What is BOTOX?

BOTOX® Cosmetic is a prescription medicine (purified protein) that is injected into very specific muscles to weaken the muscles from contracting. The end result is diminished unwanted facial lines and wrinkles.


It contains a purified and safe form of botulinum toxin A, which is produced by the microbe that causes botulism. Manufactured by Allergan, Inc., it is used to treat permanent furrows and deep wrinkles in the skin that are formed by the continual contraction of facial muscles. In addition to its cosmetic applications, it is used to treat a number of medical problems, including excessive sweating, overactive bladder, neck spasms, crossed eyes, chronic back and jaw pain, and migraines.

How does BOTOX work?

When BOTOX® is injected into a muscle it blocks the nerve signals that are sent from the muscle to the brain. These are the messages to contract a muscle, for instance. When BOTOX® blocks these messages, the brain never receives them so it never initiates the contraction, and the muscle stays at rest and relaxed.

Since wrinkles on the upper third of the face are caused by repeated muscle contractions under the skin, BOTOX® stops these muscles from contracting for around four months. This keeps the wrinkles from forming.

You can see how this would have other applications. In fact, BOTOX was first approved for the treatment of involuntary eyelid spasms. It is also used now for treatment of temporomandibular joint disorder, migraine headaches, and even excessive underarm sweating and urinary incontinence.

Applications for BOTOX Cosmetic

Although originally approved by the U.S. Food and Drug Administration for the treatment of eye and muscle spasms, BOTOX Cosmetic was quickly recognized for its cosmetic value. Properly placed injections of BOTOX Cosmetic block nerve impulses sent to muscles, weakening them to the point where they cannot contract, and temporarily eliminating moderately severe furrows and lines. BOTOX Cosmetic is used to treat the following:

  • Forehead furrows
  • Frown lines
  • Crow’s feet
  • Skin bands on the neck

According to Allergan, BOTOX Cosmetic has been “extensively researched, with approximately 2500 studies.”

BOTOX Cosmetic Procedure and Results

Using a very fine needle, BOTOX Cosmetic is injected directly into facial muscles that are causing furrows and lines. Receiving the injections requires no anesthetic, but some doctors choose to numb the area to be injected with ice packs or a topical anesthetic cream. Results can usually be seen within a few days of treatment, and typically last up to four months, although areas that are treated on a regular basis may retain results longer. Injections should be given only by qualified medical professionals.

Will BOTOX Cosmetic make me look like I’ve had work done?

The simple answer is no, not when you receive treatment at Oregon Plastic Surgeons. We pride ourselves in helping you look refreshed and natural, while minimizing facial lines and wrinkles.

Am I a good candidate for BOTOX?

Whether BOTOX® is right for you depends on the type of wrinkles you’re seeking to erase and their location. In 2002 the FDA approved BOTOX® for wrinkle treatment on the upper third of the face. This is the expressive area of the face and the wrinkles formed here are known as dynamic wrinkles. They form due to repeated muscle contractions under the skin. When BOTOX® is injected into a muscle forming a wrinkle on the surface skin above, it relaxes the muscle and it doesn’t contract. Without the contraction, the wrinkle doesn’t form on the surface skin above.

You can feel these muscles engage when you make an expression such as frowning or squinting. This is where BOTOX® is effective.

On the other hand, if the wrinkles you want to erase are on the lower face around the nose and mouth, BOTOX® has no effect on these wrinkles. These are static wrinkles and are not caused by muscle contractions, but by sun damage and other factors. These wrinkles need to be treated with dermal fillers, such as Restylane®.

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Is there recovery after a BOTOX session?

There is no recovery, although you may have some slight swelling and redness at the injection sites. It is important, however, for patients not to rub the areas of their injections for the first 24 hours after their BOTOX® session. Rubbing these areas can cause the BOTOX® to migrate to an unwanted muscle, creating problems such as drooping eyelids.

What is the difference between BOTOX and dermal fillers?

Some people classify BOTOX® along with dermal fillers like Restylane and Sculptra. But this is not correct. BOTOX® is known as a neuromodulator, and it works in a completely different fashion than dermal fillers.

As described above, BOTOX® erases wrinkles on the surface skin that are formed by muscle contractions beneath the skin. These are crow’s feet, the 11s between your eyebrows, and forehead lines. When it blocks the muscles from contracting, the wrinkles don’t form on the skin above.

Dermal fillers go about their wrinkle erasing in a completely different manner. As their name implies, when a filler is injected beneath a wrinkle, crease, or area of volume loss the filler simply “fills” the space, pushing the skin back upward. It is basically a manual insertion of volume. Dermal fillers work on static wrinkles that are caused by sun damage, declining collagen production, thinning skin, personal habits, and just natural aging. Static wrinkles are on display all the time because the skin is damaged or has lost underlying volume support.

Dermal fillers have no effect on dynamic wrinkles, such as crow’s feet. BOTOX® has no effect on static wrinkles, such as smile lines.

Where is BOTOX effective?

BOTOX® is used on the upper third of the face, the expressive area. It erases or dramatically lessens the appearance of crow’s feet at the outside of the eyes, the 11s between the eyebrows, and on forehead lines. Some people also have success using BOTOX® on neck bands, but this varies with different patients.

Side Effects of BOTOX Cosmetic

Injection-site side effects of BOTOX Cosmetic are usually mild and temporary, and include the following:

  • Pain
  • Infection
  • Inflammation
  • Tenderness
  • Swelling
  • Redness
  • Bleeding
  • Bruising

Is a BOTOX session painful?

Dr. Austin injects BOTOX® with a very tiny needle, and it is not injected to great depth. Most patients equate the feeling of the BOTOX® injections to that of a pinprick. While most patients don’t feel the need for topical numbing cream ahead of their injections, it is available if you would like some. It simply adds some time to your session, as the numbing cream needs 20 minutes or so to take effect.

How many injections will I need?

The number of injections is dependent on the areas being treated. Typically treatment for the frown lines between the eyebrows requires 5 injections using a tiny needle with minimal discomfort. For other areas it is dependent on the person’s goals. We are happy to provide more detailed answers to this question during a complimentary consultation with our nurse practitioner.

Normal activities may be resumed immediately after receiving injections.

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