(Patients trying to frown in both the before and after photos)
(There is also another recently approved competitor to Botox® called Dysport®. If you are interested in this treatement please let us know.)
Many wrinkles are actually creases that have been worn into the skin by making the same expression thousands of times. These are called "expression lines" or “dynamic wrinkles”. Typical dynamic wrinkles include “frown lines” between the eyebrows, “crow’s feet” around the eyes, and forehead lines. The presence of these wrinkles can add years to our appearance, often making us look angry, tired or worried when we are not.
Now, thanks to a new use for an approved drug, Botox®, these lines can be dramatically softened. The procedure known as cosmetic denervation uses Botox® injections to improve the appearance of worry lines, frown lines, laugh lines, crow's feet and other dynamic wrinkles.
Botox® can help you to control your facial expressions so that you don't look angry or worried when you aren't. Botox® treatments can help to prevent the unintended display of negative feelings, and in this way help some people to express themselves more accurately.
If dynamic wrinkles are starting to make you look older or more “negative”, Botox® can help restore the rested, confident appearance you desire.
Botox® has been used safely and effectively for many many years in adults and even in small children to treat many medical conditions where overactive muscles require relaxation such as cerebral palsy. Each year hundreds of thousands of patients receive Botox® treatments for a variety of medical conditions, and Botox® has also become a leading treatment for reversing some of the visible signs of aging by relaxing the muscles which cause many of our wrinkles. Botox® is also a leading treatment for excessive sweating, and for migraine and tension headaches as well as neck and back pain.
Botox® is a highly purified, naturally occurring protein which has the ability to very precisely relax the muscles to which it is applied. This relaxation lasts for a number of months, and then the treated muscles gradually return to their original condition.
Botox® does not affect the nerves responsible for sensation, so there is no numbness in the treated area.
The benefits of Botox® on wrinkles come from the ability of Botox® to selectively and precisely relax the muscles which are causing wrinkles to occur. The skin over the treated muscles gradually becomes smoother and less wrinkled as the muscles relax.
The treated muscles usually start to relax within a day or two, and reach their maximum degree of relaxation within a couple of weeks. About 3 or 4 months after the first treatment, the effects of the Botox® gradually start to wear off. If you liked the effect of your Botox® treatment you will want to return for another treatment before the Botox® effect has completely worn off.
If you have a second treatment before the treated muscles have returned to their old bad habits, your second treatment will usually last longer (perhaps 4-5 months, instead of 3-4 months). Likewise, if you have your third Botox® treatment when you notice that the second treatment is starting to wear off, the third treatment may last 5-6 months instead of 4-5 months. It is common, after a couple of years, for people to go 6-12 months between treatments.
Untreated facial muscles continue to contract in their usual way, so that normal facial expression is unaffected. Because it relaxes the muscles that cause dynamic wrinkles, Botox® treatments can also prevent new lines from forming in the areas on your face, forehead and neck which are treated.
A common use for Botox® is to reduce (often by 70-80%) the really deep furrows and lines that many people have between their eyebrows. These lines can make people look quite angry or concerned, even when they are happy. Crow’s feet around the eyes can also add years to your appearance, and make you look like you are squinting much of the time. Crow’s feet usually improve nicely when the muscles which cause the crow’s feet are treated with a bit of Botox®.
Not all facial wrinkles are related only to the activity of underlying muscles. These deep creases and skin folds (also known as “static wrinkles”) are the ones that can still be seen when the skin is lightly stretched with your fingers. “Static wrinkles” are made worse by sun exposure, by the natural maturing process, and in particular by smoking. Many “static wrinkles” result from a combination of muscle activity and aging, and can be greatly improved when Botox® (to relax the underlying muscles) is used in combination with filling substances like Perlane™ Restylane®.
In some cases, Botox® can be used to delay or eliminate the need for a surgical procedure like a facelift, browlift or necklift; and Botox® can be used to prolong and enhance the effects of those procedures if you have already had them done.
However, this procedure cannot improve wrinkles due to aging and sun-damaged skin since they are unrelated to facial muscle contractions. Botox® injections will not improve sagging skin or replace the need for a facelift or brow lift. In these cases, as previously mentioned, you may wish to consider an alternative like Restylane®, Perlane™. Please see our sections on these topics for more information.
