botox complete guide intro


Cosmetic Botox treatments are the most popular aesthetic treatment in both Canada and the US—and that's no surprise. Botox injections are a surgery-free alternative with virtually no downtime and almost no pain or discomfort in most cases. And the results, of course, speak for themselves.

Still, although Botox cosmetic injections are overwhelmingly popular, most people don't know that much about how the process works. That's why we have assembled this complete guide to Botox. In our guide we've provided detailed discussions of the questions we've gotten from clients over the years along with the insights we've gained from our combined decades of practice. And remember, contact us with any questions you have anytime.

What is Botox?

Botox is a purified protein derived from a neurotoxin that is created by the Clostridium botulinum bacteria. This same neurotoxin causes the food poisoning botulism that is sometimes caused by home-canned foods. Even so, Botox itself is a purified version of the neurotoxin, processed to render it a safe, cosmetic-grade, high-quality product that is used in medical procedures (including the treatment of visible signs of aging).

Botox Cosmetic is made by Allergan under strictly regulated conditions. This company has made the product for more than 20 years, with an excellent record for safety. During that time it has been used to treat tens of thousands of patients both cosmetically and medically and has maintained its approval on the market.

How does Botox work?

Scientists first took notice of the neurotoxin that causes botulism in the context of cosmetic enhancement because botulism can cause paralyzed muscles. This gave researchers the idea to develop the toxin in tiny, controlled doses to cause facial muscles to relax. The purified liquid Botox is injected into the muscle and its proteins bind with motor neurons. This in turn prevents the release of acetylcholine, a neurotransmitter which sends what we think of as nerve signals that trigger muscle contractions. Since it is contracting muscles that cause wrinkles, this forced relaxation of the muscles leads to softened, relaxed wrinkles.

The key to making this process work right and achieve the look you want is injecting in just the right places. By doing this you block the right signals and let the rest through. You only want to block the signals that are causing wrinkles. By leaving the rest alone you allow your face to retain its natural expressiveness.

What is Botox used for? Where does it work best?

There are a number of target areas for injections that Botox is typically very effective in treating:

  • Around and under the eyes to treat crow’s feet
  • Just below the lateral aspect of the eyebrow achieve a brow lift, smooth frown lines, and brighten the eyes
  • On the forehead to help smooth out wrinkles, horizontal lines, or worry lines
  • In the platysmal or muscle bands on the neck to reduce the bands in the anterior neck area
  • In the marionette lines of the upper lip to soften them
  • To treat chin dimples
  • In vertical frown lines (also called 11 lines or bunny lines) between the eyebrows in the glabellar area
  • To soften vertical lower lip lines and reduce the mouth's age-related downward turn

What is getting Botox like?

Getting Botox cosmetic injections is fast and easy. It is minimally invasive and the injections themselves are tiny. Your appointment time typically takes 10 to 15 minutes total. First your doctor conducts a local examination of the area you'll be treating that day by asking you to move certain muscles. Then he or she will decide precisely where the injection will go.

You will not need anesthesia because discomfort is minimal; in some cases you might use an ice pack to reduce it even further. Unusually sensitive patients may receive anesthetic cream before their injections. The actual injections take between one and three minutes in most cases and there is no downtime afterwards.

Do the injections hurt?

Do injections hurt?

Because Botox is injected with such a tiny needle, it is not painful. It is a lot like a needle used for acupuncture, so it is very fine. The Botox liquid itself does not cause inflammation or irritation. In rare cases patients experience a mild stinging feeling that quickly passes.

How long does Botox take to work?

Typically you will see the effects of Botox within 72 hours of your treatment. In some cases it can take up to a week to see the full effects, however. If it is your first treatment your doctor may ask you to come back within a week or two so they can ensure you responded well. Remember, it is common to see only a partial response after one treatment, but even when this happens the patient does get the full benefit after the second or third application.

How long does Botox last?

Usually a Botox treatment lasts between three and four months. Some muscle movement may begin to reappear at about three months, but total muscle movement will not be restored until about five months have passed. The exact time your treatments last will depend on several factors, including where you were treated, what dose you received, and to a lesser extent your own body's makeup.

