Botox Cosmetic

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.

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.

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.

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).

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.

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.

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.  

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.

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.

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.

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

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.