Thank you for your question Western cape. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.Botox comes in a powder in small vials on dry ice or a cold container. Upon receipt from the manufacturer the product is refrigerated or frozen until it is used. However, there have been reports that if the product is left at room temperature upon arrival for as long as 72 hours before refrigeration, there is no change in efficacy. Per the manufacturer’s guidelines, Botox is prepared by reconstituting the powder with preservative-free normal saline. I prepare the product using preserved saline which allows for greater comfort during injection and for the product to last longer. The guidelines call for use of 2.5 mL of saline for 100 units on Botox or 1.25 mL of saline for 50 units of Botox, which yields 4 units per 0.1 mL. I use these volumes, but some doctors prefer to use more or less to make the product more dilute or more concentrated. When the product is more dilute, it is easier to use smaller doses which are generally required in the lower face. On the other hand, when the product is more concentrated, it is less likely to spread. Because of variability in preparation, the terms used for dosing are units, not volume. This is because the same number of units can be administered with different volumes of product depending on the preparation. Recommended dosing is given in units, which is a measurement of activity seen in laboratory testing.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
