Botox

Because of the very positive effect that Botox has on facial wrinkles, the FDA approved the use of Botox for facial wrinkles in 2003.   Botox can be used to reduce or eliminate the transverse (or sideways) wrinkles on the forehead and the vertical wrinkles between the eyebrows.  In addition, Botox can raise the inner or medial position of the eyebrows.  Likewise it can raise the outer or lateral eyebrow and reduce or eliminate the “crows feet” lines around the outer aspect of the eyes.  

Botox prevents the release of chemicals called transmitters at the junction of a nerve and the muscle that the nerve feeds.  This prevents the nerve from stimulating the muscle to move.  To the extent that the pull of a given muscle causes wrinkles or creases, Botox prevents the muscle from moving or pulling which substantially reduces or eliminates the wrinkle that normally is formed in the skin as a result of that muscle pulling.

After an injection of Botox, muscle weakness is usually seen in 2 to 4 days.  The full effect or maximal weakness is seen by 7 to 10 days.  Over time, the nerve ending affected by Botox regenerates thus allowing the muscle to begin contracting again.  This regeneration usually takes about three months, sometimes longer.  Thus repeat injections of Botox are usually necessary in the range of every 3 to 6 months depending on the size of the muscle and the amount of Botox injected.  Repeat injections into a given muscle can cause the muscle to atrophy or weaken permanently—thus less Botox may be needed with repeat injections or the interval between injections can increase.  Resistance to Botox is very rare-- the percentage of “non-responders” is less than 1% to 2%. 

When injecting Botox, the needle is so small and the amount of material injected is so little that pain is not a common complaint.  Dr. Topol uses a specially formulated numbing cream for those patients who need it.

The safety of Botox has been well established and adverse effects are usually mild and transient.  Occasionally there can be swelling or bruising at the injection site and a rare patient may complain of headache or a flu-like symptom that is short-lived.  The most bothersome complications are droop of the eyelid or eyebrow.  In order to minimize these risks, you must remain upright and avoid rubbing the injection site for at least 2 hours.  If eyelid droop occurs, it may be evident between 2 and 14 days.  It can last for 2 to 12 weeks.  Special eye drops can be used to counteract this effect from the Botox.  The droop is frustrating but not permanent. 

Botox is thus effective but a temporary treatment.  It is not the same as Thermage, Laser or surgery like facelift, eyelid tightening or brow lift.  Normally, Dr. Topol will see you back 2 weeks after treatment, as additional “touch up” injections may be needed at that time.  The cost for Botox is $35 per injection with usually 8 to 12 injections per session.

If you have questions or wish to schedule an appointment with Dr. Topol, give us a call or send us an e-mail.  We will be happy to hear from you.