Not asked to smile/frown - is this a normal Botox Injection practice?

Question

So I’ve been looking for a place to begin getting anti-wrinkle injections for a while now, and my friend took the plunge and chose a clinic I’d been looking at and got it done. I asked her how it went and she told me the injector went straight ahead and started without asking her to frown/smile to see her dynamic lines. She did her forehead, then asked her to smile only once before doing her outer eyes. Is this normal? Or should I look elsewhere to get my first treatment?

Camille Cash, MD · Answer

Techniques do vary by injector.  There are some standard injection sites for common issues but most injectors would ask the patient to animate in order to determine how strong their muscle reactions are and if they are symmetrical as well as to determine areas that need to be addressed.

Jason Emer, MD · Answer

Different physicians have different techniques and approaches when injecting. ​For glabellar lines (or frown lines / ""11"" lines), we inject Botox, Xeomin, or Dysport into the muscle, causing the muscle to weaken and improving the appearance of the lines. These work by binding to receptors that send nerve signals for muscles to contract. Since your body makes new receptors and neurotransmitters all the time, it needs to be maintained otherwise the wrinkles will slowly return as the muscle regains function over time. Neurotoxins take 2 to 4 weeks to start working and lasts for up to 6 months.

For deeper glabella lines or strong 11s, I use a combination of Botox with fillers, lasers and microneedling with PRP. I suggest getting a formal evaluation with an experienced cosmetic dermatologist and expert in lasers and fillers. Best, Dr. Emer

George Yang, MD · Answer

Hi CecilyJain, The main reason to have the person frown or smiling is to see where the beginning and the ends of the muscles are located. In order to maximally paralyze the muscle, it would be nice to know where the muscle starts and ends. For the frowning muscle AKA corrugator muscle, when you frown you will note a small indentation that forms at the mid to inner brow area. This is the end of the muscle. The middle of the muscle is not as important since some botox will be injected there any way. I do like to look at their frown, to see if one side is deeper than the other, in which case I will borrow a unit from the less deep side and give it to the deeper side to try to even things out. The reason for smiling is to locate the wrinkles for the crow’s feet. Not everyone’s crow’s feet are in the same location, and sometimes one side is deeper than the other side. We don’t know why that happens, but some patients swear that the deeper side is the one that they sleep on. I don’t know if that is definitively the real reason, but I do know that the wrinkle seems to be deeper on that side, so I will borrow a unit or 2 from the better side and give it to the deeper wrinkles side. If it appears pretty symmetric, then I will inject it symmetrically. Sometimes the deeper side changes, which is why I always check. Another thing that I like to do, is to take a photo of my markings, in case I need to make an adjustment in the injections sites or if they simply really like my last pattern, I will just try to replicate the injection sites and dosing as I did the previous session. This is an attempt to provide as much value and result to the patient so they have no reason to keep jumping around from one injector to another for either convenience or pricing. Hope this answer provides some value to you. Good luck in Newcastle. Best, Dr. Yang

Douglas Taranow, DO, FACOS · Answer

Every injector has their technique.  I have the patient animate several times to asses their movement and wrinkle pattern.
There is no right or wrong.  If you see that several people have good effects at this clinic, you are fine.
Best wishes.
Dr. Taranow

James Fernau, MD, FACS - Account Suspended · Answer

Hello, and thanks for your question. Best practice is to ask the patient to smile and frown before injecting the botox, however it isn't necessarily wrong if it is not done. You may want to seek out another clinic if you feel uncomfortable going there. Best of luck to you! 
Sincerely, James Fernau, MD FACS Aesthetic Surgery Certified, American Board of Plastic Surgery Certified, American Board of Otolaryngology/Head & Neck Surgery Member: American Society of Plastic Surgery (ASPS) American Society of Aesthetic Plastic Surgery (ASAPS) International Society of Aesthetic Plastic Surgery (ISAPS) American Academy of Facial Plastic Reconstructive Surgery (AAFPRS) American Academy of Otolaryngology/Head & Neck Surgery (AAOHNS) American Society for Laser Medicine and Surgery (ASLMS) The Rhinoplasty Society

Not asked to smile/frown - is this a normal Botox Injection practice?

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Not asked to smile/frown - is this a normal Botox Injection practice?

Answers (8)

Answer: Botox

Answer: Botox

Answer: Normal botox injection practice

Answer: Normal botox injection practice

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Everything you need to know about Botox

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