Cosmetic denervation with Botox® is a simple and safe procedure. Using a tiny microneedle, a very small amount of Botox® is injected, very precisely, into several locations on the face. Because the needle is so fine and only a small amount of liquid is used, the pain associated with the injections is minimal. Most patients compare the sensation to a mosquito bite. No sedation or local anaesthetic is required, and you can resume normal activities immediately. You can even drive yourself home or back to the office. Some patients experience a slight temporary bruising at the injection site, usually less than 1 – 2 cm. With ice and covering with make-up this generally is not noticeable and usually lasts less than 2-3 days. Botox® treatments take only a few minutes and are performed personally by Dr. Waldron. A small amount of discomfort may be felt when the needle is inserted and a few drops of Botox® are applied to exactly the muscles which need relaxation. This sensation lasts approximately 5 seconds.
Please see our "General Pre Treatment Instructions".
To ensure the best possible uptake of BOTOX® by the treated muscles, we encourage you to exercise the treated muscles using normal facial movements during the first 2 hours after your BOTOX® treatment.
For example, so that your Botox® will work to maximum advantage:
a. Frown to exercise the muscles above and between the eyebrows which
cause the frown lines.
b. Raise the eyebrows to exercise the muscles which cause forehead wrinkles.
c. Squint and smile to exercise the muscles which cause crow's feet.
Do not touch or rub the treated areas until two hours after your Botox® treatment.
After Botox® is placed into the targeted muscles, the weakening effect gradually begins over 3 – 5 days, and is not complete for 2 weeks. Therefore, optimal results are not seen for at least 2 weeks, and sometimes longer.
It is also important for you to avoid rubbing or pressing on the injected areas for 2 hours to avoid spreading Botox® out of the treated muscles and into non-targeted muscles. We also recommend that you do not lie down for 4 hours after the injection to reduce the chance that you will accidentally move Botox® to an area where you do not want it.
If your Botox® was moved out of the muscles it is injected into, there might be less effect on those muscles, and unwanted temporary relaxation of nearby facial muscles, which could be a nuisance for a week or two. In rare cases, this unwanted relaxation of muscles could cause temporary drooping of an eyelid or slight asymmetry of facial expression. Because the effects of Botox® are completely reversible, these rare side effects are temporary, and resolve after a few weeks.
After four hours, there are no restrictions at all.
Instructions to Minimize Discomfort:
You may wish to take a regular dose (325 to 1000 mg – depending on your size) of plain Tylenol every 4-6 hours after your treatment for a day or so. This will generally make you more comfortable. You may also wish to apply ice to the treated area for 20 minutes every 4 – 6 hours for the first 12 –24 hours after you treatment.
There have been no long-term side effects, allergic reactions or health hazards related to Botox® use thus far. Some patients have been getting Botox® treatments for 15 years or more, with no problems.
Bruising is the most common temporary side effect. In some cases, the toxin can migrate and cause a temporary weakness of nearby muscles. In rare cases, there can be a drooping of an eyelid or asymmetry of facial expression. The risk of any side effect depends on the muscles injected. Because the effects of Botox® are completely reversible, any side effects are temporary, lasting only a few weeks.
People who are pregnant, breast feeding, have rare neurological disorders like Eaton-Lambert syndrome or myasthenia gravis, or who are allergic to albumin should generally not be treated with Botox.
You will be provided with extensive details as to the possible side effects before your treatments.
Be sure to carefully read the appropriate consent form we will provide and ask any questions you may have,
before any treatment.
When Botox® is used to treat headaches the cost of the medication and treatment may be partially reimbursable. Check with your third party health insurance, (i.e. Blue Cross, employee health plans etc.), to find out if you are covered.
A number of patients treated with Botox® for lines on the forehead, frown lines between the eyebrows, and for crow’s feet have reported that a pleasant side effect of Botox® treatment was reduction or elimination of headaches.
Formal studies of patients with headaches have confirmed that Botox® treatment often reduces the frequency and intensity of both muscle tension headaches and also some migraine headaches. Patients who respond well to Botox® generally experience improvement within a few days, sometimes enjoy several months of relief from headaches, and are able to greatly reduce (and in some cases eliminate) headache medications. Botox® can be very cost effective when it reduces consumption of medications, and allows patients to avoid missing work. An increasing duration of effect is often noted in headache patients who repeat their Botox® treatments as soon as they notice that the Botox® effect is declining.
In some cases, each point which you can identify as being associated with your headaches will be injected with Botox®, usually starting at 5 to 25 units of Botox® in each point. In other cases, it is more effective to treat larger areas (for example, the forehead and sides of the scalp) with a total of 75-600 units of Botox®.
Dr. Waldron would be happy to discuss with you, in detail, the treatment of headaches.
