Advanced Skin Clinic offers Botox injections for facial rejuvenation. In the Botox procedure, the muscles of the face that cause certain wrinkles are injected with an agent that causes a temporary paralysis of these muscles, resulting in reduction or elimination of the appearance of wrinkles. The most commonly treated areas are the glabella area (the vertical line in between the eyebrows), the forehead, and the crow’s feet area.

The results of Botox are not permanent and must be repeated every few months to maintain the rejuvenating effect. Botox injections are done with a very fine needle and do not require any pain medication or anesthesia. Many patients do not even feel the injection at all.

Botox injections are an excellent first step into the world of cosmetic procedures. It is also an excellent complement to volumizing fillers to soften wrinkles, and rejuvenating laser procedures. At Advanced Skin Clinic, all Botox injections are performed by a certified dermatologist.

Contact Advanced Skin Clinic on 0755-562430 (Office Line) or 0778-389002  for a consultation.

Botox is usually priced by the “unit”, with the number of units dependent on the treated area, size of the muscles and other factors. Specials, promotions and discounts on Botox are sometimes available, so call and schedule a no obligation consultation. Also be sure to follow us on Facebook and subscribe to our Newsletter to learn about Botox discounts.

What are wrinkles and how does Botox help reduce wrinkles?

Facial wrinkles, also known as facial rhytides, are a hallmark of aging. As the skin ages, it is less able to recover from the cycles of damage caused by facial motion. It is also less able to recover from damage caused by the environment, such as exposure to excessive sunlight and smoking. The first wrinkles to develop are typically those associated with the use of muscles of facial expression, notably where the brow furrows (glabellar wrinkles), where the brow elevates, and crow’s feet around the eyes. At first wrinkles may only be noticeable when you make certain facial expressions. These are called dynamic wrinkles or dynamic rhytides. After many cycles of using the facial muscles, the wrinkles become entrenched and remain visible even with no facial expression. These are then called static wrinkles or static rhytides.

Botox and similar treatments (such as Dysport or Xeomin) work by temporarily paralyzing the muscles of facial expression. This stops the wrinkles from becoming etched on your face and gives your skin the ability to recover to a certain extent. Botox is best used to prevent wrinkles, and the earlier you start using it the fewer facial wrinkles will develop and the less deep they will be.

How does Botox work?

Botox (botulinum toxin) is a potent neurotoxin produced by the bacteria Clostridium botulinum. Botox prevents the release of the neurotransmitter that activates the muscles used in facial expression. Once these muscles can no longer move, the lines caused by their motion are reduced, or will not form to begin with.

Botox produces localized chemodenervation and flaccid paralysis. It takes 1-2 days for onset of paralysis and 1 week for full effect (occasionally an effect may be observed within hours). It is effective for 3-6 months or longer, and there is cumulative benefit to repeat injections. However, effects reverse over time.

The neurotoxin binds to  receptors on motor neurons at the neuromuscular junction (NMJ), where it is taken up by the cell. It translocates to the cytoplasm, where it  cleaves polypeptides essential for neurotransmitter release, resulting in paralysis of the muscles.

Am I a good candidate for Botox?

Most people will benefit from the use of Botox to reduce or prevent wrinkles.

Am I too young for Botox?

Many people think that they are too young for Botox. It is important to realize that Botox is best used to prevent wrinkles, and that the earlier treatment is started the better the results. Many patients start treatments in their twenties and thirties, and can expect to have much reduced wrinkles in the course of their lives.

Am I too old for Botox?

Although Botox is best to prevent wrinkles, it can be used at almost any age to help prevent wrinkles from getting worse and new wrinkles from forming. The fewer cycles of using your muscles of facial expression over your lifetime, the less severe your wrinkles are likely to be.

Is Botox used for men?

Botox is used by many men to prevent wrinkles. Men often get the forehead and glabella treated, and somewhat less often the crow’s feet area. However, the injection technique is usually modified in men as compared to women. Men will usually need a greater amount of Botox (i.e. more units) since on average they have greater muscle mass. Also, men typically do not want an arched or elevated brow, as this can feminize the face. Men often have heavier brows as compared to women and it important to avoid injections too low on the brow, which can result in forehead ptosis (droop). So it is important to go to a doctor who is experienced at injecting Botox for men. Overall, men can benefit from Botox injections by reducing wrinkles on the upper face and periorbital region.

