Botox Injections  (Botulinum Toxin)

Concepts in facial rejuvenation over the past five years have changed dramatically. In the past, all that was considered was a facelift. As time went on, eyelid surgery and brow elevation became part of the standard surgical treatment. Over the past five years, we have learned that we no longer want to only address the laxity of the soft tissues and the wrinkling with just a face-lift and removal of eyelid fat and skin. Now we look at the entire facial complex from the skin all of the way down to the facial skeleton. We evaluate the outer and inner layers of the skin, the fatty tissue, the underlying muscles of facial expression along with the facial bone structure and the tissues that hold everything to the facial skeleton. Each of these tissues needs to be analyzed and the patient's individual anatomic abnormalities evaluated and considered for treatment.

Coincident with this new approach to facial rejuvenation has come the use of botulinum toxin or Botox to weaken the muscles of facial expression to improve facial wrinkling. Botox injections were originally used to weaken the muscles of the eye in order to allow the eyes to focus and to move together and provide binocular vision. Subsequently, Botox was utilized to weaken the eyelid muscles to treat patients with uncontrollable spasm and blinking. It was then realized that these treatments often improved eyelid wrinkles. Treatment then extended to the muscles around the eye and cheekbones resulting in improvement in "crow's feet", followed by the forehead and the brow region.

The advantages of Botox injections are that while they weaken the muscles, they do not take away from facial expression. This weakening results in less muscle activity, which then results in smoothing and flattening of the wrinkles. The current feeling is that Botox is best utilized for the furrows between the crows' feet eyebrows, and forehead. Occasionally, it could be utilized around the mouth although it is less dramatic in its overall improvement.

At the time of consultation, I like to identify the bothersome wrinkles during a facial analysis of the patient. This includes the wrinkles at rest and with animation. This is frequently demonstrated with a computer to point out the wrinkles and the type of improvement that can be accomplished. Since Botox is extremely expensive ($400.00 for 1/30th of an ounce), and its potency is diminished with time; frequently injections are performed when several patients can be treated in one session. The strength of the Botox is a big advantage because only a very small amount is necessary for treatment of each anatomic area. Very small needles are used to inject one tenth of a cc in several places around each muscle. Ice is frequently utilized to decrease the discomfort of the injection and to decrease swelling. A small amount of bruising can occasionally be encountered around the areas of the injection.

The improvement in the wrinkles is usually seen after several days. It occasionally takes several sessions to get the best result. Unfortunately, the improvement is temporary lasting three to six months. As you can imagine, Botox injections have greatly increased the treatment options for patients with signs of aging. Rather than undergo more complex surgery to weaken facial muscles and decrease the associated wrinkling, injections can be utilized to improve facial appearance and counteract some of the early signs of aging.