Approved by the FDA for the non-surgical relaxation of frown lines between the eyebrows, horizontal forehead wrinkles, and crow’s feet, BOTOX® is one of the most popular injectable treatments worldwide. BOTOX® at our Ohio practice can relax and refresh your facial appearance without compromising your natural look.
Unlike many other practices where non-physician injectors may treat BOTOX® patients, a board-certified facial plastic surgeon cares for every BOTOX® patient at Fine Arts. Dr. David Hartman is an ExpertInjector™, a distinction held by just 3 percent of the one million doctors in the United States who are approved to perform these injections.
What is BOTOX® Cosmetic?
As one of the most popular and extensively studied neuromodulators on the aesthetic market, BOTOX® is a purified solution derived from the botulinum protein. It is injected in tiny quantities directly into the facial muscles, where it temporarily blocks the over-contraction of underlying muscles that cause dynamic wrinkles of the face and neck.
How Does BOTOX® Cosmetic Work?
Starting in our 20s and 30s, certain muscles of our faces cause the overlying skin to “bunch up” and form “dynamic” (i.e. caused by movement) wrinkles when the muscles underneath contract. BOTOX® Cosmetic is carefully injected into key areas to partially weaken the wrinkle-causing muscles, while still maintaining facial expression capability.
Neuromodulators such as BOTOX® relax or weaken muscles through one simple action: they block the release of the trigger signal or neurotransmitter known as acetylcholine (ACh) from the nerve to the muscle. BOTOX® causes absolutely no injury whatsoever to the facial muscle. Likewise, the nerve is not injured. The nerve does, however, require several months to sprout new functioning signal releasers so that the muscle can once again be stimulated to fully contract. During that several-month period, our face will show little to none of the facial wrinkles that cause us to look angry, worried, tired, and older.
Where Can BOTOX® Cosmetic Be Used?
BOTOX® Cosmetic is used most commonly in the upper part of the face to address:
1) Frown lines, also known as glabellar lines or the “angry 11s” – the vertical lines between the eyebrows that make us look angry or worried
2) Horizontal forehead lines, or the “forehead washboard lines”
3) Crow’s feet lines at the outer corners of the eyes
4) The “bunny lines” created when we scrunch up our noses
5) Placement just below the eyebrows can allow the eyebrows to lift slightly
In addition to its common uses in the upper face, BOTOX® is also useful for reducing the appearance of:
6) Platysmal neckbands, the vertical bands on the front part of the neck
7) Vertical lip lines sometimes called smoker’s lines
8) Nasal tip droop
9) Gummy smile
10) Chewing muscle bulkiness
It should be noted that BOTOX® or other neuromodulators will not be effective on wrinkles caused by volume loss, excess skin, or other issues unrelated to muscle movement – facelift procedures, eyelid rejuvenation surgery, fat transfer procedures, laser treatments, and dermal filler treatment are much better suited to these.
Once dynamic wrinkles are deeper set over time, nip-and-tuck procedures, fat transfers, laser resurfacing, and filler may be used in conjunction with BOTOX® for greater wrinkle reduction. For many patients, Dr. Hartman may recommend Dysport® instead of BOTOX®. The two products are very similar.
When Does BOTOX® Begin to Show Results?
An easy to remember “Rule of Threes” can be applied to BOTOX®:
The effects of BOTOX® start to show up by 3 days.
The maximum effects are in place by 3 weeks.
BOTOX® will start to wear off in 3 months.
Individual patients can vary in these time parameters, depending on where the injections are placed, the character of patient physiology and the muscle(s) injected, and the quantity of BOTOX® placed relative to the size of the muscle treated.
How Long Does BOTOX® Last?
The short answer is three to five months. Neuromodulators such as BOTOX® smooth and beautify the face by softening the pull of the muscles that cause the wrinkles and distortions. At our practice, we appropriately soften the pull of the wrinkle-causing muscles but do not knock them out entirely. We aim to use BOTOX® to soften the dynamic wrinkles (muscle pull-produced lines) while still allowing patients to maintain the ability to make natural facial expressions.
How to Avoid Unwanted Side Effects from BOTOX®?
Of all the possible causes of unwanted side effects of BOTOX®, the one that stands out above all others is injection by an unqualified injector. Negative side effects can occur when BOTOX® is placed in areas of the face that it should never be placed. It is essential that you choose an injector who has a thorough and intimate knowledge of all 43 muscles involved in facial expression.
The injector should have the skill and knowledge to carefully observe where and when the wrinkles appear and recognize which facial muscles are causing the wrinkles. Then, this qualified injector must be able to visualize the muscles through the skin while injecting. In addition to knowing where to place BOTOX®, it is essential to know how much to place. With BOTOX®, we can always add more; we can’t, however, take it away if too much is initially injected.
Arguably, the most thoroughly trained injectors are board-certified facial plastic surgeons, first trained for five to six years exclusively in surgery of the face and neck, then trained and subsequently board certified in plastic and reconstructive surgery of the face and neck. Board-certified general plastic surgeons (distinct from general surgeons) and cosmetically trained dermatologists may also be skilled and qualified injectors. Be wary of less-than-fully-trained injectors.
A strategy that is both cost-effective and safety-conscious that I use is to slightly undertreat on the first treatment and then touch it up in a week or two. This helps us to get it just right…I like to see softening of wrinkle-causing facial muscle actions, but maintenance of natural facial expression.
– Dr. Hartman
How Much Does BOTOX® Cost?
In women, lovely relaxation of the wrinkles of the entire upper face can be obtained for $350 to $500 by a knowledgeable injector. Men tend to have bulkier muscles in the brow and forehead, and generally require roughly 30 percent more BOTOX® to achieve their desired results.