A Discussion about Botox

We would like you to be informed about the pros and cons of Botox (botulism toxin) to help you decide whether this is a procedure you would like to explore.

Botulism toxin has been used since about 1977 in children and adults to improve the problem of muscle spasms of the facial muscles as well as to correct double vision due to muscle imbalance, so it is not a new medication.  Botox injections have been used for many different kinds of medical problems in all medical fields ranging from orthopedic, gastrointestinal and even urological problems to wrinkles.

The principle reason for Botox injections to the face is that a small amount of Botox will partially and temporarily weaken the muscles and prevent or lessen the lines of the face.  Improvement takes 5-14 days to be complete, and it may take several injections until we figure out the exact dose of Botox that works best for you.  My goal is to find the least amount that will work because it is more natural-looking (and less expensive) that way.  If it turns out that the initial dose for your Botox is not sufficient to paralyze your muscles, you may come in for a “touch-up.”  However, please wait to call our office 2 weeks after your injection to report your results because there is a delay before you see the final result.

The lines that can be improved from Botox include the glabella frown lines (“eleven” lines between your eyebrows), crow’s feet and forehead lines.  In addition to this, the corners of the mouth can be injected to minimize downturn of the corners of the mouth.  The upper lip lines can also be softened, but only a small effect can be expected here because more can give an unnatural appearance.  The lateral eyebrow may also be injected with Botox to give a small amount of lift to this area, but too much Botox there has an increased risk of eyelid droop.  It can be used for the “bunny lines” or wrinkles along the side of the bridge of the nose or even in the armpits for excessive sweating as well as chin wrinkling.

The complications and side effects of Botox are minimal.  You may have some swelling or bruising, especially around the crow’s feet, and this could last for several days after the injections.  The risk of bruising from Botox is minimal though, especially now that we have an infrared vein finder called AccuVein to help localize the veins. If too much Botox is placed in the forehead, this can lower your brow and look unattractive, so I will be conservative with your brow injection especially if you are over 40 years old.  There have been rare reports of Botox causing minor headaches, but Botox has also been used to treat some kinds of migraine and tension headaches.

There are medications and herbals that can increase bruising and bleeding which you should avoid for two weeks before receiving Botox.  These are:  Advil, Aleve, Alka Seltzer, Anacin, Anaprox, Aspirin, Ascriptin, BC Powder, Bufferin, Coricidin, Dristan, Ecotrin, Empirin, Excedrin, Fiorinal, Feldene, Ibuprofen, Indocin, Lortab, Midol, Motrin, Naprosyn, Nuprin, Pepto Bismol, Percodan, Sinutab, Sudafed, Vitamin E and Voltaren.  Tylenol is fine!  Many herbals can cause bleeding — Echinacea, Ginko Biloba, Ginseng, Licorice Root, St. John’s Wort, garlic tablets — and others have not been studied well enough to know what impact they will have, so it is prudent to stop ALL herbals two weeks before receiving Botox.

There is a new botulism toxin product on the market called “Dysport.” The cost to the patient is the about same, and it tends to diffuse more into nearby tissues which can be a good or bad thing, depending on where it is injected.  Currently, my office uses Botox only in the face and neck.  

Of course you understand that this is a temporary treatment and can last from 3-6 months. Over time, the injections may need to be either less frequent or with a smaller dose, as the muscle becomes weaker and smaller.  

It will be a pleasure to discuss Botox injections with you.  Please call my office if you have any questions (804 320-8545).