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BOTOX® Cosmetic is a prescription medicine that is injected into specific muscles to improve the appearance of wrinkle lines. In Toronto, BOTOX® Cosmetic is a popular non-surgical option to reduces or eliminate frown lines between the eyebrows, forehead creases, crows feet (lines around the eyes), and muscular bands in the neck. Botulinum toxin (BOTOX® ) also has been found to be effective in relieving migraine headaches, and excessive sweating (hyperhydrosis).

BOTOX® Cosmetic Facts

BOTOX® Cosmetic was introduced in 2002, and is the first botulinum toxin to be approved by the FDA to temporarily treat moderate to severe glabellar lines between the brows. With real, noticeable results, no surgery and no recovery time, there are many reasons why BOTOX® Cosmetic has been chosen by millions of women and their doctors. Approximately 11.8 million BOTOX® Cosmetic procedures have been administered in the United States since 2002.

How does BOTOX® work?

BOTOX® Cosmetic is administered by a healthcare professional as a simple, nonsurgical treatment that is injected directly into the muscles. It works by blocking nerve impulses to the injected muscles. This reduces muscle activity that causes moderate to severe lines to form.

What areas of the face can BOTOX® Cosmetic treat?

The lines of the face that are best treated with BOTOX® Cosmetic are those that result from muscle activity. Not all muscles should be treated with BOTOX® Cosmetic. Many muscles of the face serve an important function, and freezing them may lead to unwanted functional problems or an unsightly appearance.

The most common areas of BOTOX® Cosmetic treatment have been well established in the glabella, forehead, and crows feet. Other less commonly but appropriate areas are the platysmal bands, chin dimples, masseters muscles. The last area to be mentioned as an effect use of BOTOX® Cosmetic is for excessive sweating and headaches.

Common Myths About BOTOX® Cosmetic

“BOTOX® Cosmetic will make you look frozen or expressionless”

  • This should not be the case if it is used in an appropriate manner, and administered by a properly trained healthcare professional. This point stresses the importance of choosing a trusted certified plastic surgeon for your BOTOX® treatment.

“If you stop having BOTOX® Cosmetic treatments, your wrinkles will come back worse than they were previously”

  • This is not true; if you choose to stop your BOTOX® Cosmetic treatments and allow the effects to wear off completely, the muscles will ‘wake up’, and function just as they did before. There is no ‘rebound’ effect to the muscles which makes the lines worse.

Important Considerations about BOTOX® Cosmetic

We ask patients not to take medications that can thin the blood (eg. Motrin, aspirin) for 10 days prior to their injections. The effect of BOTOX® Cosmetic is temporary, and generally lasts for 4 months.

BOTOX® Procedure Details

BOTOX® Cosmetic injection is a straight forward procedure. plastic surgeon Lawrence Tong, MD will first confirm that you are a candidate for the procedure. You will be asked to create the lines by frowning, squinting, or raising the brows. A number of small injections with a very small needle are placed strategically, customized to your anatomy. The actual procedure lasts less than 5 minutes, and you can go back to your normal activities.

Recovery after BOTOX®

We caution patients who have undergone BOTOX® Cosmetic injection not to lay down for 2 hours after the procedure, and not to perform strenuous exercise that day. People may start to see the effect within 24 hours, but it may take up to 4 days for the full effect to occur. As expected, you will find it very difficult to contract the muscle(s) that have been injected, but you may still be able to obtain some minor movement, especially at the periphery. If the lines in the skin are fairly deep, it may take up to 4 weeks for the skin creases fully relax, even though the muscles are frozen.

Specific Areas for BOTOX® Treatment

BOTOX® Between the Brows (Glabella Area)

When your frown, the vertical lines that form between the eyebrows are made from contraction of the muscles (called the corrugators). In addition to these vertical lines, there are horizontal lines across the bridge of the nose that forms when you wrinkle your nose. These are made by the procerus muscle. At Yorkville Institute of Plastic Surgery, Dr. Tong treats these areas by placing the BOTOX® Cosmetic to freeze the corrugators and procerus muscles. The typical amount of BOTOX® Cosmetic required is 30 units. You should expect the lines to be quite smooth, once the BOTOX® Cosmetic effect occurs. As expected, you will find it hard to frown. The effect lasts between 4-5 months. Patients interested in a more permanent improvement to the area should consider a surgical procedure. Either a forehead lift or corrugator removal will provide a long term improvement to this area.

BOTOX® for the Forehead

The forehead lines form when you raise your eyebrows. The muscle involved in making the lines is the frontalis muscle. Over activity of the frontalis muscle can lead to permanent and deep horizontal forehead wrinkles. Oftentimes the muscle may be overactive on a subconscious level. Injection of BOTOX® Cosmetic into this area is very effective in obtaining a smooth forehead appearance. Dr. Tong is very meticulous about the injection; incorrect placement of BOTOX in the forehead can cause the browns to droop, giving an undesired look. Typically 30-40 units of BOTOX® Cosmetic are utilized; patients may need more or less depending on the anatomy and Dr. Tong’s evaluation. The effect typically lasts 4 months. For patients who desire a more permanent smoothing of the forehead along with lifting of the brows, a forehead lift should be considered.

