Botulinum toxin (Botox, onabotulinumtoxinA) is a material that has been known for over a century and used for medical purposes for more than 50 years. A common misconception is that Botox actually paralyzes the muscles in the face. Although this can happen with extreme amounts of Botox, most physicians strive to inject just the amount that allows the patient to have some limited activity but not so much that they have overactivity of the areas. Patients should know that Botox is not used to keep them from expressing themselves but simply to keep them from making facial grimaces and frowns that have become habits and are unintended. When done correctly, most people who are not trained cosmetic surgeons will not notice that a Botox procedure has been performed but simply that the patient looks more rested or happier.
Typical injection patterns include about four or five areas on each side of the forehead and two or three areas on either eye area. More areas can be injected by skilled physicians, depending on the type of wrinkles and the desired effect for the patient. It is common for pressure to be applied if an area seems to be bleeding after the injection. While ice is sometimes applied beforehand for comfort reasons, direct pressure is much more effective than ice for control of bleeding and bruising.
Results will be evident within three to 10 days. Photographs may be taken before the procedure so that patients can check their results themselves rather than relying on their memory. It is surprising to see how many people do not recall how they looked before the procedure and are amazed at the difference when shown a picture. Prior to having the procedure done, the patient should realize that Botox does not actually erase lines but relaxes them. What this means is that deeper lines will become somewhat less deep and superficial lines will nearly disappear. This can be likened to the act of steaming a garment’s wrinklesrather than ironing them.
It may be necessary for the patient to have additional procedures, such as the use of filler substances in order to plump up the wrinkles that are now relaxed. Additionally, it may be necessary to have two or three sessions of Botox treatment for deeper wrinkles before results become optimal. The area of the crease between the eyes is a particularly ideal area for Botox use in conjunction with filler as these fixed wrinkles don’t always respond optimally to Botox alone.
Risks are very minor with this procedure. The main risks consist of headache, pain, and flu -like illness. In rare cases, there may be a drooping lid or eyebrow area. It is important for the cosmetic surgeon to assess the patient’s lids before injecting because the patient may not be a good candidate if he or she has an extremely droopy lid to begin with or one that is held up by constantly arching the lids. Ptosis (a severe drooping of the eyelid) can occur in up to 5% of patients but is very rare if the cosmetic surgeon does this procedure often. These complications are typically very minor occurrences and resolve with time.