Thank you for your question mirielles. I understand your concern. Botox is a purified proteinused to address wrinkles associated with facial expression. When injected intothe skin Botox will relax the muscles and smoothen out the overlying wrinkles. Themost common areas of treatment are in the upper face. These include thehorizontal lines seen on the upper forehead when one raises the brows, thevertical lines seen between the brows when one frowns (frown lines), and thecrow's feet seen around the eyes when one smiles.It is difficult to make an assessment without aformal exam in the office where I can view the skin in multiple angles and observewrinkles formed with facial expression. However, I hope the informationprovided here is useful.Botoxand fillers are two dermal (skin-related) products are both very popular fortheir anti-aging features. Unlike Botox, which relaxes muscles to smoothen outwrinkles associated with facial expression, fillers restore lost volume invarious areas of the face and body. Common fillers include the Juvederm family(Juvederm Ultra, Juvederm Ultra Plus, Voluma, Vollure, and Volbella), theRestylane family (Restylane, Restylane Lyft, Restylane Silk, Restylane Refyne,and Restylane Defyne), Belotero, Radiesse, Sculptra, and Bellafill. With agechanges occur in the bony structures as well as fat pads, both of whichcontribute to a youthful appearance. Over time bones move and change shapewhile fat pads get smaller by losing volume and move downward. Fillers restoresuch lost volume. Common areas of volume loss include the temples on the sidesof the face, the upper cheeks, the tear trough area under the eyes, thenasolabial folds which go from the sides of the nose to the corners of themouth, the marionette lines which are the continuation of the nasolabial foldsto the jawline, the chin, and the jawline. Often times combining fillers withBotox treatments yields superior results.The safety record of Botox is well established.The product has been used for over 20 years for a variety of treatments withminimal side effects. Botox is amongst the safest treatments for treatingfacial wrinkles.While Botox is one of the safest treatmentsoffered, there are some situations where it is not appropriate. These includeanyone who has an allergy to any of the inactive ingredients or who has had anallergic reaction to any botulinum product including Botox, Dysport, Xeomin, orMyobloc. Botox should not be placed in the skin on the site ofan infection. Those who are taking anaminoglycoside antibiotic, an anesthetic, D-penicillamine, antimalarials, orimmunosuppressants should not be treated, nor should those who have undergonechemotherapy within the previous six months. It is important to avoid bloodthinners before and after a treatment. These include both prescription andnon-prescription medications such as warfarin (coumadin), aspirin, ibuprofen,alcohol, fish oil, vitamin E, and ginko biloba. Those with conditions that affectmuscles and nerves such as amyotrophic lateral sclerosis (ALS or LouGehrig's disease), myasthenia gravis, or Lambert-Eaton syndrome should notundergo Botox treatments.The safety and efficacy of Botox treatments havenot been determined in women who are pregnant, trying to become pregnant, orbreast feeding. There is also no evidence that Botox crosses the placentalbarrier, but such studies have not been published. While some physicians arecomfortable treating women who are pregnant, trying to become pregnant, orbreast feeding, in the absence of data I err on the side of caution andrecommend that my patients avoid Botox and other such cosmetic treatments untilthey are no longer breast feeding.With any injection, there are risks such aspain, bleeding, bruising, redness, swelling, tenderness, and infection. We takespecial 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 usuallyresolve within two weeks if untreated. After a laser treatment bruises usuallyresolve in 1-3 days, but may still take two weeks for full resolution. Inaddition to these risks, with Botox there is also a risk that the product spreadsor diffuses to nearby structures. Spread to nearby muscles can lead to sideeffects such as the temporary appearance of droopy eyelids or a temporaryasymmetric smile.After a Botox treatment, I recommend that mypatients avoid heat exposure, alcohol consumption, and strenuous exercise for24 hours and not lie down flat for four hours. This is because all of theseactivities may possibly lead to the movement of the product and consequent sideeffects such as droopy eyelids as described above. Although there have been nodefinitive studies shown that these actually occur and some physicians do notprovide such aftercare instructions, in the absence of data I err on the sideof caution and recommend that my patients avoid such activities.Please consult with a doctor for specificrecommendations. Good luck!
