What is Botox®?
The cosmetic form of botulinum toxin, known as Botox®, is a purified protein injectable filler that is FDA-approved for the temporary treatment of frown lines. This simple, non-surgical injection is also commonly used to temporarily reduce or eliminate forehead creases, crow’s feet near the eyes and thick bands in the neck.
The toxin blocks the nerve impulses, temporarily paralyzing the muscles that cause wrinkles, while giving the skin a smoother, more refreshed appearance. Studies have suggested that botulinum toxin can also be effective in relieving migraine headaches, excessive sweating and muscle spasms in the neck and eyes.
Am I a candidate for Botox®?
Young to middle-aged men and women or those between the ages of 18 and 70 who would like to temporarily improve the appearance of frown lines, crow's feet or forehead lines may be good candidates for Botox® treatment. A consultation with a cosmetic surgeon from Cleveland Clinic Cosmetic & Plastic Surgery Center will help determine if Botox® is right for you.
How do I prepare for a Botox® treatment?
To prepare for a Botox® treatment at Cleveland Clinic Cosmetic & Plastic Surgery Center, your physician will answer any questions you have and ask you about your expectations and desired outcome. He or she will discuss your options, likely outcomes, and any risks or potential complications before recommending a course of treatment.
In addition, your physician may evaluate your general health status and any pre-existing health conditions or risk factors. This includes review of medical conditions and treatments, drug allergies, current medications, vitamins, herbal supplements, alcohol, tobacco and drugs.
If applicable, he or she will discuss any past treatment with injectable fillers, facial shaping, Botox® therapy, or other facial rejuvenation procedures.
Your cosmetic surgeon may also:
- Discuss options for facial rejuvenation
- Examine and measure your face
- Take photographs for your medical record.
What are the approved — and unapproved — uses of Botox® injections?
In April 2002, the FDA approved Botox® Cosmetic for the treatment of moderate to severe frown lines between the eyebrows (glabellar lines), but it is often used off-label on crow’s feet, forehead creases and bands on the neck. Botox® is approved for spasm of the eyelids (blepharospasm), severe neck muscle spasms (cervical dystonia) and excessive sweating (severe primary axillary hyperhydrosis). Myobloc is approved for the treatment of adults with cervical dystonia (muscle contractions of the neck). It has not been tested sufficiently in children with cervical dystonia. Dysport® is now approved to treat forehead wrinkles and frown lines. Currently, Boto® is being studied to treat a variety of other conditions, from knee and hip osteoarthritis and temporomandibular joint disorder (TMJ), migraine headache and benign prostatic hyperplasia (BPH).
What is the difference between Botox® and cosmetic injectable fillers?
Botox® temporarily corrects or eliminates dynamic wrinkles caused by overactive facial muscles by blocking the chemicals that cause the facial muscles to contract resulting in muscle relaxation. Botox is only effective for the correction of dynamic wrinkles. Skin sagging and wrinkles of the face start to develop as we get older as a result of thinned and broken collagen. These types of wrinkles (static wrinkles) are different from the dynamic wrinkles and require the use of fillers to fill out and plump up the depressed areas. There are several cosmetic injectable fillers available at Cleveland Clinic Cosmetic & Plastic Surgery Center, including Restylane®, Collagen, Sculptra®, Cosmopast® Cosmoderm®, Hylaform® and Radiesse®.
Can Botox® be used to treat hyperhidrosis (excessive sweating)?
Botox® injections have proven to be very useful in diminishing excessive sweating (hyperhidrosis). Hyperhidrosis is a common and extremely distressing condition. For those affected, the condition is debilitating with serious impairment in activities of daily living, social interaction and occupational activities. The condition is divided into primary or idiopathic hyperhidrosis, which is usually focal and limited to the armpit (axilla), palms, soles and face, and secondary hyperhidrosis, which can be local or generalized affecting the entire body. Secondary hyperhidrosis is due to a variety of causes including underlying medical conditions, drugs, or exaggerated physiological responses to heat, humidity, or exercise. Injections of Botox® in the armpit create a localized, prolonged, yet reversible decrease in chemical transmission to the sweat glands that results in a diminished sweat production.
One of the best ways to decide if cosmetic surgery is right for you is by meeting with a cosmetic or plastic surgeon at the Cleveland Clinic Cosmetic & Plastic Surgery Center.
