Botox is one of the most common cosmetic treatments done worldwide.  Its ability to selectively, and temporarily, relax wrinkles has taken the cosmetic world by storm, as treatments for the crow’s feet, frown lines, and forehead furrows with a fast and reliable injectable was not possible before.

What is Botox?

Botox is a formulation of botulinum toxin, which is a carrier protein attached to the active toxin.  Botox is a formulation that preserves both molecules in their entirety (as opposed to Dysport and Xeomin, which contain other variations).  It is supplied in a vial that is reconstituted with saline and then injected into muscles.

What is a Wrinkle?

Wrinkles are not random lines in the skin, but rather represent thin connections between the skin and the underlying muscle.  This relationship between wrinkles and the muscle gives most of us wrinkles in the same areas.  The “frown lines” or “11s” are due to the procerus and corrugator muscles, the “crow’s feet” are due to the action of the orbicularis oculi muscles, and we can thank the frontalis muscle for giving us forehead furrows.  There are other areas of the face that also get wrinkles, but these are the common muscle groups that people seek Botox treatment for.

How Does Botox Work?

Once injected, Botox takes action where the nerve attaches to the muscle and prevents the signal from being transmitted.  It prevents the muscle action until the body signals the nerves to make new connections to the muscle, which takes a variable amount of time-based on the muscle and individual.  Once the muscle stops moving and pulling the skin, the wrinkle gets less deep and sometimes disappears, depending on the size, depth, and muscle bulk.

How Long Does Botox Last?

Botox has an action that usually lasts between 3 and 6 months in most people.  This treatment duration is dependent on the dose used, the size of the muscle group, and the biology of the individual, as certain people just have longer lasting effects than others.  Some individuals prefer a “light” treatment with a lower dose, while others prefer less movement.  At Nuance Facial Plastics, we have a lengthy discussion about goals and dose preferences prior to treatment.
Patient picture after Botox at Nuance Facial PlasticsPatient picture after Botox at Nuance Facial Plastics
Before and After Botox

Preventative Botox

In the discussion above, we can see that a wrinkle is due to muscle action on the skin.  If the muscle is treated and its motion on the skin is decreased over a long period of time, then it will not pull on the skin with enough strength to form a wrinkle, and this is the concept behind “preventative Botox”.  This is the only way to actually prevent wrinkles from forming in the skin, and like many conditions, prevention gives much better results than waiting for them to form and then treating them.

Who is a Candidate for Botox?

Botox can be safely injected in all skin types and can be done in any individual that would like to treat fine lines and wrinkles or prevent the muscles from forming these wrinkles by decreasing the amount they “pull” on the skin.

Are There Any Risks to Botox?

Botox, like any medical treatment, does have risks associated with it.  Some of the risks are due to the action of the Botox locally in the area injected, and include drooping of the eyebrow, drooping of the eyelid, and changes to the arch of the brow.  These risks, thankfully, are rather rare and temporary.  Even rarer are the risks of the Botox entering the bloodstream and include body aches, fevers, fatigue, and headaches.  If you have any questions about these risks, Dr. Kundaria is happy to discuss them with you at your consultation.

Who Can Inject Botox?

At Nuance Facial Plastics, all injections are done by Dr. Summit Kundaria, a board certified surgeon that has had fellowship training in facial plastic surgery.  Nurses, Physician Assistants, and Physicians are all able to perform Botox treatments in North Carolina as long as certain guidelines are followed, as these treatments are considered medical treatments requiring a physical exam by an individual licensed by the state medical board.
The bigger question is “Who Do I Want Injecting My Botox?”, as the Botox is a substance in a vial, through a Botox treatment involves judgment about dose and injection site, as well as the experience to predict how to get you the results that you want.  The more skilled injectors tend to use less material, saving the patient financially, and can better avoid risks.
For more information or to schedule a consultation, please do not hesitate to reach out to Nuance Facial Plastics.

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