Botox Cosmetic - what can I expect during treatment for forehead and frown lines?

Botox has been used for cosmetic treatments for years. If the injector is experienced, you should have a wonderful experience. In my office, you would expect the following:

1. A consultation with me, no charge. This is when we discuss what you want, what can be done, how long it will last, possible complications, how much it will cost, etc.
2. Assuming we agree, you sign your consent forms.
3. We have you remove your make up so we can take acccurate before pictures.
4. I take your before pictures, with your skin at rest and while you raise your eyebrows, squeeze your eyes shut, wrinkle your nose, etc. We need both resting and squeezing pictures to use as a comparison for after pictures 2 weeks from your treatment.
5. We show you the vial of Botox including the holograms to verify that it is genuine Botox.
6. I add the bacteriostatic water while you watch. If we have recently mixed a fresh vial and used part of it on somebody else, you might not get to see me mix the Botox.
7. I record on a treatment record precisely where I am going to inject the Botox. My nurse records the lot number, the expiration date, etc.
8. I inject the Botox using a solid steel 33 gauge needle, much smaller than a TB or an insulin needle. This makes the injections almost painless and with very little bruising. You will not hear or feel any "crunching, crackling or popping" noises because the needle I use is so small and sharp.
9. We schedule you to come back and see me in 2 weeks for more pictures and touch ups if needed.
10. I remind you to move your facial muscles as much as you can for then next few hours (without touching your face) to enhance the abosorption of the Botox... no massaging the skin.

Getting Botox should be fun!

Botox is a great treatment to decrease lines in motion on the forehead and the frown lines between the eyes. Results will last for up to 3 months. Here’s what my patients experience during their Botox treatment. You may have a somewhat different experience, depending on your doctor.

• I perform a detailed medical history on my patients to see if they are appropriate candidates for Botox. If they are, I determine the proper dosage for them- each patient is different.
• I review the risks and benefits of Botox treatment with a written consent form. This is a good time to ask any remaining questions before treatment.
• I take pictures before treatment with the patient both at rest and contracting their facial muscles so the wrinkles are visible.
• I bring the patient to my treatment area, where there skin is cleansed, and the injection sites are marked. I offer patients a machine that blows cold air or a frozen gel pack to cool the treatment area. Cold air or cold packs help to decrease swelling, which is usually minimal.
• I offer the patient a chance to inspect the vial of Allergan Botox Cosmetic that will be used for their treatment.
• I draw up the proper Botox dose, and inject the treatment sites. I use a very small needle (31 gauge- about as thick as a thick hair) and a small syringe. This minimizes discomfort- most patients feel the anticipation of the Botox injection is 10 times worse than the actual injection is!
• It’s worth noting that there’s several different “noises” you may hear or feel. Sometimes a “pop” occurs when the Botox needle pokes through the muscle membrane. There can also be a crackling sensation as the Botox is injected into the muscle. These are normal. Keep in mind that these noises can and do occur, despite using a sharp needle that is very thin (30 gauge or higher). Most physicians with extensive experience in Botox injections have had patients describe this, even though these noises can’t be heard by anyone else besides the patient.
• The “crunch” with deep injections described below may even sound or feel like a weird scrape. This can happen with too deep of an injection, and can occur with less experienced injectors.
• After treatment, I review post-procedure instructions with my patients, and arrange a follow up visit in 10 days. Photos are taken at that time to evaluate treatment. Results are not seen immediately- this takes 3 to 10 days.
• Of particular importance, I advise patients not to rub the treatment area for 24 hours, and, above all, don’t rub towards the eyes. This can increase risk of vision changes and eyelid droop.

Over 95% of patients are satisfied with Botox treatments. Remember- It’s Your Face! For best results, seek out treatment from a Medical Doctor experienced in Botox treatments who performs injections him- or herself.

Botox Cosmetic is a purified protein that is injected with a very small needle into the belly of a muscle to relax it, resulting in smoother lines around that muscle. Most people tolerate these injections very well, seldom requiring any type of anesthetic prior to injection.

There are a few side effects that come from Botox injection. Some people do experience a little bit of stinging, but usually feel something afterwards mostly due to the volume of fluid injected into the muscle.

Some people may have headaches or feel a little under the weather after the injections. The headaches are usually associated with a deeper injection, if the needle penetrates the lining of the bone called the periosteum. If the needle hits this layer, you may hear and/or feel a crunch. With appropriate knowledge of the musculature, the injector should not reach this layer. I hold the muscles and determine their depth while I'm injecting, so my clients usually don't even feel the needle going in.

Prior to any injection (Botox or dermal fillers, etc), you should avoid alcohol, aspirin, and a number of other supplements that thin the blood. Ask your physician to provide a list of these supplements that increase your chance of bleeding / bruising. I recommend Arnica gel and homeopathic tablets before and after injections to minimize bruising. Avoid getting injections within two weeks of a special event, since you may bruise if the needle inadvertantly nicks a blood vessel under the skin.

You may apply ice after the injections, but do not massage the area after the treatment. I have my clients make expressions using those muscles for one hour after the treatment to help the Botox know which muscles to gravitate toward.

As for the results, patients rarely notice any immediate improvement in the lines. Over the next few days, it will progressively become harder to create the same expression, and the lines will become less and less evident. Full relaxation of the muscle can be expected at two weeks after the injection. The amount of Botox used determines the amount of relaxation.

Keep in mind that the forehead muscles (Frontalis) are the only ones holding your eyebrows up, so if too much Botox is used there, you could end up with a heavy-feeling brow, and possibly temporarily lose the arch to the brows.

The most improvement you can realistically expect is if you gently stretch the skin where the lines are while you're looking in the mirror. If these lines are permanent (also known as "static"), you may need other modalities to decrease the appearance of these lines, such as microdermabrasion, chemical peels, or dermal fillers.

I like to do microdermabrasion for my clients when they come in for a Botox Cosmetic treatment, since they will not see results from the Botox immediately. Meanwhile, they get to walk out with fabulously glowing skin, less visible wrinkles, and the lines get filled in from the collagen created with the microdermabrasion treatment.