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What is "Botox"?

Facts About Botox

Steve Fallek (Plastic Surgeon and Medical Director, Face Focus Medical Spa) gives expert video advice on: What are the potential side effects associated with Botox injections?; How does Botox help migraines and headaches?; Can I receive Botox if I am pregnant? and more...

What is "Botox"?

Botox is shorthand for botulism toxin, which is a paralysing agent. The way that Botox works is that it paralyzes the muscles in the body and therefore prevents any movement in those muscles. Therefore, wrinkles on top of those muscles are no longer going to be visible.

Who makes Botox?

Botox is purified by the Allergan Corporation in California. Even though we use the term Botox fairly generically, it is sort of a trademark name of the Allergan Corporation.

Are Botox cosmetic injections approved?

Botox cosmetic injections are actually approved for the glabella area; that's the area between the eyebrows, but many of us will inject Botox in other areas, such as the crow's feet, or in the forehead area. For many medications, the FDA approves the medication for one or two different uses, but many times, doctors will discover alternative uses for that medication and will use it in what is considered an off-label approach. Use of Botox in the crow's feet is not part of the FDA approval, but certainly almost all of us use it in an off-label approach.

Who can give Botox injections?

This is a great question because there are a lot of physicians in this country giving Botox injections. And the range of those giving Botox injections goes from plastic surgeons to family practitioners and radiologists. Almost anybody can buy Botox as long as they have a medical license. I think what's important is that whoever is doing your Botox injections is qualified. In my personal opinion, that should be either a dermatologist, facial plastic surgeon or certainly a plastic surgeon. For many physicians, what's interesting is they have either physician assistants or nurse practitioners that are giving the Botox injections within their office.

What are the potential side effects associated with Botox injections?

What I love about Botox is that it is, for the most part, safe and effective, and really works well. The major complications and side-effects with Botox are: one, sometimes there can be some bleeding at the site of injections. For most of us, we use a very tiny needle, so that's really not an issue. The second most common complication with Botox is that, for some patients, the Botox doesn't work, and for most of us, we will just re-inject that area. In terms of using Botox around the eye area, the number one concern is that sometimes you can get some eyelid drooping, and that's usually temporary and will go away. In terms of doing Botox injections around the mouth, the muscles are pretty tiny around there. As a result you can get some paralysis around the mouth, but again, that will usually wear off rather quickly.

What are the benefits of Botox?

What I love about Botox is it is safe, effective, and it really works. Botox involves a tiny injection into areas. Botox is relatively painless, and it does as it's advertised. Botox paralyzes those muscles and gets rid of wrinkles around the eye area. For other applications such as hyperhydrosis or excessive sweating, Botox really works. So Botox surgery is minimally invasive. It's a small needle stick and it really works as advertised.

What are the drawbacks of Botox?

What I love about Botox is that it is safe, effective, and really works. When do we have problems? It's usually one of two things. One is, depending on who is doing the Botox injections, there can be injections in the wrong areas where the Botox can leak out, and that's when you have problems. The other problem with Botox is overuse. What you'll see is, in your Hollywood celebrities, people with frozen foreheads and eyebrows that don't move; it's been very easy to make fun of those people. However, I think with judicious and careful use of Botox, there's really no downside.

How is Botox applied?

Botox comes in a crystallized form in a small vial. On the date of your procedure, your doctor will add either normal saline or water to the small vial, draw up the Botox in a syringe, and then inject it into the muscles that are to be paralysed. Each doctor has his own solution. There are 100 units of Botox in a vial, so how many Botox units are injected into the area will depend on how much he dilutes the Botox. That's something you may want to ask your doctor; "How many units of Botox do you usually inject in a certain area?"

How much Botox is used in an injection?

Each doctor has his own solution. There are 1 units of Botox within a vial, so how many units of Botox are injected into the area will depend on how much he dilutes the Botox. That's something you may want to ask your doctor; "How many units of Botox do you usually inject in a certain area?"

What are glabellar lines and how can Botox repair them?

Glabellar lines are the vertical and horizontal lines in the forehead area between the two eyebrows that most of us get from squinting. As we get older, those lines become more and more prominent. Sometimes when we're younger, our parents have them and we develop them at an earlier age. The easiest way to get rid of those glabellar lines, or glabellar wrinkles, is from Botox injections.

Who can get a Botox injection?

Botox injections can be injected in almost anyone, although I think there are a couple of important criteria. First of all, teenagers or young children should certainly not have Botox for a cosmetic purpose. If Botox treatment is being done for a medical condition, that's one thing. For example, I do have certain teenage patients that have excessive sweating from diabetes, and those are patients who may have Botox injections. In general, children and teenagers should not have Botox injections. The other people that should not have Botox are any people who are pregnant.

How does Botox help migraines and headaches?

What's interesting about Botox is that initially it was discovered as a paralysing agent, and was used in the field of nuerology for neuromuscular diseases. It quickly moved over to the cosmetic field as we discovered that Botox removed wrinkles. When we started injecting Botox into the forehead and crows feet area, many patients that also had migraine headaches realized that the headaches were going away with the Botox. It's a really comfortable circle that Botox is now being used again in the field of neurology for migraine headaches.

What is "hyperhidrosis" and how can Botox treat this condition?

Hyperhydrosis is a fancy term for excessive sweating. The most common areas for hyperhydrosis are in the armpits, the hands and in the soles of the feet. Hyperhydrosis can be quite embarrassing and what's great about Botox is it paralyzes the small muscles around the sweat glands. So it really takes care of hyperhydrosis in those areas. Botox works for about six to eight months and works very well before the wedding day and before the Oscars.

What is a "Botox party"?

A “Botox party” is really a slang expression for when a variety of patients get together, either in a doctor's office or in an informal setting, and all get Botox injections together. The reason that Botox parties have gotten a negative response is because many times there was alcohol served, and what is considered a medical procedure was really treated in an informal manner. There's nothing wrong with having a Botox party, but the members of the Botox party should always remember that it is, in fact, a medical procedure that requires an informed consent. Having a couple of beers before a medical procedure is never a good idea.

How long does Botox last?

Botox usually lasts anywhere from six to nine months. Some of it is dependent on how many units of Botox are injected into an area, so that might be something you may ask your doctor. What's great about Botox is that it's a small needle, a tiny injection, and done in your doctor's office and done rather quickly. For most of us there's really no downtime associated with Botox. There are very few restrictions involving Botox, such as not doing yoga or standing on your head. However for the most part you can have a Botox injection and then go right back to work, or do whatever you need to do.

Can I receive Botox if I am pregnant?

There are no specific regulations against injecting Botox into pregnant patients, but I believe that the majority of plastic surgeons and other cosmetic surgeons in this country should not inject Botox into anyone that's pregnant.

What should I tell my doctor before receiving a Botox treatment?

It's important to tell your doctor whether or not you have any medical conditions before getting a Botox injection, specifically if you have a neuromuscular disease or any autoimmune diseases, you may not be a candidate for Botox injections. The other issue before a Botox injection, and what many patients neglect to tell their doctors is whether or not they're taking aspirin or any other anticoagulants, or blood thinners, before having a Botox injection. If you are taking certain blood thinners, or certain herbal medications that can make it more likely that you'll bleed after the procedure, you may be better off holding off on Botox injection for a week or two.