Botox Injections - Treating Facial Wrinkles WHAT is BOTOX? Botox is a new concept in treating facial wrinkles in the forehead, between the eyes and in the "crows feet" areas (upper third of the face). Botulinum toxin, or Botox works by weakening the muscles of facial expression. Once the resting tone of the treated muscles is weakened, the pull of the muscles relaxes and the overlying skin flattens. This approach is different than the other local treatments for the aging face. Silicone, collagen, autologous fat transfer, Alloderm, Softform etc. all work by filling in wrinkles or depressions. These fillers are frequently not as effective as Botox in treating wrinkles in the upper third of the face. By physiologically weakening the muscles, wrinkles are lessened naturally. HOW LONG DOES IT LAST? Injection of this material into the small muscles between the brows, in the forehead, and at LAST the corners of the eyes causes those specific muscles to halt their function (be paralyzed), thereby improving the appearance of the wrinkles. This paralysis is temporary, and re- injection is necessary within three to ten months. Options for alternative treatment include injection of either collagen or free fat, or the surgical excision of the muscles, usually through a brow-lift incision. Complications are rare but may include paralysis of a nearby muscle resulting in its temporary loss of function ( e.g., a drooping eyelid). HOW IS IT USED? Botox is freshly prepared on the day of injection. Once prepared, the medication needs to be used within 12 hours as the potency diminishes with time. Because of the short shelf life and the cost, Botox is not available every day in our office. In order for the treatment to be cost effective, more than one patient can be treated on the same day. Very small amounts of Botox are injected into the muscles to be paralyzed using a very tiny needle. Depending on the areas being treated, 5-15 needle pricks ( or more) may be required. Discomfort is minimal and lasts only a few seconds. SIDE EFFECTS Occasionally, the tiny needle may puncture a small blood vessel during the injection and a small black and blue area may develop. Such an area can last 5-10 days and requires makeup to cover. There are no known generalized side effects to Botox. If any of the Botulism toxin reaches a facial muscle not being treated, partial weakness of that muscle may last for several months. (It is for this reason that you are requested not to massage the injected areas for 12 hours following injection.) In the event of an area of unwanted muscle weakness, the only "treatment" is to wait for the effect of the toxin to wear off in several months. Botox has been used safely in the treatment of muscular facial spasms for approximately 15 years. BOTOX in combination with FACIAL SURGERY Botox injected in conjunction with nearby facial surgery has caused spread of the toxin and unwanted facial weakness in at least one patient. For this reason, we will inject Botox only as an isolated facial procedure or treatment. NOTES The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation. All procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are rare.

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