BOTOX® Cosmetic Background:

There are two categories of facial wrinkles: static and dynamic. Static wrinkles are visible when your face is at rest. Static wrinkles occur during the aging process because of the loss of elastic tissue. Dynamic wrinkles appear temporarily when a muscle contracts during facial expression (i.e. smiling, frowning). Dynamic wrinkles are commonly found in areas of facial expression like the forehead (worry lines), between the eye brows (glabellar lines), and around the eyes (crow’s feet).

BOTOX® Cosmetic diminishes or eliminates the appearance of dynamic wrinkles because it paralyzes the underlying muscle causing the wrinkle. When injected directly into the muscle, the purified Botulinum toxin type A prevents the muscle from contracting by blocking the transmission of nerve impulses to the muscle. Because the muscle cannot contract, the wrinkle cannot form and it gradually diminishes.

BOTOX® Cosmetic is not as effective on static wrinkles. Static wrinkles are better treated surgically or with dermal fillers.

BOTOX® Cosmetic is mainly used to treat dynamic wrinkles in the upper third of the face. However, many physicians use it to cosmetically treat other areas of the face and neck. Moreover, BOTOX® Cosmetic has also been used to treat migraine headaches and excessive underarm sweating.

BOTOX® Cosmetic Injection:

BOTOX® Cosmetic is injected directly into the muscle causing the dynamic wrinkles. A very small needle is used to minimize discomfort. The injection feels like a small prick with a little stinging. The entire procedure takes about 10 minutes. Since the procedure is non-surgical, no recovery time is needed, and patients can return to work or other activities immediately.

How BOTOX® Cosmetic Works:

The BOTOX® Cosmetic enters the nerve endings and blocks the release of acetylcholine, a chemical that causes muscles to contract. The paralysis takes 1 to 5 days to occur and peaks in two to four weeks. Results last from three to six months. The effect gradually wears off, allowing the dynamic wrinkle to return. Thus, follow up treatments are necessary to maintain the desired result. Repeat treatments may lead to improved results as the muscle causing the wrinkles becomes less responsive over time, a process called chemical denervation.

BOTOX® Cosmetic Side Effects:

BOTOX® Cosmetic can’t be used if there is an infection at the proposed injection site(s) or in individuals with known hypersensitivity to any ingredient in the formulation (the milk protein Casein).

Patients with neuromuscular disorders like Myasthenia Gravis and Eaton Lambert Syndrome may be at increased risk of clinically significant systemic effects from typical doses of BOTOX® Cosmetic.

The most common side effects are headache, respiratory infection, flu-like syndrome, temporary eyelid droop, and nausea.

Less frequently occurring (<3%) adverse reactions include pain in the face, injection site redness, and muscle weakness. These events are thought to be associated with the injection and occurred within the first week.

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All photos courtesy of S. Zimmet, MD and P. Bitter Jr., MD