Botox Injections

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• QHow long do Botox injections for wrinkles last?

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  A Dr. Arthur W. Perry, MD , Cosmetic Surgery, answered

  On average, Botox lasts about 4 months, and then, within 2 weeks, your scowl returns with a vengeance. So, I certainly recommend "dosing up" just before the effect dissipates.
  
  You'll be happy to hear that a new study has found that if you use Botox every 4 months for 2 years, the muscles weaken so much that they begin to take longer to recover. And so after 2 years, most people can lengthen the time between injections to 6 months. And while there isn't any data yet, my bet is that when you hit 4 or 5 years of continuous Botox, that wrinkle-killing drug will last nearly a year.

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• QWhat should I know if I'm considering Botox injections?

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  A Dr. Michael Roizen, MD , Internal Medicine, answered

  Almost 1.5 million people knowingly had poison injected into their bodies this past year. Namely, Botox. And that makes Botox the most popular of all cosmetic procedures. Like a smart bomb in search of a target, Botox locks on to your nerves and destroys them within days. This leaves your muscle unable to move. That's great if you want to get rid of those scowl lines between the brows or your crow's feet, but bad if too much is injected into your upper lip. Can you say drool? (Not if you've had too much Botox, you can't.) So that's why most plastic surgeons won't inject those smile lines. It's too difficult to balance the smile and get rid of lines. Botox is as much of an art form as rhinoplasty (over-Botoxing can leave you expressionless). So make sure a real doctor injects your Botox (and don't do it you're pregnant or if you have any sort of neurologic disease).
  
  And make sure you get Botox from the real manufacturer, not the industrial-strength research-grade varieties, which have been associated with all types of complications. You might have heard about a dozen or so deaths throughout the past decade from Botox. Fear not—these problems were seen in patients with complex neck-muscle problems using doses 100 to 1,000 times higher than the normal cosmetic dose. No big problems have occurred in cosmetically treating wrinkles around the eyes. Botox injections need to be repeated every three to six months.

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• QWhat does botox do?

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  A Dr. Ellen S. Marmur, MD , Dermatology, answered

  Injections of botulinum toxin type A is the number one cosmetic procedure in the world, with more than 4 million treatments done in the United States in 2006. (Interestingly, 60 percent of female Botox users have never had any cosmetic surgery before, according to the Aesthetic Surgery Education and Research Foundation.) Its supreme popularity is for a good reason: it works. Botox and Dysport are purified forms of botulinum toxin type A (and no, the shots do not produce the deadly disease botulism). When injected in tiny amounts, the neurotoxin causes facial muscles to relax and almost magically erases frown lines, forehead wrinkles, and crow's feet. Because it smoothes the skin, the procedure also makes slight structural changes to the face: opening up the eyes, widening the forehead, and elevating the brows.

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• QWho can get botox and dysport?

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  A Dr. Ellen S. Marmur, MD , Dermatology, answered

  Anyone who is bothered by fine lines or wrinkles is a perfect candidate, but botulinum toxins have other off-label uses. They've been shown to be a good treatment for migraine headaches and also block receptors in the sweat glands (so shots under the arm decrease perspiration). Many dermatologists use this drug to manipulate the shape of the face slightly too. A touch of Botox at the base of the nose gives it a more turned-up appearance, and an injection at the upper lip can bring it down slightly and minimize a gummy smile.

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• QHow does botox and dysport work?

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  A Dr. Ellen S. Marmur, MD , Dermatology, answered

  For aesthetic work, Botox and Dysport are used in almost homeopathic doses, very tiny amounts. They both block the nerve receptors on the muscle, paralyzing the ones that cause actions that reinforce wrinkles such as crow's feet, marionette lines, and forehead furrows. Think of the receptor as a baseball mitt and Botox or Dysport as the ball. Once it lodges itself in that receptor nothing else can get in, so it blocks any signals that would trigger the muscle to move. Receptors (like skin cells) have a limited life span, and they are constantly being renewed. A blocked receptor is blocked until it dies off and a new receptor takes its place. This is why the effects of Botox and Dysport are temporary and muscle movement returns. Once the drug sticks in the receptor, it stays there like a key in a lock and does not travel or function anywhere else.

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• QWho should not get botox or dysport?

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  A Dr. Ellen S. Marmur, MD , Dermatology, answered

  Botulinum toxins work wonders on lines and wrinkles, but they do nothing for sun damage or skin texture. For those issues, laser treatments or chemical peels are the best option. Botox has been tested thoroughly since the FDA approved it for cosmetic use in 2002 and has been proven safe. Recently, an Italian medical study done on mice found that botulinum neurotoxins migrated to their brains.1 Doctors read through the literature and were not worried about the ramifications, since any safe medication will be harmful to a small animal if it's overdosed with it. The study was interesting but not clinically relevant to cosmetic use in humans because the dosage is very small and the risk of migration is extremely low. It was certainly taken seriously, and there is a black box label warning, but the judgment remains that Botox and Dysport are safe for cosmetic use. Patients with certain neuromuscular diseases (such as multiple sclerosis) or autoimmune diseases (such as lupus) need clearance from their specialist before considering any injectable.

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• QWhat are the side effects of botox and dysport?

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  A Dr. Ellen S. Marmur, MD , Dermatology, answered

  The most common side effect is some slight bruising at the site of the injections, and (rarely) some people develop a headache afterward. A more serious complication of Botox injections can be ptosis, when the eyebrow and eyelid droop. This can happen when the skin is too lax or when the muscles right above the brow or the ones between them are injected. Often a slight one- or two-millimeter drop reverses within two weeks, but unfortunately the effect can last as long as the Botox results and there's no way to reverse it. There's a long list of potential side effects you should be aware of before consenting to this procedure, but most of them are extremely rare.

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• QCan Botox injections prevent wrinkles in young population?

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  A Dr. Daniel Kapp , Plastic & Reconstructive Surgery, answered on behalf of MDLIVE

  The action of Botox is to paralyze muscles.  There are two types of wrinkles; dynamic wrinkles and static wrinkles.  Dynamic wrinkles are wrinkles that are caused by the mechanical action of muscles pulling on the skin.  In young people dynamic wrinkles occur when smiling or raising the brow.  The action of Botox is to paralyze muscles and thereby, reducing the muscle action on the skin.  This reduces the appearance of dynamic wrinkles.  Over time dynamic wrinkles, as they become confluent, can become static wrinkles or permanent wrinkles.  Static wrinkles do not change in relation to the mechanical action of the muscles.  While Botox can prevent dynamic wrinkles from becoming static wrinkles, Botox will not prevent the more common causes of static wrinkles which are smoking and injury to the skin from repeated exposure to UV radiation from sunlight.  In order to prevent wrinkle formation over time, a lifestyle of sun avoidance is necessary, especially during the peak hours of sunlight, from 10a to 3p.  Additionally, topical medications such as Retin-A, have been shown over time to decrease static wrinkles.

• QAre there benefits to Botox besides fewer wrinkles?

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  A Dr. Stuart A. Linder, MD , Plastic Surgery, answered

  There are 3 major categories of use for Botox. The first is for Blepharospasm, cervical dystonia, chronic migraines, overactive bladder, strabismus, and upper limb spasticity. The second is Botox Cosmetics for moderate to severe frown lines between the brows. The third is for symptoms of severe underarm sweating when topical agents don't work well enough according to Allergan pharmaceuticals.

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