Your face is home to 43 muscles, and the optimal dose for each spot is different. Your initial consultation with your doctor will be the time you discuss the details of how long each spot's treatments will probably last, and recommended doses. The goal of treatment varies depending on your aesthetics and the problem area. The glabella area, or the frown lines between the eyebrows, are treated with the goal of eliminating them entirely. On the other hand, horizontal forehead frown lines must be treated conservatively to avoid bad results. All mouth and lip lines demand a middle of the road approach; the goal is to reduce the lines but avoid interfering with functions like eating, laughing, and smiling.

Often patients come three or four times during their first year of Botox treatments and then only two or three times a year in following years—once their bodies are more relaxed and used to the treatment it takes less to maintain that state. Every patient is different, so there is no way to predict this exactly.

If I'm getting Botox for a special event, when should I time my treatment?

Lots of patients time Botox treatments to coincide with special events like weddings or reunions. If this is your plan, don't delay and ruin the effects you're hoping for! If you've never had Botox before, schedule your first appointment about four months before the event to be sure you have enough time for your initial consultation and treatment. This way, if for any reason your treatment isn't what you'd hoped or you need to refine your results, you've got time to work together with your doctor to make it happen.

If you've had Botox already, three to four weeks of lead time before an event is about right. You want to make sure you have time to recover in the unlikely event of slight bruising or redness, but not enough time for any of the benefits to wear off.

What happens to Botox once it's in my body?

As we mentioned above, Botox binds to its target right away after it is injected; it doesn't travel around in your body. It then gets metabolized and broken down by your body.

Isn't Botox really just for celebrities or much older people? Who gets Botox?

Actually, although it's easy to think that Botox and other procedures are just for the elite, this isn't the case. These treatments are actually far more accessible to everyday people since they are less costly and don't cause you to miss work. The Aesthetic Surgery Education and Research Foundation found that the typical aesthetic injectable patient is a married, working mother between the age of 41 and 55 with a household income under US $100,000.

Even though the average patient is in the 41 to 55 year old age range, Botox injections are often used by people in their 20s and 30s to prevent deep furrows and wrinkles from forming as quickly in the first place. The prevention of the muscles contracting to form the lines in the first place slows down the entire process.

Can I only use Botox or can I use it with other treatments for better results?

can i onluse use botox or can i use it with other treatments for better results?

You don't have to choose only Botox and stick to it. Many patients use Botox in some areas and fillers like Juvederm in others; really it depends on the look you're going for and the problem area you're targeting. In fact, teaming up fillers and Botox can make the fillers last longer because fewer muscle contractions mean longer lasting smoothness and volume from the filler.

Who should administer Botox?

It's very simple: the difference between Botox that looks terrible—and obvious—and Botox that is invisible yet totally effective is the person who administers it. Board certified physicians are the most qualified to perform Botox injections because they have a deep and extensive knowledge of the physiology of the facial muscles. Experience is also a critical factor; to achieve a truly natural look your physician must have years of practice administering Botox injections to many different patients. Someone who is truly skilled with Botox knows how to customize your treatment to meet the needs of your individual face. He or she can assess your face for asymmetries and facial muscle balance, determine which facial muscles you use the most, factor in things like your social life and job, and blend all that together to produce the look you want. This takes technical expertise, aesthetic artistry, and steady hands.

How can I be certain that what I'm getting is actually Botox?

At Physician Skincare Centre we use only Botox Cosmetic purchased directly from Allergan. Each FDA-approved label has the “Allergan Cosmetic” hologram and is manufactured in and shipped from the US according to FDA safety procedures.

Allergan is the only authorized maker of Botox Cosmetic, so patients must be careful when they see injectables at extremely low prices. Using products from offshore suppliers can be downright dangerous. These knockoffs are not subject to the same quality standards, and leaving this kind of substance baking in the sun on a dock somewhere, for example, not only decreases its effectiveness, but also means it may be unsafe.

Does Botox have medical side effects?

In rare cases, Botox can cause some side effects. These range from very mild side effects like redness or slight bruising to severe side effects like vision problems. Any of these kinds of side effects are incredibly rare. Here are the rarely seen yet possible side effects:

  • Redness at the injection site which typically fades in under one hour
  • Small bumps at the injection site which disappear within 20 minutes of treatment
  • Mild bruising, especially around the eye
  • Partial ptosis or puffiness/ droop under the eyebrow
  • Headaches
  • Blurred vision which resolves within 24 hours
  • Allergic reactions within the first 5 minutes (which your doctor will resolve) Your doctor will discuss all possible side effects with you before any treatments.