BOTOX® for the Crows Feet

The appearance of crow’s feet can be seen easily when the eyes are squinting or tightly shut. The muscle involved in producing the lines is called the orbicularis oculi muscle. Multiple factors can contribute to the appearance and progression of crows feet: significant sun exposure causing loss of skin elasticity, persistent squinting, and loss of facial fat with aging, all contribute. The use of BOTOX® can dramatically decrease the appearance of crows feet by freezing the muscle. The duration of BOTOX® to the crows feet lasts 4 months on average. Unfortunately, there is no minor surgical option to eliminate crow’s feet as effectively as receiving BOTOX® injections. A Facelift or Mini Facelift will help with crow’s feet but generally not as much as a BOTOX® treatment for freezing the muscle.

BOTOX® for the Neck Bands

You may notice that as people get older, there are changes to the appearance of the neck. One of these changes is the appearance of ‘neck bands’. These are muscular cords that run vertically along the front of the neck. They become more visible as we age, and are more apparent in thin individuals. These bands are actually part of the platysma muscle, a muscle that covers the front of the neck. Changes in the muscle occur as we age, making the cords much more easily seen. One way to treat these bands is through the use of BOTOX® . Typically, each band requires 15- 20 units of BOTOX® and most patients have between 2-4 bands that need to be treated. If you are looking for for a more permanent solution, a Facelift, Neck Lift, or Mini Neck Lift will correct this problem on a long term basis.

BOTOX® for Jaw Reshaping

Patients may have increased width of the jaw/face due to overgrowth of the biting muscles (masseter muscles). Patient commonly have associated teeth grinding at night. A way to decrease the width without resorting to jaw surgery is to inject BOTOX® into the muscles.

BOTOX® for Excessive Sweating of the Underarms or Palms

Do you have a sweating problem? Patients with excessive sweating complain soaking of the underarms within minutes of getting dressed. They also complain of persistent wetness of the palms. The sweating is often uncontrollable, embarrassing and not anticipated. Patients who do not seek treatment suffer their entire throughout their entire lives from it, and can have severe psychological and emotional effects from it. Sweaty palms is the most common form of hyperhydrosis, Before the days of BOTOX® , surgery was one of the only methods to help some of these patients. Nowadays, excessive sweating can be easily controlled with BOTOX® injection.

  • How it works: BOTOX® works by freezing muscles, but it also works to treat hyhperhydrosis by blocking the chemical signals from the nerves that stimulate the sweat glands.

BOTOX® for Chin Dimpling

Frequent or constant chin dimpling occurs when there is over activity of the muscle located on the chin (called the mentalis muscle). It is usually subconscious, and is often related to having an under projected chin (‘weak chin’), or a certain configuration of the teeth to the lips. BOTOX® injection can correct this appearance.

BOTOX® for ‘Smoker’s Lines’

Smoker’s lines are the contraction lines of the muscle around your mouth. Smokers can have over activity of these muscles leading to the appearance of vertical wrinkles lines. Women complain that these lines make them appear aged, and cause their lipstick to bleed. Although these wrinkles are referred to as smoker’s lines, patients who do not smoke may also have them. Other factors that contribute to the lines are aging, sun exposure, loss of facial fat, and genetics. Whatever the cause, a small amount of BOTOX® placed carefully in strategic areas can help relax the muscles and smooth the appearance. BOTOX® administration in this area must be done carefully as too much can cause a crooked mouth or smile. Dr. Tong has plenty of experience with injections to this specific area.

BOTOX® for Headaches

Research has indicated that migraine headache sufferers can benefit from BOTOX® injection.

Possible Complications

Fortunately, complications from BOTOX® Cosmetic are fairly unusual. However, when they do happen the most common side effect is that the BOTOX® is working too well or in areas that it was not intended to freeze.

BOTOX® Cosmetic working too well: Some patients may complain that their forehead feels or looks too heavy after BOTOX® Cosmetic injection; this occurs in patients who are used to habitually elevating their brows, and can no longer do so because of the BOTOX® effect. This results in the sensation or appearance of brow heaviness. Dr. Tong can usually identify patients these patients, counsel them on the risk, and place the injection in a manner that minimizes the risk.

Example of BOTOX® Cosmetic working in unintended area: Rarely, the BOTOX® can affect adjacent muscles, causing unwanted relaxation in other areas. One example is a slight droop in the upper eyelid that can be associated with injections for lines between the eyebrows. Fortunately, this rare complication can be treated with eye drops, and is generally very temporary.

Wrinkle Reduction at a Glance

What the procedure does
Reduces or eliminates wrinkles on a temporary basis
Duration of the result
Average: 3-4 months
Length of time to perform the procedure
Injections take 2-3 minutes
Type of anesthetic most commonly used
No anesthesia is required
Length of time off of work
No time off work is required
Time to get back to exercise
24 hours
Pitfalls your Plastic Surgeon should avoid
  • Migration of BOTOX® to adjacent areas
  • Causing drooping in susceptible patients