Botox

Reviewed by Scott R. Miller, MD, FACS

Botox is the number one cosmetic procedure in the United States, with 3.8 million treatments in 2005. Botox was introduced in the late 1980s by ophthalmologists for treating optic muscle disorders. It was approved by the FDA for cosmetic use in 2002, helping millions of patients get rid of nagging facial lines and wrinkles.

Today, the variety of Botox uses includes ocular muscle spasms, problems with eye coordination, severe armpit perspiration, and as an anti-wrinkle treatment for crow's feet, frown lines, and to eliminate furrows in the forehead.

How Botox Works

Botox combats wrinkles that are created when nerve cells within the muscles beneath the skin release a chemical called acetylcholine. This chemical triggers a muscle contraction that creates wrinkles. The Botox product, medically known as Botulinum Toxin Type A, is an injectable compound that disrupts the release of acetylcholine, which essentially paralyzes the muscle and stops the contraction. Results are fully evident within one week after treatment and remain for a minimum of three months.

Botox typically reduces wrinkles by 80 percent. Patients are typically between the ages of 35 and 60. Results vary among individual cases, and the results are temporary. You will need to plan for additional injections, depending on your long-term treatment goals.

The Botox Procedure

Botox injection is performed in the doctor's office, usually without anesthesia. However, a numbing cream may be applied to the treatment area. Patients may experience some minimal discomfort from the needle injection. Depending on the extent of treatment, the procedure can take a few minutes up to 20 minutes. Generally, patients return home shortly after the treatment is complete.

The selection of injection points is critical to the success of the procedure. The points of injection are first scored with a marking pencil. The doctor may select numerous injection points for each location to be treated. These points may not be located on the wrinkle itself, but at the area where the muscle contracts. Antiseptic is also applied.

The doctor will then determine the amount of Botox to be used for the procedure.

The Botox filler is then injected into the marked points beneath the skin. The toxins in Botox fasten to the muscles' nerve endings, which inhibits the release of the chemical acetylcholine. This will stop the muscle contractions that wrinkle the skin.

Results are usually evident within one week and last about three to five months.

Botox Side Effects and Recovery

The most common side effects of Botox include headache, nausea, flu-like symptoms and redness and pain at the injection points. Infrequently, patients may experience muscle weakness or drooping of the upper eyelid muscles. This side effect usually resolves itself within days, or in rare cases, months after the procedure.

You can resume normal activities immediately, but your doctor may advise you to stay out of the sun. Report to your doctor immediately any unmanageable pain or symptoms that are progressive or abnormal. Talk to your doctor to fully understand the risks, complications and remedies.

[Please click here for an update on the current FDA review of Botox after reports of adverse reactions among patients receiving injections for non-cosmetic reasons.]

Alternative and Additional Treatments

There may be alternative treatment options, depending on your condition. Other minimally invasive procedures include collagen, Restylane, fat fillers or Gortex. For severe wrinkling, surgical procedures may be more appropriate, such as a facelift, forehead lift, and eyelid surgery.

Your doctor may recommend additional treatments for you to consider in conjunction with Botox. These might include chemical peel, laser skin resurfacing, or microdermabrasion.

Consult a Qualified Doctor About Botox

If you are considering Botox injection, consult a qualified doctor about your goals and expectations from the treatment.

Here are some tips to consider when consulting a doctor:

• Review the doctor's credentials, education, training, type of certification held and number of times the doctor has performed the treatment.
• Many types of physicians perform Botox. Find a doctor with extensive experience in performing the injection. One type of error that can occur is directing the injection at the point of the wrinkle, when it may be that the injection should be directed in the area of the muscle contraction.
• Find out the appropriate dosage that will be required to achieve a satisfactory result for your condition. For Botox injection, the FDA has approved the use of one syringe per patient.
• View before-and-after photos of patients with similar conditions who received Botox.
• Inquire about complication risks and possible side effects, including the impact that smoking and medications may have on your treatment.
• Ask the doctor to estimate the number of treatments required to achieve and maintain the maximum benefit.
• Request a list of pre-op and post-op instructions. Following these instructions can reduce the risk of complications.

The Cost of Botox

Costs vary over a wide range depending upon the doctor, your region, and the extent of treatment.

A lot of doctors perform the Botox procedure. Not all of them have extensive expertise with the injection, proper dosage, or a medical setting that can offer the highest level of quality care. board-certified plastic surgeons and dermatologists typically charge more for Botox as they are best equipped to perform your procedure.

The cost for Botox may range from $125 to $400 per treatment area.

You may want to ask your doctor about payment plans. For financing options and tips, continue reading about Patient Financing.

[page updated June 2008]