Botulinum Toxin Injection

Botulinum toxin (Type A) is a cosmetic injection that blocks the nerve signals that cause muscles to contract. This effect relaxes and smooths the look of lines and wrinkles caused by repetitive movements on the face—most commonly, between the brows, crows-feet around the eyes, and horizontal forehead creases. Botulinum toxin is also used cosmetically to balance facial asymmetry and relax tight neck bands, as well as medically to reduce perspiration and to treat migraine headaches and muscle spasticity.

WHEN TO CONSIDER BOTULINUM TOXIN INJECTION

  • Deep lines between your eyes make you look tired, angry, sad, or upset.

  • Your facial expressions cause wrinkles in and around your eyes and forehead.

  • There is asymmetry in your eyebrows or face that can be corrected by relaxing a muscle.

  • You suffer from migraine headaches and botulinum toxin may provide relief from this condition.

CONSIDERATIONS

PROS

  • Injections are relatively painless and carry a low risk, with little-to-no downtime.

  • Can help you appear less angry and more approachable

  • Make subtle changes that give you a refreshed or well-rested look

CONS

  • Effects of injections will only last three to six months

  • Risk of droopy eye or muscle if injected incorrectly

  • If area to be injected is sensitive, bruising may occur

These are the top three pros and cons to weigh when considering botulinum toxin. If you wish to focus on what is unique to you, please consult with your aesthetic plastic surgeon.

Are you a good candidate for botulinum toxin injections?

You may consider botulinum toxin injections for cosmetic reasons if you are developing lines and wrinkles on your face due to common facial movements. Depending on genetics, lines can appear on the face as early as your late twenties to as late as your early forties. If you are prone to developing "frown lines" and to making facial expressions that lead to wrinkles, your plastic surgeon may also recommend using botulinum toxin as a preventative measure.

Certain facial wrinkles or creases in the face caused by the weakening or sinking of the soft tissue, such as the nasolabial folds, which extend from the sides of the nose to the corners of the mouth, are generally best treated with fillers, fat grafts or surgery (although occasionally botulinum toxin is used to soften or partially improve them).

If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.

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Botulinum toxin injection to correct vertical lines between the eyebrows.

HOW IS A BOTULINUM TOXIN INJECTION PERFORMED?

Botulinum toxin A injections can usually be completed on the same day as the initial evaluation. They do not require hours to perform or days to recover. Once you and your surgeon have decided on an appropriate treatment, he or she will prepare you and the medication for the procedure. The injection site will be cleansed and will usually not require anesthesia prior to injection. The needles used are very short and thin, causing minimal pain. Depending on your specific concerns and condition, a number of injections will be needed to achieve the desired result. Slight pain, short-lasting swelling, and minimal redness and bleeding will likely occur as a result of your procedure.

Once the neurotoxin has been injected, it will take several days to reach full effect and a follow-up visit is often scheduled weeks to months after the initial injection.

In the hands of an experienced injector, such as a board-certified plastic surgeon, your procedure will seem simple and you will experience minimal discomfort. The injector's understanding of the muscles in the face and body is essential for a safe and successful procedure.

WHAT ARE MY OPTIONS?

There are many formulations of botulinum toxin; some are only appropriate for cosmetic use (Botulinum Toxin Type A). Here is a list of both cosmetic and medical conditions that botulinum toxin can help treat:

  • Lines and wrinkles

  • Facial asymmetry

  • Muscle spasticity 

  • Eyelid spasms (blepharospasms)

  • Hyperhidrosis or excessive sweating (see perspiration reducer)

  • Chronic migraines

  • Cervical dystonia

  • Movement disorders

  • Crossed or lazy eyes

Your plastic surgeon and/or injector will help you determine which botulinum toxin will be best for you.

AFTERCARE AND RECOVERY

After the injections you can return to your regular activities immediately; however, strenuous activity is discouraged for the remainder of the day. Redness and swelling that occur at the time of injection usually resolve quickly. Any bruising that might occur post-treatment will usually resolve over a week or two. 

Some quick tips for the best results:

  • Avoid massaging or touching the injected area afterwards; this may inadvertently cause the botulinum toxin to spread to an unintended area.

  • Lying down or inverting the body shortly after injection can also cause complications.

  • Avoid strenuous or vigorous activities for the rest of the day.

  • Ask or call the office before taking painkillers or medication.

HOW LONG WILL THE RESULTS LASTS?

Depending on your age, skin condition and habits, effects of botulinum toxin could last anywhere from three to six months.

Maintain a relationship with your aesthetic plastic surgeon


A follow-up appointment in weeks or months may be scheduled after the injection for re-evaluation, touch-up or additional treatments as indicated. You are of course encouraged to schedule your own follow-up sooner if you have any questions or concerns. Because the effect of the botulinum toxin is not permanent, it is best to develop a good relationship with your plastic surgeon and set a schedule for additional injections.

LIMITATIONS AND RISKS

Although all procedures have some degree of risk, FDA-approved injections of botulinum toxin are relatively low risk in the hands of an expert injector. The most common side effects are:

  • Temporary muscle weakness. 

  • Redness, irritation and swelling at the injection site. 

  • In rare instances, patients may experience dry mouth, headache, dizziness, nausea and fever.

If you have a symptom that is more serious, such as a rash or trouble breathing, please call your doctor immediately.

You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your botulinum toxin injection.