Botox is the number one cosmetic injectable done to improve one’s appearance in the entire world. It has been around for decades and has an excellent safety record. In honor of National Botox Day, taking place November 16, 2022, Dr. Berman reviews the ins-and-outs of Botox.
WHAT IS BOTOX?
Botox is a neurotoxin. This means that it temporarily weakens the muscles that are innervated by nerves that are injected with the botox. This sounds scary but all local anesthetic is blocking nerve impulses. The difference is that Botox does not affect sensory nerves, but instead, blocks the muscle contraction. This means that the feeling of the injected area will remain normal.
HOW IS BOTOX ADMINISTERED AND PREPARED?
Botox arrives at the doctor’s office as a small powder at the bottom of the vial. The rest of the vial is emptied of air and it arrives on dry ice. It is kept in the freezer until reconstituted with sterile saline. It is then kept in the fridge. A new needle and syringe are used. The 100 unit vials can be used on more than one patient. This is common, as it would be very unusual for one patient to get 100 units. Patients of Dr. Berman feel much more comfortable knowing that they are in the best care while receiving Botox at Berman Cosmetics and Surgery, because Dr. Berman performs the injections himself rather than delegating the task to others.
HOW LONG DOES IT TAKE TO START TO WORK AND HOW LONG WILL IT LAST?
Botox onsets within 4-10 days, though some patients have mentioned they have noticed it working the next day. It will typically last about 4 months, however some patients will notice it wearing off sooner. Other than increasing the dose, which may have a small effect on longevity, there is nothing that can be done to make it last longer. Dr. Berman recommends that most patients consider planning their next injection about 3.5 months later so that the effect from the dose does not completely wear off before the next dose is administered.
WHAT SHOULD OR SHOULD NOT BE DONE AFTER THE INJECTION?
When Botox first came on the market, there were all sorts of silly advice such as frown or don’t frown, don’t lie down or don’t exercise etc. Often the advice varied from doctor to doctor and often contradicted each other. Dr. Berman never felt any of the above advice made any sense. The medication is injected into the subcutaneous tissue or muscle, in a very small dose with a tiny needle. It is not going to travel to another area because of facial movement or lying down or exercising. After receiving Botox injections, that patient can resume regular daily activities immediately.
WHAT AREAS ARE COMMONLY TREATED COSMETICALLY?
Remember Botox is not going to improve lines that you see at rest. It only affects those muscles when they contract.
The commonest areas are:
Other less common areas that are treated:
WHEN SHOULD BOTOX BE STARTED?
Botox should be started when it is needed. Some women will start Botox treatments in their 20’s and 30’s because they have very active muscles in these areas. However, it is more common for women to start in their late 30’s and older. Although there are those who advocate for starting Botox extremely early as a prophylactic manner. Dr. Berman’s top priority is being honest with his patients and giving them realistic expectations. He believes starting Botox early is not necessary nor preventative.
WHAT ARE THE COMMON SIDE EFFECTS?
There are very few side effects from Botox from a medical standpoint.
Some minor side effects may include:
Bruising – Any time you get stuck with a needle it can hit a small blood vessel and cause a bruise. Generally speaking, it will be a small bruise. It will not look as though you were hit in the face by a fist! Bruises will typically last 2-3 weeks. You can apply makeup to hide the bruise, if it occurs. Avoiding aspirin and other blood thinners will help to minimize the chances of getting a bruise. Every doctor who does a large number of injections will occasionally cause a bruise. If your doctor tells you he/she has never caused a bruise, then they either do not do many injections, or they are lying, or have a short term memory. It happens to all of us. Good gentle technique can minimize this but it does occasionally happen to all of us.
Abnormal position of eyebrows – When the forehead is injected anywhere above the eyebrows, it changes the balance between those muscles which cause the brow to elevate and the muscles that pull the eyebrows downward. Sometimes women want a mild elevation of the lateral third of the eyebrow and this oftentimes can be planned and carried out but if not always predictable. Occasionally, sometimes the lateral brow elevates too much and causes a “Spock” like effect and this is not desirable. This can be remedied by applying some further Botox.
Sometimes if too much Botox is injected or it is injected too low or if the person is very sensitive to Botox, it can cause either the eyebrows to feel heavy or actually cause them to droop or less commonly the eyelid to droop. This will generally improve with time but remember there is no antidote to Botox.
If too much is injected above the lips, it can cause abnormal or limited movement to the lips, causing problems drinking, eating or talking so it is especially important to be conservative in this area. Remember you can always add more Botox but you cannot remove it.
Weakness of the lower lids – it is important not to inject either too much or too close to the lower eyelids or they may droop or sag away from the lower eyelid.
WHAT ELSE CAN BE DONE IN ADDITION TO BOTOX TO HELP US LOOK BETTER?
When we age, many things change. There is no one thing that will make us look youthful. Frequent things that Dr. Berman recommends be considered either at the same time or part of program to look our best may include the following:
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Please let him know that you came to him via my website. It has been an honor and a privilege to be your plastic surgeon.
Warmly,
David Berman MD, FRCSC