Botox Treatment

Dr. Julia Tzu, a double board certified and double fellowship trained dermatologist, graduated with advanced fellowship training in cosmetic dermatology at the Hospital of the University of Pennsylvania.  She has a decade of experience injecting botox for aesthetic enhancement and routinely treats New York City’s most prestigious clientele. We purchase Botox directly from the manufacturer (Allergan) as opposed to third party websites.  At Wall Street Dermatology, you can feel confident that you are being treated in the most skilled of hands with trusted injectables in a sterile, state-of-the-art facility.

You should schedule a consultation with an experienced dermatologist to discuss your cosmetic goals.  During the consultation, the doctor will go through your previous surgeries, current and past medical conditions, allergies, medications, and nutritional supplements you are currently taking, to determine if you are an appropriate candidate for the procedure.

It is important to keep in mind that not all wrinkles or grooves can be treated using Botox injections. After going through a detailed medical history, the dermatologist will also need to perform a physical exam of the area to be treated.  Characteristics such as adjacent skin and muscle movement, skin elasticity, skin thickness, and the degree of wrinkling are all assessed. After a careful analysis of all these factors, the dermatologist will explain what the procedure will entail, its risks and benefits, and the cost of the procedure.

While cosmetic Botox treatments are very safe when administered by an experienced physician, as with any procedure, there are potential associated risks and side effects.  The more commonly reported side effects include:

• Procedural Pain
• Bruising
• Swelling
• Injection site reactions
• Heavy brow
• Dropped eyelid
• Headaches
• Wrinkle/movement asymmetry

Less common side effects include blurry vision, weakness swallowing, and severe allergic reactions.  Allergic symptoms such as itching, dizziness, wheezing, rashes, faintness, and breathing issues require immediate medical attention.  Some patients have been reported to develop antibodies to Botox, making the treatment less effective with time. However, this is not common.

Because this a minor injection-based procedure, you are allowed to resume most normal activities right away after the injections. However, you are advised to avoid strenuous activities/exercise for at least 24 hours and maintain an upright position for at least 5-6 hours after the procedure.  Avoid active rubbing or massaging the injection sites to prevent spread of the Botox.

Botox Cosmetic treatment is approved for patients between the age of 18 and 65. The following represents a partial list of factors that may prevent one from being an appropriate candidate for the treatment:

• History of allergies to Botox or any of its ingredients
• History of surgeries in area of intended injection
• Active infection around the area of intended injection
• Taking certain medications/supplements
• Pregnancy or breastfeeding
• Bleeding disorders
• Neuromuscular disorders such as Lambert Eaton or myasthenia gravis

Botox works by weakening contraction of specific muscles that are responsible for causing facial wrinkles. Via this mechanism, both dynamic wrinkles (wrinkles that form during active muscle contraction) and static wrinkles (wrinkles that persist even when muscles are relaxed), are reduced in appearance. The end result is smoother skin.

Botox can be used to improve horizontal forehead lines, glabellar frown lines, crow’s feet, upper lip wrinkles, neck lines, and “square jaw”.

It can also be used to give the brows a mild lift.

The effects of cosmetic Botox injections typically last between 2-4 months, so routine injections every 3 months is often suggested.  However, it is important to keep in mind that there are several factors that may affect injection frequency. These include age, physical activity, smoking, skin care routine, facial structure and expressions, sun exposure, and frequency of botox injections.

Botox is not only FDA-approved, but also has a long track record of proven efficacy. However, you should always take precautionary measures like telling the doctor about your health issues and follow the pre and post-injection instructions carefully.

Besides diminishing unnecessary muscular contractions of the face that lead to wrinkling, new data suggests that Botox itself can independently rejuvenate the skin by promoting the production of collagen and elastin within the skin.

Existing (static) wrinkles caused by hyperactive muscle contractions that can be targeted with botox can be improved.  However, the improvement is temporary, and reinjections every three months will be needed to keep the wrinkles at bay.

The pain associated with Botox injections is fairly minimal, as the needles used are very small.  However, under specific circumstances when pain control is needed, numbing cream or cold packs can also be preadministered to reduce the discomfort from the procedure.  

Allergy testing is not routinely performed for cosmetic botox injections, but can be performed under specific circumstances.

The physician may inject a small amount of Botox into a patient’s forearm to see if there are allergic reactions that cause redness, itching, or other worrying symptoms.  Two skin tests often within a month, but two weeks apart, are performed.

Botox/Dysport/Xeomin, also known as injectable neuromodulators, are injected into the skin to reduce the appearance of wrinkles and fine lines.   With increasing age, the lines associated with facial expressions become deeper, more numerous, and more permanent. Given enough time, the wrinkles persist even at rest.

Botox minimizes unwanted and excessive movement of specific muscles on the face, thereby minimizing severity and number of wrinkles.  When injected correctly, the appearance is subtle and natural.  Wrinkles are reduced, but important facial expressions remain intact. One’s overall appearance becomes relaxed and refreshed.  Botox is also injected as a preventative procedure to prevent the onset of wrinkles associated with aging.

Sometimes, Botox injections can also be used to slim the lower face by reducing the bulk of the jaw muscles. This results in a softer, more feminine facial contour.

Botox/Dysport/Xeomin injections require a combination of surgical skill and aesthetic talent. The injector should have a profound understanding of the three dimensional anatomy of the face, including critical structures such as blood vessels, nerves, muscles, and other tissue layers.  The best outcomes come from precise injections at the correct points along specific targeted muscles.   Optimal aesthetic outcomes reduce wrinkles but still allow natural movement of the face. Common areas for treatment include the forehead, brows, crow’s feet, upper lip, jaws, and the neck.  When these muscles are relaxed, the patient appears refreshed and rejuvenated.

Neuromodulators work by relaxing the muscles to prevent movement of the overlying skin. With time, the relaxation flattens out existing wrinkles. Because neuromodulators are broken down naturally in the body, regular injections every three months may be needed to prevent wrinkles from returning. The exact interval needed for reinjection depends on several factors, including quantity of Botox used, area of treatment, and how the patient’s body responds to the Botox.  Patient should work closely with their cosmetic dermatologist to develop the right dosing schedule that achieves their individual aesthetic needs.

Patients should expect the effects of Botox to begin anywhere between three days to two weeks, at which time patients may begin noticing a weakening of the injected muscles.  Peak results may not occur until one month after treatment and may plateau for the next two months.  If more muscular weakening is need, more botox can be injected on a subsequent visit.  It is important for patients to work closely with their cosmetic dermatologist to achieve the right outcome for their individual needs and expectations.