily weakening muscles to relax wrinkles.  Specifically, Botox blocks the release of the neurotransmitter Acetacholine.  Acetacholine (Ach) is a chemical transmitter that activates muscles.  ACh is released between a motor (skeletal) nerve and associated muscle fiber.  The release of acetacholine from the preceding neuron opens channels in skeletal muscle that initiates a sequence of steps to finally produce muscle contraction.  The Botox works by blocking the Ach release between the motor nerve and muscle receptor, thereby blocking the nerve impulse or message to the muscle to contract.  Eventually, however, the Botox wears off because of the body’s natural turnover capability.  The full effect of the Botox takes 5 to 7 days to become visible after the injection.  The effect lasts between 3 and 5 months as muscle activity returns gradually over this time.  The procedure is repeated after the desired effect wears off. Botox does not cause cell death.

4.  What causes facial lines and wrinkles?

Dynamic “rhytids” (wrinkles) are those wrinkles seen when conveying emotions through facial expressions such as smiling, squinting, frowning or concentrating.   Static “rhytids” (wrinkles) are those lines or wrinkles present at rest.
Certainly individual genetics and lifestyle choices, such as smoking, influence the development of premature aging.  However, the anatomical cause of facial lines and wrinkles has to do with the movement of muscles in comparison to the attachment to the overlying skin.  If the facial muscle contracts (moves) in one direction then the skin wrinkles in the 90-degree position.  Please see my hand drawn diagrams indicating the direction of muscle contraction versus the overlying and visually apparent skin line or wrinkle.   One example is the horizontal lines on the forehead.  We developed horizontal (ear to ear) forehead lines because the frontalis muscle, or muscle in the forehead that is responsible for lifting the forehead moves up and down (vertically).  The overlying skin consequently moves and wrinkles horizontally.  Botox will slow or stop the muscle from pulling up and the resulting consequence will be fewer horizontal forehead wrinkles.  If you do not understand this concept then please don’t worry.  Human anatomy and physiology is confusing.  I will be happy to explain this to you in person or you can learn to trust me by experiencing acceptable and reproducibly positive results.

5.  What are some FDA approved applications for Botox?

Botox Cosmetic is FDA approved for use in the temporary improvement of moderate to severe glabellar lines in adult men and women 65 or younger. Botox is also approved for abnormal spasm of the eyelids (blepharospasm) in people 12 years or older and for symptoms of severe underarm sweating (severe primary axillary hyperhidrosis)

6.  Is Botox Cosmetic safe?

BOTOX has been used therapeutically for over 20 years.   Botox is approved in approximately 60 countries for aesthetic use. Botox has been extensively researched with approximately 2,000 published studies.  Millions of treatments are performed annually without definitively serious adverse events at recommended doses.   Distant spread of toxin effect is rare.

7.  Are there side effects to Botox Cosmetic?

The most common side effect is temporary bruising or mild discomfort at one or possibly two injection sites.  Most patients have no bruising at all.  Make-up can be applied immediately following the treatment.  Other less common and rare side effects include drooping of the eyelid.  As of 2011, in my entire Botox injecting experience, I have had two patients with temporary drooping of one eyelid.  This side effect will typically last from 3 to 8 weeks.  Temporary medical treatment using an eye drop called Iodipine, will improve this side effect until the effect wears off.   My patients have not experienced or reported other potential side effects.  Allergan, the makers of Botox report other side effects including dry mouth, tiredness, headache and allergic reactions.  Rare more severe complications have not been reported using cosmetic quantities of Botox.

8.  How is Botox Cosmetic supplied?

Botox is measured in units.  Allergan Inc., the company that makes BOTOX, supplies BOTOX Cosmetic in 50 unit and 100 unit vials.  The BOTOX comes as a freeze-dried residual powder, which must be reconstituted with sterile saline (salt water) just prior to the use.  Multiple objective and subjective factors are involved in deciding the proper dosing for each area on a patient.  Some factors to consider when applying BOTOX to a treatment area include; gender, muscle thickness, degree of muscle hyperactivity, severity of lines and wrinkles, shape and position of the forehead and brow, as well as the degree that the patient wishes to have his or her forehead immobilized.  It is a fallacy to believe that people who receive BOTOX will have “frozen” or paralyzed facial features.  Many patients as well as Television and Film actors who receive BOTOX wish to maintain the ability to display emotional signs conveyed by the movement of the brow, forehead and eyes.  In these cases, choosing an appropriate dose to allow for both continued movement and simultaneous smoothing of facial lines and wrinkles is effective and reasonable.  

9.  How and where is Botox administered?

Botox Cosmetic is performed in an office-based setting.  Botox is an injectable type product.  The tiniest of needles is used to place the Botox into the correct position.  Many times topical anesthetic is used on the skin to make the treatment maximally tolerable.  Many of my patients who have had Botox treatments previously do not ask for or require topical anesthesia.  However, our goal is to make your experience as comfortable as possible, the application of topical anesthetic is perfectly appropriate and does provide for maximum comfort during your treatment.

10.  How much Botox do I need?

Each patient must be treated individually.  Factors including gender, previous Botox treatments, muscle thickness, and personal goals are taken into consideration to determine the proper amount of Botox to be placed.

11.  How long does Botox last?

When proper dosing is used, the effects of BOTOX Cosmetic last from 3-5 months.  In areas such as the lips where much lower doses are used because of the physiological need to retain oral (mouth) function, the effects of Botox will last about 6 weeks.

12.  How long does the treatment take to complete?

The actual treatment takes about five minutes to complete.  The resumption of normal activities is immediate.  

13.  Why chose Dr. Mitchell to perform your Botox?

Dr. Mitchell is a Board-Certified Facial Plastic and Reconstructive Surgeon.  Dr. Mitchell has successfully injected hundreds of patients with Botox since 2003.  In addition, Dr. Mitchell is a personal and regular user Botox Cosmetic.  His artistic ability and thorough knowledge of facial anatomy translates into reliable and consistent success using Botox.  

14.  Disclosure

Botox may not be right for you.  Only a consultation with Dr. Mitchell will help to determine if you are a good candidate for Botox.  While excellent results are typical, every treatment or procedure has risks or potential complications.

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