During this first consultation, you and your surgeon will discuss your goals and expectations. Your surgeon will also:
- Review your complete medical history (including past and current medications)
- Evaluate the part of your body that you want treated
- Give recommendations
- Answer any questions you have
- Learn more about a physician consultation
How is a Botox® treatment performed?
Botox® is injected directly into the muscle that causes dynamic wrinkles (wrinkles that appear temporarily when a muscle contracts, such as smiling or frowning). A very small needle is used to minimize discomfort causing the injection to feel like a small prick with a little stinging. The entire procedure takes about 10 minutes. Since the procedure is non-surgical, no recovery time is needed, and patients can return to work or other activities immediately. Typically, Botox® injections need to be repeated every three to four months.
Cleveland Clinic Cosmetic & Plastic Surgery Center specialists offer Botox® injections to treat:
Face:
- Frown lines
- Crow’s feet
- Forehead creases
- Brow shaping (Botox injections can be used to alter the shape of the eyebrows to create a more aesthetically pleasing appearance).
- Brow elevation (lift)
- Correction of eyebrow asymmetry (to elevate the lower eyebrow to the same level as the higher eyebrow)
- Elevation of the corners of the mouth
- Upper/lower lip creases
- Marionette lines, “drool grooves”
- Lip lengthening to correct gummy smile
- Chin softening (peach pit chin and excessive cleft)
- To improve the appearance of new and old facial scars
Neck:
- Horizontal “necklace” creases
- Vertical neckbands (turkey neck)
Chest:
- Wrinkling of the central mid chest (décolleté).
Are there different types of Botox treatments?
Yes. Botox® Cosmetic (Allergan), Botox® (Allergan) and Dysport® (Ipsen) are both derived from botulinum toxin Type A. Myobloc® (Solstice Neurosciences) is derived from botulinum Type B. The Botox® product is the only one of its type with over 10 years of success in treating patients with a variety of conditions. Botox® Cosmetic has a dosing specific for the treatment of frown lines.
What results can I expect?
Botox® injections offer dramatic results that are fully apparent within five to seven days. In clinical trials, nearly 90 percent of the men and women surveyed rated the improvement in their brow lines as moderate to better. For many, Botox® virtually “erases” these lines.
Results may vary for each person, depending on the severity of wrinkles and the strength of muscles treated. Your Botox® treatment’s results typically last from three to six months, with most people gradually returning to their former state. Normally, your cosmetic surgeon will recommend that Botox® Injections be repeated every three to four months. With repeated treatments, some patients may notice that the effect of the Botox® is longer lasting.
What is involved in recovery?
Unlike surgery, Botox® injections are fast, simple and minimally invasive, with no downtime or recovery. Botox® procedures are performed on an outpatient basis at Cleveland Clinic Cosmetic & Plastic Surgery Center, and most people return directly to work or normal activities following treatment.
Is Botox® safe?
Yes. Very. According to both the American Society for Aesthetic Plastic Surgery (ASAPS) and its sister organization, the American Society of Plastic Surgeons (ASPS), Botox® is extremely safe. More than one million people have received Botox® injections. Year after year, Botox ranks number one among nonsurgical cosmetic procedures among both men and women.
Complications from Botox® are rare; the most common side effects include:
- Headache
- Bruising and numbness at the injection site
- Temporary eyelid droop (“ptosis”)
- Nausea.
Dysport injections have been used safely and effectively for over 15 years to treat many ophthalmologic and neurologic disorders.
The most common side effects of Dysport include:
- Temporary soreness or mild bruising around the injection site
- Slight headache that lasts for several hours after treatment
- Temporary eyelid droop ("ptosis").
Why Choose Us
If you’re considering Botox®, look for a board-certified cosmetic surgeon with specialized training and significant experience performing this procedure. While any authorized health care professional can administer Botox®, you should consider going to a cosmetic surgeon who is affiliated with a major medical center, such as Cleveland Clinic, for the best results. Ask your cosmetic surgeon about their credentials, training and how many Botox® injections he or she has performed.
Is this procedure covered by health insurance?
Like all cosmetic procedures, Botox® is not covered by health insurance. Ask to talk with a financial representative from Cleveland Clinic Cosmetic & Plastic Surgery Center who can explain the costs of the procedure and payment options.
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.
© Copyright 1995-2010 The Cleveland Clinic Foundation. All rights reserved.