1. Is there any danger in using Botox?

Botox is an interesting drug that is currently used to relax muscles. This allows for the smoothing of facial wrinkles, but was also effective in people with abnormal speech dysfunction involving vocal cords, such as stuttering.

Interestingly, over 20 years ago I was involved in the initial research with Botox and its use in treating infants and children with torticollis, a condition where the muscles in the neck are contracted and affect the movement in the head. During this research we used multiple variations of Botox and various concentrations, and we had no significant complications from the use of Botox in infants or adults. In fact, the amount of Botox we used on infants is very similar to the amount we use to correct facial lines in adults. In general, Botox is extremely safe and has been used for years.

Complications from Botox are rare and typically occur after a high dosage used on a patient with airway and respiratory issues. An extremely small percentage of patients have an allergic reaction. The most common complication from Botox is asymmetry of facial movement and eyelid positioning after its use.


2. What are glabellar lines and frown lines?

Glabellar lines and frown lines are the vertical lines between the eyebrows over the nasal region. The muscles in this region that leads to this line are called corrugator superciliary muscles. There could also be a horizontal line in this region called the procerus muscle. Both of these muscles are treated using Botox therapy.


3. Is there any downtime?

Botox usually takes three to seven days to have an effect. During the immediate post-injection period, there will be some swelling at the injection sites. This swelling is usually minimal and will resolve within two to three hours.


4. Will my lines look worse if I choose not to continue treatment?

Actually, the lines of the forehead and the glabellar area improve long term with the use of Botox. If you stop using Botox, the lines will come back in terms of depth, but some patients report long-term improvement even after stopping. Botox works by decreasing the strength of the muscle. The muscle then becomes partially paralyzed or weakened by the therapy, and therefore fewer lines occur.


5. What happens overtime?

Knowing that Botox leads to decreased muscle movement, and therefore muscle atrophy, I often recommend that patients consider some fat grafting to the orbital area after many years of therapy. This is because over time, the volume in this area will naturally reduce. Again, this reduction can be caused by natural aging, but may be accentuated by long-term use of Botox. Put simply, these lines will come back in to play to some extent.


6. When will I see results from Botox cosmetic treatments?

The results occur typically between three to seven days, usually with maximum results occurring between seven and ten days.


7. Is their anything I need to tell my doctor?

I think it is important to emphasize to the doctor what your goals are in terms of your results to ensure that realistic expectations are met. It is also important to talk about any blood thinning agents that you might be taking such as aspirin, plavix, warfarin, heparin, and even medications such as Aleve and Advil that can lead to increased bruising.