Botox Overview

Everything you need to know about botulinum toxin injections.

Frown lines, forehead wrinkles, and crow’s feet may be the signs of a life well-lived — full of laughter, smiling and deep thinking. But these persistent little lines also show our age. Wrinkles have a way of taking the softness out of your face, causing you to look tired or even angry.

That’s why diminishing wrinkles can make you feel that much more vibrant and energetic. Until recently, there weren’t many minimally-invasive options for wiping wrinkles away. That changed with the discovery that botulinum toxin could help remove wrinkles. Botulinum toxin—first marketed under the brand Botox—is a neuromodulator (this category of drugs used to be called neurotoxins, which is too scary-sounding of a category for the benefit it offers). Botox and the other drugs in the same category that have recently been approved by the FDA, like Dysport and Xeomin, all work under the same principle. “All of these products are used for wrinkles caused by muscle contractions,” explains Mark Ballentyne, MD, aesthetic medicine specialist with Atlantic Plastic Surgery Center in Portland, Maine.

How Botox Works

Neuromodulators like Botox work on the muscles, essentially weakening them. This would be a bad thing if you injected it into the muscles that keep us alive and moving and breathing. But when you inject just a small amount directly into the facial muscles that cause frowning, for example, it blocks nerve signals and relaxes those muscles (effectively freezing them). Without the contracting muscle, the appearance of wrinkles is diminished.

The three areas patients most commonly complain about are forehead wrinkles, frown lines, and crows’ feet around the eyes, Dr. Ballentyne says. “That’s 95 percent of the areas we treat,” he says. How a Botox treatment works: your provider uses a very thin needle to inject a small amount of the botulinum toxin into the correct muscles (no anesthesia is necessary). You have 43 muscles in your face, and it’s crucial that your provider knows which muscles to target and exactly where to perform the injections. The whole procedure should only take 15 minutes or so, and there’s no downtime or recovery.

Is Botox Right For You?

Botulinum toxin injections are quick and essentially painless, and you can see results with days. The downside, however, is that the results aren’t long-lasting. “It can last up to four months,” Ballentyne says. “Most of my patients come about three times a year. Once they see results, they like it, and they want to keep seeing results,” he says. For example, getting Botox injections in the forehead can raise the brows up, which makes for a more youthful appearance. As for Botox cost, in 2009, the American Society of Plastic Surgeons found that the national average was $405 per botulinum toxin treatment.

Also, because botulinum toxin affects the muscles, it only targets the muscles that cause frowning. It can’t help the static wrinkle lines that aren’t caused by muscles contractions. For those, you’ll need to have dermal fillers injected. Dermal fillers plump out the skin, easing away and softening the deeper lines. In fact, a combination of botulinum toxin and dermal fillers can be very effective, says Ballentyne.

Botox Risks and Side Effects

Injecting neuromodulating drugs into the facial muscles does come with a few side effects, but they are mild, Ballentyne says. The most common side effect is a small bruise at the site of the injection. You may also notice some redness and swelling, but that generally lasts less than an hour. The most common risk is a droopy eyelid (which usually happens if the toxin isn’t injected properly).

If you’re considering getting Botox, Dysport, or Xeomin, make sure you go to a provider who is experienced at giving injections. “It’s not really about their title,” Ballentyne, who travels to train providers how to perform the injections, says. “It’s the amount they do and the training they have.” A physician’s assistant who does injections day in and day out and is skilled at doing them is better than a plastic surgeon who only does them occasionally. Shop around and ask questions, he says.

 
 

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