Botox® is an FDA approved injectable cosmetic treatment in a family of drugs called neuromodulators. While Botox® is the most widely known neuromodulator, several other similar products are available, including Dysport® and Xeomin®. Botox® works by temporarily blocking the release of the neurotransmitter acetylcholine so muscle contractions are reduced. This decreased muscle activity helps reduce the appearance of certain facial lines and wrinkles. Botox® is approved by the FDA for treatment of glabellar lines (vertical folds between eyebrows) and canthal lines (crow’s feet). It is also frequently used to diminish other facial lines, such as transverse forehead lines, smoker’s lines around the lips, and nasal wrinkles. Additionally, it can be used to alter the appearance of downturned lips as well as modulation of eyebrow position.

Botox® is administered via injection using a small insulin syringe. Typically, there are four to six injections per area treated. The effects begin within 2-3 days, increasing in intensity during the first week. The effects then last between 3-4 months. Most patients get treatments 2-4 times per year to maintain the beneficial effects. Improvement is gradual and continues to progress as long as treatments are maintained. Deep lines take longer to improve. Following treatment, patients should refrain from strenuous activity for 24 hours.

Many people ask me when they should start getting Botox® . Ideally, treatments should begin before the facial lines are noticeable at rest (static wrinkles). It is much easier to prevent deep wrinkles than it is to treat them. However, even the deepest of static wrinkles are improved by treatment with neuromodulators.

Like any medical intervention, there are risks. Serious risks include hypersensitivity reactions and distant spread of the toxin. However, it should be noted that these events are extremely rare and no definitive serious adverse events from distant spread of toxin have ever been reported when using a reputable product at recommended doses. The most common adverse event is migration of the toxin into surrounding muscles, like the eyelids, causing a droopy eyelid or eyebrow. This has been reported in up to 3% of patients. It is a temporary effect, but distressing nonetheless. This is why I stress to anyone considering a cosmetic treatment, but especially Botox® , to go to an expert. Board Certified dermatologists and plastic surgeons like myself are trained to be proficient with these procedures to keep the risk of adverse events as low as possible. I perform hundreds of these injections each month, and have unfortunately seen many patients with unsatisfactory results from non-core specialty injectors. So, think twice before you let your (dental hygienist, dog groomer, landscaper…etc.) convince you to have Botox®. You wouldn’t want me to clean your teeth, would you?

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