Where can Botox be used?

Botox is commonly used to treat a number of facial areas. Some of the more common uses are described below.

Glabellar Lines. The most common area treated with Botox is the vertical lines that you get from furrowing your brow. These are called glabellar lines, or sometimes are known as “the elevens”. Injection into the responsible muscles will prevent the frown lines from forming and can also elevate the brow.

These lines are caused by the corrugator and orbicularis muscles (medial movement of brow) and the procerus and depressor supercilli (inferior movement). There is significant variation in the location and size of “frown” muscles, necessitating individualized treatment. Deep-seated wrinkles that cannot be eliminated by spreading with a fingertip on either side will be decreased but not eliminated with Botox. Adjunctive treatment, such as dermal fillers, may be necessary to treat such lines.

Botox eliminates or reduces dynamic wrinkles in this area, reducing a stern or angry countenance. It can also elevate the medial brow by up to 2 mm, opening up the medial eye. Injection of 2-3U at the lateral eye brow can result in further elevation of lateral brow (this is not usually performed in men.) Numerous approaches are possible. Injections in the procerus and corrugator supercilli is the goal. Due to greater muscle mass, men usually need more units of Botox than women. The needle should be aimed up and away from the eyes, at least 1 cm above the orbital rim to avoid lid ptosis. This area should not be massage afterward to prevent spread and ptosis. The first injection is typically placed directly above the medial canthus on either side. The second injections may be placed 2 cm lateral and slightly superior (at least 1 cm superior to orbital rim in the mid-pupillary line). A second injection can be avoided by re-angling and advancing the needle. Placement in the corrugator muscle can be confirmed by having the patient frown and relax. An additional injection at the intersection of a line drawn between each medial eyebrow and the contralateral medial canthus (i.e. procerus) may be desirable. Many other approaches are possible.

Forehead Lines. Injection of Botox into the forehead can prevent or reduce the horizontal lines on the forehead, the sort of lines that you make when you raise your eyebrows. It is most common to inject the glabella and forehead lines at the same time. Injecting the forehead lines without injecting the glabella lines, can increase the risk of the forehead feeling heavy and the eyebrows descending. If you have heavy eyelids it is very important that you not inject too much Botox into the forehead, and to always balance it with injecting the glabella. When the forehead drops it is called “brow ptosis”.

Horizontal forehead lines result from contractions of the frontalis (brow elevator). The goal is to soften lines, rather than eliminate them. It is advisable to treat depressors (i.e. glabellar) at the same time. Adverse effects that can result from treatment are lack of expression and brow ptosis; more lateral injections are more likely to lead to ptosis. Treatment of only medial aspects can result in “Botox Eyebrows”—a raised lateral eyebrow.

Four to six evenly distributed injections 2-3 cm above the eyebrows is the usual placement, especially if the glabella is also treated. Extend up to, or just beyond, the mid-pupillary line. An additional 2-3U lateral to the midpupillarly line, at mid-brow, can drop the lateral brow, eliminating “Botox Eyebrows” (which are especially undesirable in men.) Wider foreheads may require more injections, while taller foreheads warrant more of a V-pattern or additional injections in the upper forehead. Pressure is safe on the forehead and helps to distribute the injection.

Crow’s Feet. Injecting the crow’s feet area around the eyes with Botox is very common. This prevents the crinkly wrinkles you get when smiling. It is also important to inject this area if you are trying to elevate the lateral eyebrow. However not all wrinkles around the eye can be treated or prevented with Botox. Some wrinkles in the crow’s feet area come from movement of other muscles of the face.

For crow’s feet, the injection is usually placed superficially; thin skin is prone to ecchymosis (bruising). Two to four injection sites are typical, each 1 cm from the orbital rim. The injections should be directly into the wrinkle accentuated by smiling , and 1 cm above and below this site. The goal is to weaken the lateral fibers, not the entire orbicularis occuli.

Vertical Lip Lines. Botox is used to treat vertical lip lines around the mouth. Here only small amounts are used, as injecting too much can cause difficulty with drinking or speaking. Always be sure to go to an experienced Botox injector for this area.

Depressor Angularis Oris. The depressor angularis oris muscle participates in pulling down the mouth into a frown. Careful injection of Botox into this area can decrease frowning and elevate the corners of the mouth.

