Dr. Copeland: Botox is one of the most common procedures performed today in the United States, and it's an effective way to reduce lines and wrinkles of the face. It's FDA approved only for the reduction of the glabella lines, but we do use it off-label for crows-feet, for the furrows of the forehead, often for reducing the platysma bands in the neck and even the perioral rhytids that can occur.

It comes in two different sizes: one is a 100-unit vial, and another is a 50-unit vial. And it's supposed to have been prepared fresh, and the way it is prepared is mixing it with a sterile preservative-free sodium chloride solution. And I use a tuberculin syringe to do this, it's prepared fresh.

Now, the Botox is diluted, and you can dilute it either to two and a half or three millimeters. I prefer to use the three-millimeter dilution. So we mix it up right before we do the procedure. And now I'm going to demonstrate my technique for Botox.

So Susan has had Botox before, and typically my patients return for their treatments anywhere from 4 to 6 months. We're going to be doing it in the frown lines, the glabella lines, the forehead, the crows-feet, a little bit in the platysma bands, as well as the perioral area. So she's pre-iced to help with some vasal constriction. And now, what we're going to do is I'm going to have her make the facial movements, so that directs me as to where I am going to inject the Botox.

So we pre-alcoholed all the areas, swabbed all the areas that I'm going to be applying the Botox. And now I'm going to ask Susan to make some facial expressions. So the first thing you're going to do is smile. All right, and as she does that, that will direct me into putting just minute amounts of Botox in this area. I prefer to under-correct than over-correct.

Frown now. This is going to direct me into the glabella area. Now raise your eyebrows. And of course, we want to be very careful not to drop the eyebrows. So I do put a little bit right in the arch of the brow, and then a small amount along the forehead as she's raising her eyebrows. So that allows me to know where to apply it.

So we've applied Botox in where the crows-feet are, the glabella, the forehead, taking care not to drop the eyebrows. And now I'm going to be putting... just clench your jaw slightly. So we can see where the platysma bands are, and that's where I inject. I inject right into those bands. And that will help soften these bands, and it creates a more defined jaw line.

Now the next step will be the perioral. And I use the technique, as I said, of meso Botox. So that's not being directed directly into the muscle but into the subdermal area. And we're applying pressure where we've injected in the forehead.

Now what I'd like you to do is just puffy your lips. This directs me as to where I'm going to be injecting this very dilute solution of Botox which will help soften these lines without affecting the ability to move the muscles. So I check again and see. And that's sufficient.

So you can do this on the upper lip, you can also do it on the lower lip. Sometimes when there are fine lines, I use that same technique. But that's sufficient to mount.

So we're applying ice to the areas that we injected in, and she stays here for a few minutes before she leaves. And of course, we give her instructions as what you can do afterwards. And as I said, Botox takes between 24 and 72 hours to see an effect, but up to 2 weeks to see a maximum effect. So I do have my patients come back in 2 weeks, and if they need more, I include that in the treatment. And I do that so that it's not an over or under-correction. I think that helps to avoid drooping eyelids, eyebrows and inability to move the mouth.

So we can see here she'll be ready to go. And people do this at lunch time, at least in New York City.

Botox Preparation and Injection Technique

Dr. Michelle Copeland explains how she prepares the Botox solution as well as her personal technique for injecting specific areas of the patients' face for tightening and smoothing.