Botox® is actually a neuromuscular toxin that inhibits the release of acetylcholine within the nerves. These nerves are located within the muscles that are injected. Without the release of acetylcholine muscles become paralyzed. This paralysis lasts 4 to 5 months. You start to notice it 2 to 3 days after injection.

Initially, Botox® was used in the early 1970s to help correct over-active eye muscles that caused a lazy eye. Like many other occurrences in medicine, some of the Botox® was inadvertently injected into the crow's feet area and was found to help dramatically. After all, many of the wrinkles around the eye are caused by over-active muscles. Botox® simply controls muscular paralysis.

Ironically, the biggest disadvantage of Botox® can also be considered one of its advantages. That disadvantage is the fact that it only lasts 4 to 5 months. In the unlikely event that you are unhappy with the result, you know that it is only temporary. Most of patients, however; are so happy with their results that they return for repeated injections and often request a more permanent surgical solution.

Benefits

Botox® can dramatically improve all wrinkles that are caused by over active muscles. Most people, both men and women, over the age of 30 can benefit from Botox®, if performed correctly. This is not to say that all wrinkles can be removed with Botox®. Remember, Botox® only helps with wrinkles that are caused by over-active muscles. Static wrinkles, which are always present regardless of whether you're smiling or not, or very fine wrinkles are not removed by Botox®. These wrinkles are caused by changes within the skin itself or are due to the aging changes of the skin and underlying fat. Correcting these wrinkles requires a thorough evaluation to determine the exact cause so that the most effective treatment is performed. This could involve Chemical Peeling, Laser Skin Resurfacing, Face Lifting with or without fat resuspension, Fat or Collagen Injection, Blepharoplasty, or Brow Lifting.

How can you tell if your wrinkles are caused by over-active muscles? This is definitively determined during your consultation with your doctor. But you can be reasonably sure that Botox® will help if the wrinkles are made worse with muscular movement i.e. smiling, elevating the eyebrows, or tightening the neck, etc.

The most effective areas for Botox® include the furrows of the forehead made worse when you elevate your eyebrow, and the crow's feet area made worse during smiling. Other areas may also be helped such as neck banding, also known as “turkey neck. ” Botox® can also be used in conjunction with other procedures.

Botox®’s benefits can be summarized as follows

• Very effective at reducing or eliminating dynamic wrinkles.
• Relatively painless.
• No anesthesia necessary.
• Great for crow's feet, laugh lines and forehead wrinkles.
• No downtime.
• Relatively low-cost.
• Minimal risk.
• Reversible (this may be considered a disadvantage)
• Quick.
• Effectively delays the need for more invasive plastic surgery.

Are you a good candidate?

As mentioned above, a good candidate is someone that has wrinkles that are caused by over-active muscles primarily of the forehead and/or around the eyes. Particularly good results are seen in patients who have deep furrows of the forehead giving them a mean look. These patients are often mistaken as being mad or unfriendly just because of their over-active forehead muscles.

Another group of patients that are particularly good candidates are those with wrinkles around the eyes and temporal area that worsen when smiling or when making facial gestures. When you think about it this is truly unfortunate. Here you are smiling, and feeling good about yourself when all of a sudden you look in the mirror and see someone who looks much older than you actually feel. There is no doubt that how you feel about yourself has a huge influence on how you feel in general. Fortunately, Botox® can go a long way in reducing these lines and making you look and feel younger.

Other wrinkles may be helped with Botox® as well. These include creases around the chin and mouth, excessive nasal flaring, and banding of the neck. During your consultation, your plastic surgeon will determine if your particular problem can be treated effectively with Botox®.

Possible complications

Significant complications with Botox® are rare but must be discussed. The most common complication is incomplete removal of the wrinkle. It is not realistic nor is it usually desirable to expect complete removal. Depending on location, complete removal of the wrinkle may lead to a look that is flat and without expression. The positive side of Botox® is that with proper application, in the hands of an experienced plastic surgeon, it does a wonderful job of diminishing the wrinkles without creating an artificial look.

Another advantage of Botox® is that if the desired results are not achieved a simple second injection can be performed. This is often a good way to start gradually.

Another potential complication called “ptosis,” which can rarely be seen when Botox® is found in the forehead region. Ptosis is a reversible problem where the eyelid droops for 4 to 6 weeks. It is caused when some of the Botox® diffuses into the muscles that elevate the eyelid. Fortunately, in experienced hands this problem is extremely rare.

Other problems associated with it are more of an annoyance than a complication. These include swelling, minor bruising, minor pain and mild asymmetry.

Do's and Dont's prior to surgery

Because of the relatively benign nature of Botox® there is not that much to do prior to having it done compared to other procedures. The most important thing is to avoid aspirin and aspirin containing products for at least two weeks prior to the injection. Ingestion of these products will lead to more bruising and swelling.

There is no problem with eating or smoking prior to having Botox®. It's probably a good idea not to eat right before coming in but the fact is that many people come in on their lunch break and go right back to work afterward.

Anesthesia

No anesthesia is necessary.

After the procedure

Immediately after the injection you may feel a little funny or you may fill nothing at all. You can leave immediately and go back to work or do whatever you need to do. Do not expect immediate results. Remember, Botox® takes about 2 to 3 days to start working.

When it does take effect do not be concerned if you have a slight feeling that “your face is not your own” as this is normal. This feeling goes away quickly. By day 3 you will notice a marked improvement in your wrinkles. In fact, you will feel as if much of tension around your eyes or forehead has gone away. Many people who suffer from chronic headaches and migraines have significant relief after having Botox®. This improvement will remain for approximately 4 to 5 months.

Recovery time

The great thing about Botox® is that there is really no downtime. Often patients come in on their lunch break and go right back to work. Friends and co-workers will not notice any immediate changes. But do not doubt, the wrinkle improvement caused by Botox® is very dramatic by day 3.