Pebbly or Dimpled Chin. A few units of Botox injected into the chin can decrease the appearance of a pebbly or dimpled chin.

Bunny Lines. Botox can be injected into the lateral nose to decrease bunny lines or scrunch lines. Some people naturally have these lines, but many people will develop these lines when they start using Botox in the glabella area. Since the “frown” muscles can no longer be used, sometimes people make funny expressions to try to move muscles that don’t want to move. The result can be bunny  lines or nasal scrunch lines. A few units of Botox solves this problem.

Gummy Smile. Some people show too much gum when they smile because the involved muscles elevate the mouth too much. A few units of Botox carefully placed can solve this problem, but it is very important to get precise and correct placement.

Enlarged Masseter Muscle/Square Face. Botox is commonly injected into the masseter muscles. These are the muscles that you use when you chew or feel when you clench your teeth. In some people these muscles are naturally large, and in other people they enlarge due to teeth grinding or gum chewing. Injection of Botox into the masseter muscles reduces their size, creating a more tapered and sculpted jaw line.

How is Botox Injected?

Botox is injected using a small gauge (e.g. 30 G, 6 mm, BD Ultrafine II) needle and 0.3-1.0 ml syringe directly into the muscle of facial expression responsible for the wrinkle. Some propose subcutaneous or intradermal placement, especially for the crow’s foot region in order to minimize bruising. Elevating the injection site can help with intramuscular placement. Veins or arteries must be avoided. Caution must be exercised with patients on NSAIDS or anticoagulants.

The patient can be upright or supine, depending on the site to be injected and preference of the physician. Some practitioners use topical anesthesia or ice to reduce the pain of injection, but this is not usually required. If the site is marked prior, one must be sure to avoid tattooing; the mark should be placed slightly above or below to avoid contamination. The patient should be instructed to contract and relax the muscle just prior to injection, but the injection should be placed with the muscle at rest.

Mild to moderate pressure can be applied to stop bleeding. Pressure also helps to spread the Botox. Excessive pressure in the glabellar and supraorbital area should be avoided, as this may result in spread to periocular muscles, and ptosis (drooping of the eyelid). Patients should be instructed to avoid manipulation or pressure on injection sites for several hours.

What Is The Facial Anatomy For Botox?

A knowledge of facial anatomy is required to understand the use of Botox.

Upper Face

Glabellar wrinkles

Glabellar wrinkles result from the action of the “depressor group” of muscles. The action of these muscles is downward and medial.

  • Procerus. Straight down
  • Depressor supercilli. Straight down
  • Corrugator supercilli. Diagonally oriented. Pulls eyebrows down and in. This muscle contributes most to glabellar wrinkles.

Forehead wrinkles

The frontalis muscle pulls the forehead upward to create horizontal forehead wrinkles. This muscle opposes the downward pull of glabellar muscles. Patient’s with “heavy” brows may rely on the frontalis muscle to prevent brow ptosis (droop). This must be tested for by having the patient open and close her eyes and observing for use of the frontalis. If the frontalis contributes to eye opening, then Botox can cause brow droop. Simultaneously treating the glabellar muscles may reduce brow droop in this case.

  • Orbicularis oculus. Primary muscle responsible for crow’s foot wrinkles.
  • Zygomaticus major and minor. These muscles run diagonally upward and contribute to wrinkles to a minor degree. They are activated when one smiles. This group raises the cheeks and causes lower crow’s foot wrinkles. They also contribute to melolabial fold formation.

Lower Face

  • Orbicularis oris. This is the sphincter around the mouth. It contributes to perioral wrinkles.
  • Mentalis. Pulls mouth straight down. It can contribute to a deep chin crease.
  • Depressor anguli oris. Extends from corner of mouth diagonally out to mandible. It depresses the corner of mouth.
  • Platysma. A thin muscle on the anterior and anterolateral neck and chest. In the face, it extends to the lower mandible and chin. It pulls the neck and upper chest upward, and the mouth downward. It contributes to horizontal and vertical bands in neck.

Is Botox antigenic?

Antibodies to Botox have been reported with high doses. Neutralizing antibodies are unlikely in dermatologic applications. Non-neutralizing antibodies are common.

What are the benefits of Botox?

