Elective treatments
Cosmetic Botox
Botulinum toxin type A, given cosmetically, is injected in small doses into specific muscles of the upper face. It blocks the signal from nerve to muscle, so the injected muscle contracts less, and the lines that muscle produces when it moves soften while the effect lasts. It is the same medication used at much larger doses for spasticity and for several neurological conditions — a different purpose, a different target, and a small fraction of the dose.
Where it is used
-
Glabellar lines
The vertical lines between the eyebrows, produced by the muscles that draw the brows together. One of the areas the FDA has reviewed and approved for cosmetic use.
-
Lateral canthal lines
The lines at the outer corner of the eye, produced by the muscle that closes the eyelid. Also an approved cosmetic indication.
-
Forehead lines
The horizontal lines produced by the muscle that raises the brows. Approved, and treated cautiously, because that muscle is also what holds the brow position.
-
Other areas
Elsewhere on the face the use is off-label — outside the indications the FDA has reviewed. Off-label prescribing is lawful and common throughout medicine, and it is worth knowing which category any proposed treatment falls into.
What the procedure involves
-
Assessment of movement
The muscles are assessed while they move, because the pattern of movement is what decides where the dose goes and how much of it. A line present at rest behaves differently from one that appears only on expression.
-
The injections
Several small injections with a fine needle into the chosen muscles. The whole procedure takes a few minutes, and anaesthetic is not usually needed.
-
Immediately afterwards
Small raised marks at the injection points settle within an hour. Staying upright for several hours and not rubbing the treated area is commonly advised.
-
Review
The effect is assessed at around two weeks, when it is fully developed. Small asymmetries are adjusted then rather than at the time of injection.
Timeline
-
Onset
Movement begins to reduce three to seven days after the injection and reaches its full extent by around two weeks.
-
Duration
Three to four months is usual, and the first treatment often lasts less than subsequent ones. The effect fades gradually as the nerve endings recover.
-
Repeat interval
Intervals shorter than three months are generally avoided, both because the effect is still present and to limit the chance of reduced response over time.
Risks and who should avoid it
-
Common and short-lived
Bruising at the injection sites, a headache for a day or two, and brief discomfort during the injections.
-
Drooping and asymmetry
Spread of the medication to a neighbouring muscle can cause a drooping eyelid or an uneven brow. It is uncommon, it is temporary, and it may take several weeks to resolve.
-
Spread beyond the injection site
Every botulinum toxin product carries a boxed warning about effects spreading away from the injection site. Cosmetic doses are very small and such reports are very rare, but the warning applies to the medication regardless of the dose.
-
When it is not given
Pregnancy and breastfeeding, neuromuscular disorders such as myasthenia gravis, infection or active skin disease at the injection site, and known hypersensitivity to the product. Some antibiotics increase its effect and should be mentioned.
Common questions
Is it the same as filler?
No. Filler adds volume beneath the skin. Botulinum toxin reduces the movement of a muscle. They address different things and behave differently over time.
Will expression be lost?
How much movement remains is a function of dose and placement, and it is decided before anything is injected. It is worth being explicit about the result you want at that point rather than afterwards.
What happens if it is stopped?
Muscle movement returns to how it was. Nothing accelerates when the treatment ends.
Does it hurt?
Brief stinging with each injection. Most people describe it as easily tolerable and it is over within a few minutes.
General reference information, and not advice about your own case. It may not reflect the most recent guidance or what is offered on a given day — call (201) 408-5151 to check.
Schedule an appointment
Dr. Yoo Rehab Clinic welcomes new patients from across Northern New Jersey and New York City, including Englewood, Teaneck, Fort Lee, Palisades Park and Ridgefield. Call today to learn more about insurance, scheduling, and how we can help.
