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Introduction: What is Botox?

Botox injection or Botulinum toxin injection is most commonly known for its successful use in cosmetic therapies.

Initially, Botox was approved to treat strabismus (crossed eyes), blepharospasm (spasm of the eyelids), and cervical dystonia (muscle contractions in the neck). Added to the list of indications is FDA approval for relaxing frown lines in the glabella area between the eyes on the forehead.

Botox injections reduce facial lines and wrinkles formed from the aging process and by hyper-functional muscles. It can also be used to treat excessive sweating.

Botox is a purified protein toxin produced by the Clostridium botulinum bacteria. Although Botox is a toxin, there have been no serious side effects reported. This is because it is used in extremely small amounts for medical treatments and does not spread throughout the body.

Who is an Ideal Candidate for Botox?

Anyone who has facial movements can essentially be a candidate for Botox injections. All facial movements involve contractions of facial musculature and these contractions can lead to one of the most common signs of aging – wrinkles. These wrinkles, especially if they appear when your face is at rest, can make you appear tired or even angry when you are not. Botox is a way to help quickly get rid of these lines or at least minimize them if they are more deep set.

The conditions which are contraindicated for the use of Botox injections include:

  • Pregnancy and breastfeeding
  • Previous history of reaction to the toxin
  • Neurological diseases (myasthenia gravis, Eaton-Lambert syndrome, neuropathies)
  • Age -below 12 years
  • Infection or inflammation at the injection site
  • Use of certain medications such as aminoglycoside antibiotics (may increase the effect of botulinum toxin), chloroquine and hydroxychloroquine (may reduce effect), and blood-thinning agents, warfarin or aspirin (may result in bruising)

Pre-Injection Assessment

Before your injection, a detailed medical history is obtained, and a thorough facial analysis is performed to see if Botox is right for you. During your consultation, your doctor will advise you to stop smoking, if you smoke, to avoid post-injection complications. You should inform your doctor of all medications that you are taking and about significant medical conditions, allergies and previous surgeries if any.

Photographs will also be taken during pre-injection consultation, to be used for before and after comparison. Your goals will be discussed, and realistic expectations will be set. After discussing your goals, we will make an individualized injection plan together that best suits your goals. Your Botox injection can happen on the same day as your initial Botox consultation.

This is the best time to ask all your questions so that you can feel comfortable and confident going into surgery.

Procedure: Botox Injection

The area to be injected is cleaned thoroughly. The Botox is injected into the specific muscles that are being targeted with a very thin needle. The needle may be replaced multiple times as needed so that it does not dull.

By targeting the specific muscles that relate to the specific wrinkles that you want to minimize, the remainder of you natural facial expressions can be preserved.

Botox injections typically take less than 15 minutes.

Risks and Complications of Botox Injections

Botox injection is relatively safe, however, there are complications that can occur including:

  • Bruising and soreness at the injection site
  • Flu-like symptoms
  • Headaches
  • Nausea
  • Redness
  • Temporary facial weakness or drooping eyelids

*Do not rub or massage the treated areas after the wrinkle treatment because it can cause the Botox to migrate to another area of your face. If this happens, you could have temporary facial weakness or drooping.

*It is very unlikely that the toxin might spread beyond the treatment area, causing botulism-like signs and symptoms such as breathing problems, trouble swallowing, muscle weakness and slurred speech.

Recovery after Botox Injections

No anesthesia is required for Botox. There is no downtime or recovery for Botox, although after you leave the office and lateral that night you may notice bumps or redness where Botox was injected; these changes should be gone by the next day.

You may resume normal activities right away.

One note of caution: Don't rub or massage the treated areas after the wrinkle treatment because it can cause the botulinum toxin to migrate to another area of your face. If this happens, you could have temporary facial weakness or drooping.


The effects of Botox can start to be seen in the first 24-48 hours. However, the results will be evident after 1-2 weeks. The results typically last about 3-4 months and during this time you will enjoy a wrinkle free or minimized wrinkle appearance. When the effects of Botox start to wear off, you will notice a gradual increase in facial muscle contractions and a return of your wrinkles.