Botox can help you preserve a youthful appearance and decrease the appearance of wrinkles. But Botox is not the entire answer to all cosmetic problems. Often Botox is used along with fillers. Fillers restore volume to the face, which can be lost over time. Common fillers are Juvederm Voluma and Juvederm UltraPlus. These can be combined to create a more complete facial rejuvenation. Lasers can also be combined with Botox in various ways. Some lasers can be used to reduce age spots and discoloration from sun damage, while other lasers can be used to reduce wrinkles that are already entrenched, and on which Botox is not expected to result in a full correction

What should I expect in a Botox treatment?

First your dermatologist will evaluate your face and develop a treatment plan that may include Botox, fillers, lasers, or other rejuvenating modalities. Once the treatment area is determined, your dermatologist will mark the spots to be injected. Topical numbing may be applied, or an ice pack can be used to decrease discomfort. The number of Botox injections and number of units used depends on the area to be treated. The actual injections only takes a few minutes. After the procedure there might be a little “bleb” on the skin, which will decrease in a few hours. Rarely, a bruise might occur. After the procedure, your dermatologist will provide instructions on which activities to avoid, but generally you can go back your regular routine.

How long does Botox take to start working?

Usually by four days after the Botox injections you will begin to see results. Full results may take up to a week to be seen.

How long does Botox last?

In most people Botox lasts about 3 to 4 months. It is meant to be repeated on a regular basis. For best results, Botox treatment should be repeated before it wears off completely. This will best prevent wrinkles from forming. Many people who have used Botox regularly find that they need fewer units for maintenance as time goes on, so doing Botox treatments regularly will not necessarily increase your total cost of treatment.

How much does Botox cost?

At SOMA Skin & Laser, Botox is priced by the unit. During your consultation, your dermatologist will advise you as to how many units are required.

Like any medical procedure or medication, Botox has potential side-effects. Your dermatologist will review any possible side-effects with you before your procedure. Side-effects can include:

  • Ecchymosis (bruising) and localized swelling.
  • Headache, usually a mild discomfort or heavy feeling in the mid-forehead. It usually resolves after several days, though severe long-lasting headaches have been reported.
  • Skin eruptions at the injection site and a diffuse dermatologic eruption have been reported.
  • Ptosis (droop of eyelids) occurs in less than 2% of glabellar injections; this rate is even lower when performed by experienced physicians. It results from spread of toxin to the levator palpebrae superioris. It is temporary, lasting 2-10 weeks. Ptosis can be reduced with alpha-1 agonist eye drops (e.g. apraclonidine 0.5%, Naphcon A, Vasocon A) that stimulate Mueller’s Muscle (parasympathetic innervation), which raises the upper lid
  • Asymmetry.
  • Over- or under-treatment
  • Deep-seated wrinkles may not be fully eliminated.
  • Injection into cervical or perioral structures can result in dry mouth, drooling, difficulty with articulation, dysphonia, dysphagia, dyspepsia, neck pain and headache. This is not generally an issue with the small amounts of Botox used and the superficial placement used by dermatologists.
  • Systemic effects are rare (e.g. allergy, anaphylaxis, fever, flu-like symptoms, cough, and nausea.)
  • A known hypersensitivity to any ingredient in the formulation is a contraindication to Botox use.
  • Caution should be exercised in patients with neuromuscular disorders (e.g. myasthenia gravis).
  • Patient with coagulopathies are at increased risk of ecchymosis and other bleeding complications.
  • The product contains albumin (human blood product).
  • Patients on aminoglycoside antibiotics should receive lower dosing.
  • Botox should not be placed in sites of active infection.
  • The lethal dose is estimated at 2,500-3,000 U.
  • Botox is pregnancy Category C

Patients should be advised to avoid napping or lying down for several hours and not to manipulate the injected areas. Exercising the injected area for the first 90 minutes can improve uptake of the toxin into muscle. Cosmetics can be applied directly after injection. See our Botox Post-Procedure Handout.

 SOMA Skin & Laser for Botox

At SOMA Skin & Laser, Botox injections are always performed by an experienced board-certified dermatologist. Botox is a medical procedure and should be performed by a physician trained in its use and whose specialty includes proper training in its use and possible complications. Your Botox consultation at SOMA Skin & Laser is always free.

Call 973-763-7546 to schedule your Botox consultation today

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