Of the many ways in which our bodies age and show the "wear and tear" of the years, one feature looms above
all others as the hallmark of aging: the wrinkle. Wrinkles, a characteristic of being old, often make us look
tired, and perhaps angry or sad - even when we are not. The desire to minimize them is one of our patients'
main goals, and we have ever more tools at our disposal for their eradication.
Dynamic lines or wrinkles, most commonly noticed as frown lines, on the forehead, and in
the crow's feet area, may seem to disappear from the face when we are expressionless, only to reappear when we
use our muscles of facial expression: frowning, squinting or smiling. Though peel techniques or fat /Collagen /
Restylane® injections may improve these, they often fall short because the problem is not just the fold in your
skin, but has to do with the muscle underneath. Therefore, correction inevitably would have to involve
something that could weaken the muscle that is causing them. The best analogy that Dr. Sayah uses is that of a
piece of paper. As you fold the piece of paper over and over again along the same line, you will notice a fold
in the paper as cellulose within the paper breaks down. Now imagine folding the skin on your face at the frown
area over and over again for your entire life until today. That would represent anywhere from 20 to over 80
years of folding your skin along the same line. Eventually the collagen in the skin breaks down, much like the
cellulose in the paper, and you are left with a crease or wrinkle at the frown line. BOTOX® Cosmetic essentially prevents
wrinkles by stopping the muscles associated with frowning from folding the skin.
BOTOX® Cosmetic is easily administered during an office visit, or it can be given during surgery if you are planning
on having another procedure done. We do not dilute BOTOX® Cosmetic.
The medication is administered with an extremely small needle into areas of concern. Multiple injections may
be necessary for larger areas such as the forehead. Dr. Sayah uses a special technique to minimize the number
of needle sticks while injecting the same dose of BOTOX. You will be given an ice pack to apply to your face in
order to minimize the small chance of bruising.
After the Procedure
Day of procedure: You will be asked to remain still after the injection. Refrain from
reclining on your side, bending over, and lifting heavy objects on the day of the procedure in order to prevent
migration of the injected BOTOX® Cosmetic to the peripheral areas. Avoid sports, hot showers, and warm packs as they may
increase circulation to the injection sites and decrease efficacy of the BOTOX® Cosmetic.
Day 1-5 after procedure: The BOTOX® Cosmetic has likely bound to all of its receptors minimizing any
chance of migration. You may resume normal activities. Some immediate effect may be noticed, but BOTOX® Cosmetic usually
takes 3-5 days for the full effect of the treatment to be realized.
Month 3-4 after procedure: Most patients maintain the full effect for about four months,
but it may be shorter or longer. Usually any effect of the injection has resolved by 6 months. When the effect
diminishes to the point that you would like another treatment, you can then schedule for another injection.