By Southern Marin Dermatology’s Dr. Ashley Smith
By now, Botox has become a household name. Most people have either had a treatment or know someone who has. Sometimes people mistakenly think an overly aggressive and unpleasing cosmetic outcome is due to Botox when in fact, it is more likely due to too much cosmetic surgery! Botox may not be to blame.
Botox is a simple injection procedure, which takes about 5 minutes. The placement of the injections is very important. The placement and dosage of the Botox is what dictates the final cosmetic outcome.
Performed correctly, Botox should provide a natural, relaxed appearance to the skin and face. At Southern Marin Dermatology our goal is to inject Botox into specific muscles, which then inactivates them. Hence, the muscles cannot contract so vigorously and cannot create deep furrows and lines. No longer will your work colleagues inappropriately think you are upset or distressed during a business meeting. The line between your brows doesn’t need to be constantly contracted! This often occurs when we are listening intently or pondering something.
Unfortunately, over time, the constant usage of certain muscles leads to permanent etched in wrinkles and these wrinkles are not desired by many patients. Botox can help prevent this from occurring! I tell my patients, it’s one of my top three preventative treatments. (The other two are broad-spectrum sunblock containing adequate Zinc Oxide and prescription Retin-A or tretinoin).
When is the Right Time to Start?
Many of my patients are excited to learn that Botox can be a preventative treatment. In 2006, plastic surgeon Dr. William J. Binder did a groundbreaking twins study, which proved the effectiveness of Botox as a wrinkle preventer. In the study one identical twin was injected with Botox for 13 years (starting at age 25) while the other was Botox-free. Despite living in sun-damaging Malibu (her non-Botox injected sister lived in Munich) the treated twin looked at least five years younger!
You also might be relieved to know that once you receive a Botox injection, you are not signing up to continue it forever. (Unless you want to! And here is your fair warning, you will like the smooth, natural results.) If you choose to discontinue future Botox treatments, nothing “bad” happens. Your face will not fall or sag. In fact, you will look better since you relaxed those muscles during the treatment course (it usually has an effect for 3-4 months).
Where Does Botox Get Placed?
The most common area for Botox treatment is between the eyebrows (called the glabella). Other popular areas are the forehead, “bunny lines”(nasalis muscle), chin (to reduce “pebbly” texture), lips (to reduce “smoker’s lines”), corners of the mouth to reduce a strong frown (depressor anguli oris), or the neck to reduce banding or “turkey neck” (platysma muscle).
Before and on the Day of Treatment
To reduce the chance of bruising (with any injection!) it’s best to avoid taking aspirin, anti-inflammatory medications (like Advil, Motrin, Ibuprofen), herbal supplements with garlic, ginkgo, vitamin E, or fish oils for 2 weeks prior to injection. This is not a requirement but may be helpful to reduce bruising. Some patients opt to take oral Arnica Montana from the health food store to further reduce chances of bruising. Fortunately, bruising with Botox injections is rare. The most common area of the face to bruise is around the eyes, or crows feet area.
On the day of Botox treatment, it’s important to avoid exercise after the injection. This is to reduce the chance of any migration of the injected medication. So you can either do your run, yoga, or cycling before your Botox or just use it as an excuse to skip a day of working out!
What Else Do You Need to Know?
Well, Botox is a purified protein derived from a bacteria. It has been used safely in medicine for about 25 years. Its initial indications included its use in kids with crossed-eyes (strabismus). Its approved use for cosmetic indications occurred in the USA in 2002.
It is a very safe medication, however it should not be injected during pregnancy or breast-feeding. The black box warning by the FDA highlights very rare cases of migration of the medication in sick patients, typically with major spasticity of large muscles and receiving very high dosages.
Botox is approved for use in adult cosmetic patients. While the majority of patients receiving treatments are still women, the number of men receiving injections is increasing. Careful placement of Botox in male patients is important, since treating a male patient with doses or placement typical to a woman, may cause feminizing features, e.g. an arched brow. While an arched brow is pleasing in a female (and often why women receive Botox- to lift their brows and open their upper eyelid back up), it’s not the ideal for most men.
So whether it’s for prevention and/or reversal of fine lines, Botox can be artfully placed for a beautiful outcome. Are you considering it?