You may have read about Botox Cosmetic in advertisements, blogs and celebrity gossip magazines, or heard about it from your friends. But there are a lot of misconceptions about Botox treatment and how it is used.
Botox Cosmetic has been available by prescription in the United States since the FDA approved it in 2002. The exact same Botox injected for medical purposes (such as uncontrolled muscle spasms) was first approved by the FDA in 1989.
In 2015, it was the top nonsurgical cosmetic procedure in the U.S. among both women and men, with 4,267,038 injections (of Botox, Dysport and Xeomin) performed by physicians and their physician assistants and nurse injectors. Men received 10.3 percent of the injections.*
In this article we present only the facts, as well as recommendations from respected medical professionals. After reading it, please feel free to contact us with any questions you might have by using the form below.
What Is Botox Cosmetic?
Botox, or onabotulinumtoxinA, is used for three main purposes: muscle spasm control, severe underarm sweating and cosmetic improvement. In this article we concentrate on the third use, achieved with the product called Botox Cosmetic, which contains botulinum toxin type A (the active ingredient), human albumin (a protein found in human blood plasma) and sodium chloride.
Botox Cosmetic is used for the temporary smoothing of glabellar lines (also called frown lines), which are the lines between your eyebrows that can make you look tired, unhappy or angry.
It is FDA-approved for this use and in this area only. However, it is often used off-label for horizontal forehead lines, crow’s feet, marionette lines at the corners of the mouth and smoker’s lines around the lips.
Don’t confuse Botox Cosmetic with injectable fillers. Dermal fillers work differently, plumping up tissues so that lines and wrinkles diminish or disappear (Restylane, Radiesse and Juvederm are examples).
Your practitioner can help you decide which product(s) will solve your particular appearance issues, though as a general rule, Botox is used mostly in the upper portion of the face, and fillers are used mostly in other areas.
How To Know If You Are A Candidate For Botox
In the United States, the FDA has approved Botox Cosmetic for people aged 18 to 65. But you shouldn’t use it if you:
- Are allergic to any ingredients in Botox or Botox Cosmetic.
- Are allergic to another botulinum toxin brand (such as Myobloc, Xeomin or Dysport) or had any side effect from these products in the past.
- Have a skin infection or other condition in the injection area.
- Have ALS (Lou Gehrig’s disease), myasthenia gravis, Lambert-Eaton syndrome or another disease that affects your muscles or nerves.
- Have breathing problems, such as asthma.
- Have difficulty swallowing.
- Have bleeding issues.
- Plan to undergo surgery.
- Have had facial surgery.
- Have weakness in your forehead muscles.
- Have drooping eyelids.
- Are taking or have recently taken certain medications, vitamins or supplements (see below).
Botox Cosmetic is not expected to travel far enough through the body to affect a fetus or breastfeeding infant. However, for ethical reasons, clinical studies have not been done on expectant or new mothers, so nobody knows for sure.
Therefore, the manufacturer (Allergan) advises that you should not have Botox injections if you are planning or trying to conceive a child, are pregnant, are planning to breastfeed or are currently breastfeeding. It’s better to be safe, and you can always have Botox later on.
How Botox Injections Work
A wrinkle in the skin is typically formed perpendicular to a contracting muscle located directly beneath it. For example, the muscle in the forehead is a vertical muscle, and when it contracts (such as when you raise your eyebrows), the lines that form (wrinkles) will be horizontal.
Likewise, the two muscles that are responsible for the frown lines are positioned slightly horizontally between the eyebrows, so when they contract, the frown lines appear vertical.
Botox Cosmetic is injected into muscles, where it blocks nerve impulses to those tissues. The muscle activity that causes the frown lines is reduced, and a smoother look results. Without a contracting muscle beneath it, the skin has a difficult time wrinkling.
Facial lines that exist when your face is totally relaxed are not very good candidates for Botox. These lines are better handled by the dermal fillers. Botox can frequently “soften” these lines but not always get rid of them.
The injections take about 10 minutes, and you should have no downtime afterward.
Normally you would see improvement within a few days. Botox requires two to four days for it to attach to the nerve ending that would normally stimulate the muscle to contract. The maximum effect usually occurs at about 10-14 days. Therefore, whatever effect is obtained two weeks after the injections should be considered the maximum effect that is going to occur.
Is Botox Painful?
Any injection can hurt, but the needles used for Botox injections are very small, so pain is usually minimal. The area can be numbed with a topical anesthetic cream or cold pack 10-20 minutes before the injections are given, so you may not feel much pain, if any.
You may feel a little discomfort later, once the anesthetic cream has worn off. Other side effects are listed below.
How Often Should You Get Botox Injections?
You’re probably wondering how long Botox lasts. Most people see effects for three to four months, but several factors may shorten or lengthen that period:
- Your age. Older people with less muscle tone may see results diminish sooner than those with younger, firmer facial muscles.
- Your facial structure and expressions.
- Whether you smoke.
- Your diet.
- Whether you take good care of your skin; use facials, microdermabrasion or other resurfacing methods.
- How much sun you get and how much sun damage your skin already has.
- Whether you use Botox repeatedly or not. However, this seems to differ from one person to another. Some obtain a longer-lasting effect with repeated use, while others seem to develop a resistance to the drug and need more frequent treatments.
Doctors disagree on which of the above factors are the most important; it’s a good question to ask your practitioner. In any case, it is not recommended to have injections in the same injection site (such as for crow’s feet) more frequently than every three months.
As with the injection of any medication, your body’s immune system can develop antibodies to the medication, which render the drug less effective or possibly cause development of an allergy to the drug. The more frequently the drug is injected or the more quantity that is injected, the higher the risk for these antibodies to be formed against the drug.
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