Does Botox have unwanted cosmetic side effects?

Does Botox have unwanted cosmetic side effects?

We understand why this worries our patients! We've all seen bad Botox, usually on celebrities. In almost all cases what you're really seeing isn't a Botox problem; it's a lack of skill on the part of the person who administered it. Here are the common cosmetic issues you see, and how they are avoided by a skilled professional:

Frozen face/forehead. This looks just like it sounds: the face that doesn't move. It doesn't look natural and prevents genuine looking facial expressions. In some more extreme cases a practitioner may need to relax certain muscles such as the corrugator muscle which helps you frown to “reset” the face for a more relaxed default. If this is the case and a treatment falls to close to, say, a photo session, you may get a bad celebrity result. However, even if you need to use a higher dose in the beginning to achieve this relaxation, ultimately over time you'd adjust this dose to promote enough movement to allow for natural expressions.

Droopy eyelids. There are two possibilities here. If your eyelids are truly drooping after Botox, call your physician. He or she can help you fix this problem. Sometimes, though, your eyelid just feels heavy because your brow has dropped a bit. In this case, it is just a sensation, so try to pay close attention as you assess the problem. The perma-surprise. This is the look of the last third of one or both eyebrows being permanently arched or popped up too much. This has the additional unintended consequence of creating new wrinkles over the lateral brow. When this happens a few strategically placed drops can solve the problem.

Heavy forehead. Too much Botox in the forehead makes it feel too heavy. It also makes your face look even worse, because it is the result of a poor assessment of your muscular needs. Those of us who have excess eyelid skin raise our eyebrows to avoid hooding around our eyes. The frontalis muscle in the forehead raises the eyebrows; if it is too relaxed the eyes look even more hooded. A doctor skilled with Botox injections should be able to parse this out.

Are Botox parties safe?

You may have heard of Botox parties or even been invited to one. So are they safe and effective? “Botox Parties” are usually planned by providers hoping to gain new clients who would otherwise not seek out treatment, either because they're looking for a deal or because they're intimidated by getting treated inside a medical facility. Unfortunately, the standard of care at these parties is not always up to snuff. Common problems include lack of informed consent, lack of follow up, and inadequate medical histories.

The bottom line is that a medical setting is the only place for cosmetic treatments such as Botox injections. Conference rooms, hotel rooms, homes, and malls are not as clean as your doctor's office, and they don't have the emergency care resources on hand, either. The ability to port and administer Botox injections doesn't imply that you should!

Are there permanent treatments that are alternatives to Botox?

There are always a range of cosmetic options for patients. Whichever doctor you choose to work with, discuss all options with them and ask all of your questions. The treatment that is most effective for you depends on your goals, your body, and other factors, so you and your doctor need to work together to make these decisions.

Some wrinkles can be treated non-invasively with laser skin resurfacing. Surgical alternatives include eyebrow lifts and corragator resection surgery which is the surgical division of the corragator frown line muscles between the eyebrows.

What is the difference between Botox and fillers?

Botox relaxes the facial muscles to soften fine lines. Fillers actually add volume to the skin to deal with more dramatic wrinkles caused as skin loses volume over time. For this reason the cause and type of the line you're dealing with in part controls which works better. The target area is also important. For example, fillers are more useful in places where we can't sacrifice the ability to move—like around the mouth.

Botox myths and facts

Myth or fact: Don't lie down after getting Botox. Myth! You can lie down, this doesn't matter. You can't fly for 24 hours after getting Botox. Myth.

You can't wear makeup after getting Botox. Myth.

Take arnica tabs to reduce your risk of bruising. Well, maybe. Arnica may relieve swelling and bruising. There are not major studies that prove it, though.

You shouldn't go to the gym after Botox. Sort of factual—but not because it affects Botox at all. Because it increases circulation, working out can increase your risk of bruising. For this reason, some doctors prefer that their patients wait a day to get back to the gym.

Don't take blood thinners on your Botox appointment day and for one week leading up to the appointment if possible.

Fact. Avoid Aleve, aspirin, fish oil supplements, ibuprofen, Motrin, and omega 3s because they all thin your blood and increase your risk of bruising.

If I keep taking Botox I'll develop a resistance to it. Almost certainly myth. This kind of resistance is extremely rare.

Conclusion We hope this complete guide to Botox has answered some of your questions. Please don't hesitate to reach out to our team of experts at any time with your concerns.