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photos of Dr. Binstock’s patients

How is Botox Cosmetic used?

Botox Cosmetic is botulinum type A derivatives used to relax frown lines, forehead wrinkles, crow’s feet, and the depressors at the corner of the mouth. They can also elevate the eyebrow area, affecting a nonsurgical brow lift. In the neck, Botox Cosmetic is very effective in reducing horizontal neck lines and in relaxing the mid-neck vertical cords, i.e., thickened bands of underlying platysma muscle. They can also reduce lip lines, enhance lip fullness, and reduce marionette lines.

Botox Cosmetic is injected directly into the muscles targeted for relaxation; thus, for example, diminishing your ability to frown, as once the frowning muscles are relaxed, they cannot contract and the frown lines fade away. The frown lines are the only FDA-approved use for both products. Treatment of other areas is considered “off label.”

When Botox Cosmetic is injected into the platysma muscle and bands of the neck, it causes them to relax, improving the neck vertical neck cords that develop over time. This effect actually simulates a neck lift in those individuals who do not have a lot of excess neck skin. Botox Cosmetic can be injected into the frontalis muscle of the forehead to reduce and smooth out forehead lines, as this is the muscle that elevates the eyebrows and causes horizontal forehead lines. Treating the orbicularis oculi muscles just above and around the eyebrows can affect a nonsurgical brow lift by inhibiting the muscles that pull down the eyebrow. Around the mouth, Botox Cosmetic can lessen the depth of upper lip lines, marionette lines, and downward tilt of corners of the mouth. The chin can be injected to reduce dimpling.

How do these products work?

Botox Cosmetic is a purified toxin produced by the bacteria clostridium Botulinum. In very large amounts, this is one of a group of toxins that in unison block nerve impulses to multiple muscles, causing a form of paralysis called Botulism. As we use extremely small doses injected directly into a specific muscle or group of muscles, only the action of that/those muscle(s) injected will be relaxed.

What else do I need to know?

Botox Cosmetic is injected using a very fine needle during a simple office visit. The actual treatment takes only a few minutes and the Botox Cosmetic take effect in three to ten days. Gradually over four to six months the muscle relaxation will fade, and the muscle’s action will return. When lines start to reappear, a simple treatment is all that is necessary to maintain a desired benefit.

Who can perform Botox Cosmetic treatments?

These treatments are best performed by a dermatologist skilled in the use of muscle relaxers and knowledgeable in the action, location, and interrelated function of facial muscles.

How have Botox Cosmetic been tested?

Botox Cosmetic has been used since the 1980s for treatment of strabismus (lazy eye) in children, as an alternative to surgery, and in blepharospasm (uncontrolled eyelid blinking) in adults. Botox Cosmetic was first used for frown and wrinkle lines in the late 1980s, and a major study of this technique was published in 1995 in the Journal of the American Academy of Dermatology.

What are the side effects?

There may be slight discomfort from the needle and a small chance of bruising at the site of the injection. To date there have not been any permanent side effects with the use of Botox Cosmetic for cosmetic purposes.

The risks associated with Botox Cosmetic are minimal, very unlikely to occur, and generally resolve over several weeks. Rarely an adjacent muscle can be weakened for several weeks after an injection. This can manifest as a temporary droop of an upper eyelid in 1–2% of patients whose frown lines were injected. Occasionally, upon injection of frown or forehead lines, numbness of the forehead or discomfort may occur and last a few weeks.

With crow’s feet injections, there may very rarely be a temporary lower eyelid droop.

Injection around the mouth can cause an asymmetry of the smile lines, or corners of the mouth, and injections into the lips can cause weakness in pursing of the lips or sucking on a straw, as well as asymmetry.

Neck injections may very rarely result in temporary neck muscle weakness or temporary difficulty in articulating and/or swallowing. This and other severe reactions have been reported when these products have been in very large doses in children for treatment of spasticity, not when used in small doses for cosmetic reasons.

Who should not be treated?

People with neurologic disorders, swallowing and breathing problems, pregnant and breastfeeding women, people on certain medications that potentiate the action of these agents.

Any and all references to Botox Cosmetic refer to Botox Purified Neurotoxin Complex, which is a registered trademark of Allergan Laboratories, Inc.

Botox Don’t Sweat Treatment for Increased Axillary Sweating

What causes underarm sweating?
Most people with excessive sweating are bothered primarily when they are emotionally stressed, physically active, or overheated. Botox is an answer and can prevent sweating for months by blocking the release of the neurotransmitter acetylcholine, which causes the glands to produce sweat.

What are alternative treatments?

  • Deodorants and antiperspirants. These prevent sweating by clogging the sweat ducts in the skin, can be irritating with continued use, and are largely ineffective in people with excessive sweating
  • Anticholinergic drugs and tranquilizers. Oral medications currently used often provide relief, but can cause dry mouth and blurry vision
  • Tap water iontophoresis. Battery-powered electrical devices applied to the skin that decrease sweating in some people. They are time consuming and need to be repeated on a daily or a weekly basis
  • Surgery. Surgical alternatives include cutting the sweat glands from the skin of the underarms, therein leaving visible scars and possible permanent numbness. Neurosurgeons use a fiberoptic surgical tube to cut the nerves in the neck which lead to the axillary sweat glands (endoscopic sympathectomy). This approach cures the axillary sweating and causes a compensatory increase in sweating over body areas below the level of nerve transaction. Cosmetic surgeons and dermatologists have also attempted to scrape the underside of the axillary skin with liposuction cannulas to remove sweat glands; results had been mixed

How is Botox given?
Fifteen to twenty drops of Botox are injected via a very small needle into the hair-bearing skin of each underarm. Normal activity can be immediately resumed, while heavy exercise should be avoided for several hours.

When will Botox take effect?
Underarm sweating will be decreased by 90% within forty-eight hours and full effect will be seen within one week. There may be a simultaneous disappearance of odor associated with decreased sweating, but this is not consistent.

How long does Botox last?
Most patients will obtain the benefit of dryness with one treatment of Botox for six to ten months.

What are the risks and complications?
Complications from injection into the axillary skin include tiny bruises which fade in a few days, and small persistent areas of sweating that may need a second treatment. There is no risk of numbness or permanent change in the axillary skin, and the risk of temporary muscle weakness is remote.

Any and all references to Botox Cosmetic refer to Botox Purified Neurotoxin Complex, which is a registered trademark of Allergan Laboratories, Inc.