When Botox® is used to treat chronic neck, back and/or muscular pain the cost of the medication and treatment may be reimbursable. Check with your third party health insurance (i.e. Blue Cross, employee health plans etc.), to find out if you are covered.
Formal studies of patients with chronic neck, back and/or muscular pain have confirmed that Botox® treatments often reduce the frequency and intensity of such pain. Patients who respond well to Botox® generally experience improvement within a few days, sometimes enjoy several months of at least partial relief from such pain, and are able to greatly reduce (and in some cases eliminate) pain medications. Botox® can be very cost effective when it reduces consumption of medications, and allows patients to avoid missing work. An increasing duration of effect is often noted in chronic pain patients who repeat their Botox® treatments as soon as they notice that the Botox® effect is declining.
In some cases, trigger points can be identified as being associated with your neck, back and/or muscular pain and these would be ideal for injection with Botox®, usually starting at 5 to 25 units of Botox® in each point. In other cases, it is more effective to treat larger areas with a total of 75-600 units of Botox®.
Dr. Waldron would be happy to discuss with you, in detail, the treatment of chronic neck, back and/or muscular pain.
(Allergans offers to cover cost of first Botox treatment for this condition - click here for details.)
When Botox® is used to treat excessive sweating the cost of the medication and treatment may be partially reimbursable. Check with your third party health insurance, (ie Blue Cross, employee health plans etc.), to find out if you are covered.
Botox® is also used to control excessive sweating of the armpits and palms, and occasionally other parts of the body. About one person in 100 has a serious problem with excessive sweating in these areas. This usually starts in childhood or adolescence, and sometimes other family members have a similar problem. This kind of excess sweating is caused by a reflex reaction of the nervous system and is beyond voluntary control. This kind of excessive sweating is sometimes associated with stress or heat, but often there is no cause that can be identified.
There can be considerable emotional and social stigma attached to excessive sweating of the hands and armpits, and this can lead to a loss of confidence and self-esteem. For example, those afflicted with excessive sweating often feel that when people see big sweat marks under their arms or feel their sweaty palms they may decide that the individual is nervous or insincere, even when that is not the case. Social engagements and simple things like physical contact with other people may be avoided because of uncontrollable sweating.
Patients afflicted with excessive sweating can routinely soak through clothing in a matter of minutes, and some patients have to use Kotex™ pads in their armpits, shields, absorbent tissues and frequent changes of clothing to cope with the disorder. Shirts and jackets can be quickly stained and ruined, and dry cleaning and replacement of clothing is sometimes a substantial expense.
Questions to ask yourself when considering Botox® treatment for excessive sweating include:
• Over the past week, how embarrassed or self-conscious have you
been because of your sweating?
• Over the past week, how much has your sweating interfered with normal activities like shopping or looking after your home?
• Over the past week, how much has your sweating influenced the clothes you wear?
• Over the past week, how much has sweating affected any social or leisure activities?
• Over the past week, how much has sweating made it difficult for you to enjoy any sport?
• Over the past week, has your sweating interfered with working or studying?
• Over the past week, has your sweating created problems with your partner, friends or relatives?
• Over the past week, how much has your sweating created sexual difficulties or interfered with intimacy?
Individuals troubled by excessive sweating often do not respond adequately to antiperspirants, and they may not respond to (or be willing to tolerate) systemic medications, electrical treatments on the areas of excessive sweating, permanent destruction of the nerves which control sweating, or surgery (in the armpits) to either scrape away the sweat glands or to cut out the areas of excessive sweating.
Botox® treatment, by contrast with the above, is a simple office procedure with little discomfort or risk; and can be much less expensive than surgery. Some people will only want Botox® treatment before an important event (for example, a wedding). Others, whose sweating is mainly a problem during hot weather, may have Botox® treatment at the start of every summer. Botox® treatments can be safely continued year-round if necessary to maintain control of your sweating.
Treatment of the armpits is easy, and no anesthetic is needed. Both armpits can be treated at the same time.
After Botox® treatment, excess sweating starts to decrease within a couple of days, and the full effect is reached in a week or two. The goal of Botox® is reduction of sweating to a normal level, but not total elimination of sweating to the point where the treated area becomes abnormally dry.
The effect of the Botox® treatment for excessive sweating usually lasts for 4-6 months, but in some cases can last for up to a year. Because you continue to sweat normally in other areas, there is no concern about overheating.
Patients usually report very high satisfaction with Botox® treatments, return for additional treatments, and would recommend Botox® treatments to their friends.
Dr. Waldron would be happy to discuss with you, in detail, the treatment of excessive sweating.
Please see are section “what does it cost”