BOTOX® Cosmetic

BOTOX® Cosmetic injections for the treatment of facial wrinkles is one of the most common procedures performed by Dr. Neil Zemmel at Richmond Aesthetic Surgery. There are many contributing factors that lead to facial aging. Common causes include smoking, underlying medical problems, sun damage, and genetics. Wrinkles may be divided into two categories based on their cause: static wrinkles and dynamic wrinkles. Static wrinkles are caused by the effects of age, gravity, and loss of facial volume. These wrinkles are best treated with soft tissue fillers such as Juvederm® to revolumize these areas. Dynamic facial lines are caused by the repetitive action of the facial expressive muscles. Over many years time, the muscles of facial expression will cause the overlying skin to form creases. For example, raising your eyebrows causes horizontal creases across the forehead, which after years of repeating the action, become permanent wrinkles that are visible even when the forehead is relaxed. Other areas include the vertical frown lines between the eyebrows, “bunny” lines in between the eyes and the “crow’s feet” around the eyes.

BOTOX® Cosmetic Mechanism of Action

BOTOX® Cosmetic, when injected into the muscle, inhibits the release of the neurotransmitter acetylcholine, which causes muscle contraction. When injected, the treated muscle will be significantly weakened and will no longer contract. This renders the muscle temporarily non functional and that specific facial expression cannot be made. This temporary muscle paralysis allows for the skin to remodel over time and the permanent lines will smooth out and in some cases completely resolve. Results can be seen a week after treatment and last on average 3-6 months. Patients with very deep creases of the forehead or frown line area may require a soft tissue filler (JUVÉDERM®) in addition to optimize treatment.

Muscles Treated with BOTOX® Cosmetic

BOTOX® Cosmetic is most commonly used for wrinkles of the upper face including transverse forehead lines, vertical frown lines, and crow’s feet around the eyes. There are a number of areas where BOTOX® Cosmetic is effective in the lower face. These include the vertical wrinkles around the mouth, as seen in smokers, and for prominent cobble stoning of the chin. More advanced techniques are also common with the treatment of prominent jaw muscles and defined platysmal bands of the neck.

BOTOX® Cosmetic Candidates

Individuals with wrinkles present while making facial expressions or at rest are great candidates for this treatment. In the past, BOTOX® Cosmetic was most commonly seen among women over the age of 40. Now, it is very common practice for both men and women beginning in their late twenties. Not only does it improve the wrinkles that are already there, but it is also a wonderful preventative tool for younger men and women. The amount of BOTOX® injections performed in individuals between 20 and 30 has increased 22% over the last year.

What to Expect

Your BOTOX® Cosmetic treatment begins with a consultation with Dr. Zemmel or Physician Assistant Emily Leisy. Dr. Zemmel and Ms. Leisy will determine your goals with treatment and formulate an individualized treatment plan. Your entire face will be examined looking for telltale signs of facial aging. Your face will be examined at rest and during animation of the facial muscles. Dr. Zemmel and Ms. Leisy will look for transverse forehead crease, vertical glabellar lines, bunny lines, crow’s feet, down turning of the corners of the mouth, and depressions of the chin area. You will receive a cold pack before treatment and a light topical anesthetic before treatment. Dr. Zemmel and Ms. Leisy use extremely small needles during injections rendering the procedure virtually painless. Several small injections are then made into each muscle, and minute amounts of BOTOX® Cosmetic are injected into each. The entire procedure takes approximately 10 minutes, and you can resume normal activity immediately.

Side Effects

The most common side effects of BOTOX® Cosmetic treatment include slight redness, minute bruising, and minimal pain along the injections sites. These usually resolve within the first 48 hours. More severe and rare side effects are drooping of the eyelid, flu-like symptoms, allergic reaction, and blurred vision.

BOTOX® Cosmetic for Excessive Sweating (Hyperhidrosis)

BOTOX® Cosmetic is used by Dr. Zemmel and Ms. Leisy for the treatment of hyperhidrosis, or excessive sweating of the underarms. This procedure takes an average of 15-30 minutes and consists of approximately 15-20 small punctures with a very fine needle. Studies have shown that results are seen within days of treatment and last on average 6 months. Many patients have complete resolution of sweating from the underarm area. Typically 100 units are used during this treatment.