Botox ®

Botox ® by Allergan is one of the great contributions to the armamentarium of all plastic surgeons. I have particularly enjoyed giving Botox® therapy to my patients. In a one word summation, Botox® is wonderful. Most products have the two lists: the good news list and the not so good news list. Botox® offers only good news. There simply is no bad news.

Botox® is a product given by direct injection into a muscle. Its affect is to weaken the function of selected small muscles and thus stop the undesirable results of those muscles contracting. It lasts 4 to 6 months on the average and when properly used by plastic surgeons, it is about as complication free a product as one can imagine. Over the past ten plus years I have treated many, many patients with Botox®. I have found Botox® beneficial for many conditions or problems. Wrinkle reduction is, of course, one of the fortes of Botox®. The human frown can be beautifully corrected. Lateral eye lines (crowsfeet) can be 90% plus reduced with Botox® as well as bunny scrunch lines of the nose. Botox® is a blessing for reduction of forehead transverse worry lines, yielding a more peaceful, happy, youthful appearance. The orange peel texture and lined appearance of the chin can be eradicated. Upper lip lines can be reduced and the progressive formation of such lines prevented.
In addition to wrinkle erasing, Botox® can also be a great agent for fine position adjustment of facial features. Eyebrows can be elevated laterally or even more extensively. Lower eyelid skin positioning can appear to be adjusted in an eye lift endeavor. The corner of the mouth can be beautifully elevated by a Botox® induced to weaken muscles responsible for pulling down the corner of the mouth. A rather sour unhappy expression can thus be converted to a more youthful optimistic appearance. Neck bands that contribute to the turkey gobbler aging appearance are relaxed with Botox®. Each band is individually injected with Botox®.
Botox® is a spectacular treatment for excessive perspiration of the hands, feet and underarms. Dryness comes in a few days and progresses to maximum in a week or so. The duration is expected to last 4-6 months.
Facial asymmetry from whatever cause, trauma, stroke, surgery, neurologic disease, etc., can be easily adjusted with Botox®.
Other uses for Botox® have included treatment for migraine headaches, bladder spasms, spastic muscle problems (cerebral palsy), just to mention a few. For such conditions, I refer patients to neurologists and urologists.

What is a treatment with Botox®® like? What happens? Is there recovery time, risks, pain or bruising? What's the time involved and can I return to work after treatment? Botox® is truly a quick treatment. Although bruising is rare, we feel it critical for patients to do all they can to help prevent any bruising. Prior to a treatment, it is advisable to avoid aspirin, ibuprofen (anti-inflammatory) type products, vitamin E, fish oil, or oral herb therapies. Tylenol is okay. Prior to injection, a cold compress (ice) is placed over makeup free skin for about 5 minutes. The proper number of Botox® units is selected. The patient is given a small vibrator to vibrate near the injection site. The vibration tends to overload the nerve fibers carrying sensory information to the brain, thereby reducing any pain to nearly nil. Tiny 30 gauge needles are used (human hair thickness or less) for this procedure, which I find brings next to no discomfort. When injections have been completed, a light ice pack will again be placed over the injected areas. There are no restrictions on activity, position, or diet. The injected sites may be a bit red for an hour or two, but dissipates quickly. Patients may plan social or business activities immediately after. Since there is always the occasional unlucky patient who develops a small bruise, I recommend not doing Botox® within 48 hours of a very important event. A very tiny needle placed in the skin eventually can hit a tiny blood vessel and a small bruise can occur. Again, it's very unusual, but can happen. The effects of Botox® (smooth forehead or crowsfeet, etc.) often start in 24 hours and max out in 7 - 14 days (usually earlier). Duration of Botox® is thought to average 4 to 6 months. I have seen 3 or 4 patients where it lasted as little as 6 to 8 weeks and another 4 or 5 where duration was up to 2 years (both rare).

Fees for Botox® are best understood by talking in units. Botox® is sold in 100 unit vials. There is no other size available. There is currently only one legal type of Botox® available, i.e. Botox® Cosmetic by Allergan. Other products may pop up, but only Botox® Cosmetic by Allergan is legal and used by all reputable offices. Always ask and get proof. I feel Botox® is best offered as a cost per unit (the unit times number of dollars). Prices will range from $125 to $2000 per treatment, depending on the number of units used. My unit price will always be posted on my web site. It is easy to then simply translate into areas. The actual number of units needed for an area correction varies according to the muscle size (big male vs. tiny female). Here are some approximates:

Frown 15 to 25 units
Forehead 20 to 25 units
Crowfeet 10 to 20 units each side
Chin 5 to 7.5 units
Droopy Mouth 10 to 15 units
Axillary perspiration 50+ units each side
Hand perspiration 50+ units each hand
Foot perspiration 50+ units each foot
Neck Bands 5 to 25 units
Nose (Bunny lines) 10 to 15 units
Upper Lip 5 units
Raise outer brow 5 to 10 each side

In the world of cosmetic enhancement, many comets have come with a flash and quickly departed. Then there are the stars that stay and shine on forever (for all practical purposes), Botox® is a real STAR, a fantastic performer here to stay!