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Skin testing for allergy , as previously done with collagen(animal derived) is typically not indicated. Injections of botulinum toxin blocks muscular nerve signals, which then weakens the muscle so it can’t contract. The end result is diminished unwanted facial wrinkles.

Botulinum toxin can be used to help smooth:

  • Frown lines between the eyebrows(glabellar region); called the 11 lines by many patients
  • Forehead furrows or lines
  • Crows feet
  • Downturned corners of the mouth


Q. Am I a candidate for botulinum toxin?

A. Smiling, frowning, squinting, and chewing-any facial movement- can eventually lead to a common sign of aging: wrinkles. They can make you appear tired or angry even if your not.

Botulinum toxin is a quick and safe way to decrease or soften these lines.

Q. What are the risks and safety with the use of botulinum toxin products?

A. You may resume normal activities immediately. However, do not rub or massage the treated areas because this can cause migration or spread of the toxin and possibly create untoward results with temporary facial weakness or drooping where you don’t want it.
Although generally safe, side effects and complications can include:

  1. Bruising and pain at the injection site
  2. Flu like symptoms
  3. Headache(although the toxin is used by neurologists for some types of headaches)
  4. Temporary facial weakness or drooping
  5. Very rare and associated with toxin spread is breathing effects, swallowing, weakness.

Q. How is the procedure actually done?

A. A very thin needle is used to inject small amounts of botulinum toxin into specific muscles.
Although this will seem like a simple procedure to you, remember it is an art and science that only an experienced professional should do. The healthcare professional should have a complete understanding of the muscles and nerves of the face and their role in movement and creation of wrinkles to best optimize results for you as an individual.

Q. What happens at the consultation/ procedure day when I have this done?

A. You should be able to discuss your goals, medical conditions, drug allergies and medical treatments. Current medications, vitamins, herbal supplements, alcohol and tobacco use.

Various over the counter supplements and meds can thin the blood and thus increase bruising or untoward effects.
Certain neurologic diseases must be noted and will contraindicate treatment such as Guillain Barre, ALS(Lou Gehrig disease). Patients with very frequent bouts of fever blisters will typically be pretreated with acyclovir(Valtrex and other antiviral meds) prior to any treatment .

Q. What are the recovery expectations after treatment?

A. No anesthesia is required. Some patients may want a topical local anesthetic if very sensitive to even fine needle injections. There is typically no downtime or recovery time . Resuming normal activities is immediate . Do note as stated above that no massage or rubbing of the area should be done to prevent migration of the toxin and cause unwanted results.

Realize that although the wrinkles or lines are smoothed or relaxed, the line itself was formed in the skin by underling muscle contraction and is still in the skin. Ways of addressing the deeper lines and enhancing the decreased muscle contraction is to use a filler of the line or furrow by the use of hyaluronic acid fillers (Juvederm, Restylane, etc.) If multiple areas are treated autogenous fat grafting from your tummy or thighs can be a longer lasting option. Of course the side benefit of fat grafting is you get liposuction of the area the fat is harvested from.