Ask Dr. Peirson all about Botox®
Ask Dr. Peirson all about Botox®
by Dr. Mary Peirson, M.D., C.C.F.P.
ArtMed, The Art of Cosmetic Medicine
At ArtMed we answer questions about the use of neurotoxins like Botox and Xeomin each day. We’re providing this FAQ page as a resource for the most commonly asked questions we receive. We hope it’s helpful in addressing questions you may have about Botox or Xeomin. All answers below apply to both Botox and Xeomin. If you have a question that is not listed here please don’t hesitate to contact ArtMed to have your inquiry addressed.
What is Botox® exactly?
Botox® is a neurotoxic protein derived from the bacterium Clostridium Botulinum. It temporarily prevents the release of a neurotransmitter called acetylcholine from nerve endings. Acetylcholine stimulates muscles to contract. So when Botox® prevents acetylcholine release, muscles do not contract, leading to muscle paralysis.
Who is qualified to prescribe and inject Botox®?
Botox® is a prescribed medication with a DIN number. It must be injected by or be overseen by a qualified medical practitioner. Medical doctors and nurse practitioners can prescribe Botox®. Other nurse injectors must operate under the supervision of a medical doctor or NP.
Who should not have Botox®?
Botox® is contraindicated in individuals with neuromuscular disorders such as Lou Gehrig’s disease or myasthenia gravis. It shouldn’t be used if you suffer with any disease that causes muscle weakness, if you have double or blurred vision, severe lung disease, swallowing problems and movement disorders or if you are allergic to botulinum toxin.
When is Botox® the right option for me?
Botox® is primarily used to treat dynamic wrinkling. This means any kind of wrinkling that is specifically caused by movement of muscles. Common conditions treated include frown lines, forehead lines and lines around the eyes (crow’s feet). Botox® is also used to treat medical conditions like twitchy eye, migraine headaches and excessive underarm sweating. Botox® is not used to treat wrinkles caused by gravity or volume loss such as nasolabial folds, marionette lines etc.
How much Botox® will I need? What will it cost?
Each area of the face requires a different amount of Botox® and within each area a range of dosing is possible. Most physicians and nurses quote Botox® in terms of ‘units’ and at ArtMed a single unit of Botox® costs $10.50 (and for repeat clients who book in advance it is $9.50/unit) plus tax. The typical number of units needed per area for women is forehead 5-10 units, frown 20-30 units, eyes 10-20 units. Men sometimes need 25% more.
How long will Botox® last?
Like any medication, the length of effect can vary a little from person to person based on their physiology and metabolism. Typically though, Botox® will last about 3-4 months. With regular use over time (greater than 1 year) many people notice that their Botox® seems to last longer. This is because your brain effectively ‘forgets’ you have these muscles so even once the Botox® wears off it takes a while for the muscles to become active again. Frequently individuals may find after a year that they need re-treatment every 4 months instead of 3. Not everyone has this effect, but it is very common. If you use Botox® intermittently you won’t notice this benefit of regular use.
Will wrinkles improve immediately?
This depends on the wrinkles. If you have lines when your muscles are at rest and if you stretch the skin and the line is still there then the lines are sometimes referred to as a ‘fracture’ in the skin. This kind of line will never disappear because it has become permanent in the skin although it can be treated with interventional laser. Most lines, however, are not fractures but instead form because the involved muscles have become very strong from use.
As we age it becomes increasingly difficult to relax the muscles and so they are in effect working out all the time. This results in the muscle getting bigger and stronger. When the muscle gets bigger, we start to develop hills and valleys in the skin that don’t disappear even when the face is at rest.
Because Botox® weakens the muscles it effectively prevents them from moving and this leads to atrophy of the muscles back to their normal size (like you stopped working out all the time). When the muscles get smaller the lines will start to disappear. This process of atrophy and smoothing out typically takes 3-4 rounds of regular Botox® treatment (9-12 months). You will see immediate improvement after your first treatment, but complete resolution of lines may take time.
Does Botox® injection hurt?
Injections are injections and will hurt a little. However, the needles used are extremely tiny (smaller than insulin syringes) so most people find it completely tolerable. Injections usually take under 5 minutes to perform.
What are the side effects of Botox®?
The biggest risk is weakness of muscles that you don’t wish to treat. This is why it is very important that you receive Botox® from a skilled injectionist. Lid drop, brow drop, or a heavy feeling are adverse side effects that can result from Botox®. About 5% of people develop a headache within 24 hours of injections. This can be treated with Tylenol or Advil if needed. High doses of Botox can pose higher risks. For the full product monograph visit: Botox Monograph (https://www.allergan.com/assets/pdf/botox_pi.pdf)
My Botox® didn’t work. What do I do?
Botox® works in virtually everyone so it is unlikely it didn’t work. It far more likely that you need a higher dose than you received to get the effect you are desiring. Some people want a little movement for a natural look and others want to be fully paralyze the target muscles. It is important to let your injectionist know what your treatment objective is.
My Botox® result is uneven. What do I do?
In the early days of treatment an injectionist may need to make small adjustments in dosage or placement of Botox®. Botox® treatment is an art and should be customized to the individual and how you respond to initial treatment can vary from person to person a little. It is not uncommon to make small adjustments until the ideal result is achieved. Call your clinic and ask to be seen in follow-up.
Do I need to follow up after my first treatment?
You do not need to follow up unless you have a concern. But you should book to treat again within 3-4 months to maintain results. At ArtMed pre-booking your next appointment allows you to access loyalty pricing of $9.50 a unit.
Anything to avoid after injection with Botox®?
Do not exercise vigorously after Botox® treatment for 24 hours. Plan to stay upright for 3-4 hours after treatment. Do not touch or press on treated areas and avoid other treatments that day (e.g. massages, chiropractic adjustments etc.). Do not have any facial procedure such as laser for at least 1 week after Botox®. You can apply makeup to treated areas within 1 hour after treatment.