What is BOTOX® Cosmetic?
BOTOX® Cosmetic is purified botulinum toxin type A. It is a naturally derived
product used to reduce unwanted muscle activity. It has been used for medical
purposes for more than 20 years, primarily for ophthalmologic and neurologic
muscular diseases, for which it is FDA approved. More recently, it has been
used for the cosmetic reduction of facial expression lines. It is considered safe
and effective when properly used. BOTOX® Cosmetic is a great adjunct to laser
photorejuvenation in reducing the appearance of wrinkles in all ages.
What is the cause of wrinkles and facial expression lines?
Lines and wrinkles develop, at least in part, from the action of facial muscles on
the overlying skin. After years, furrows may remain along these facial
expression lines even without any active facial muscle expression. This is
especially true of lines of the forehead and between the eyebrows. Other lines,
such as crow's feet, may make us appear older than our chronological age.
The development of these lines is promoted by years of sun exposure, and to a
lesser degree, by smoking. BOTOX® Cosmetic is capable of preventing these
unwanted facial expression lines and wrinkles.
How does BOTOX® Cosmetic work?
BOTOX® Cosmetic acts by producing muscle relaxation at treated sites. It does
this by inhibiting contraction of the targeted muscles, causing them to relax.
The strategic relaxation of certain facial muscles leads to decreased wrinkling
of the overlying skin.
What kind of facial lines does it remove?
Prominent facial expression lines, especially horizontal lines on the forehead,
vertical lines between the eye brows, and crow's feet are most dramatically
improved with treatment.
How does BOTOX® Cosmetic compare to other products such as collagen
and filler materials?
Unlike filler materials, BOTOX® Cosmetic treats the underlying cause of the
facial expression lines. Filler materials, such as collagen, only plump up the
skin. Although fillers reduce the appearance of lines when there is no facial
expression, the moment the person does smile or frown, the lines reappear.
BOTOX® Cosmetic actually prevents the unwanted lines from appearing with
facial expression, and often even at rest.
How is treatment performed and how many treatments are required?
A small quantity of solution is injected directly into the muscles that are the
cause of the prominent furrowing or expression lines. Typically several
injections are given with each treatment, and one or two treatments are usually
effective in achieving the muscle relaxation required to eliminate the unwanted
How long do the results of BOTOX® Cosmetic last?
The muscle relaxation with BOTOX® Cosmetic lasts for 3 to 6 months. When
the effect of BOTOX® Cosmetic wears off or diminishes, (i.e., the muscles that
contribute to these facial expression lines again become active and the lines
gradually reappear) treatment can again be administered.
How does the skin appear after BOTOX® Cosmetic?
Immediately after treatment the skin appears normal or there may be minimal
redness and swelling at the treated sites. Occasionally, there can be mild
bruising. If present, these changes resolve within a few hours to days. The skin
feels normal and there is no unusual sensation.
When can I expect to see results after treatment?
Within 48 hours after treatment reduction in the muscle activity can be noticed.
About two weeks after treatment the maximal benefit is attained and continues
for a few months.
Are there any limitations after treatment?
No. Immediately after treatment you may resume all normal activities.
Is there any discomfort with treatment?
There is usually mild discomfort at the injection sites. This only lasts for a few
seconds. Many patients choose to use a numbing cream on the skin prior to
the injections, however, this is only seldom needed.
Are there any risks or side effects?
Rarely. If BOTOX® Cosmetic should affect an adjacent muscle, it too may have
reduced activity. This has been reported in about one percent of those treated
and if this does develop, the most common change is some eyelid drooping.
However, any such unwanted muscle relaxation would also be temporary.
There are no reports of any injury to the eye when BOTOX® Cosmetic is
administered to the muscles of the forehead.
Can BOTOX® Cosmetic cause botulism?
No. Extraordinarily small amounts of BOTOX® Cosmetic are administered.
These quantities are insufficient to cause botulism or any related symptoms.
Call for complimentary consultation
Not All BOTOX® Is Created Equal!
Unfortunately, the BOTOX® you get at one practice may not be
exactly what you get at another. Clostridium botulinum toxin type A is
supplied in a manufacturers’ vial containing 100 units of the vacuum-
dried neurotoxin complex. In order to be able to inject these active
units of BOTOX®, a physician must add saline to get it in “liquid
form.” This process enables the BOTOX® to be extracted from the
vial into the syringe.
There are 100 units of BOTOX® in every vial. As you can see in
Table A (see below), the more saline (in mL) added to the BOTOX®
vial, the less active units present in each 1/10 mL extracted into the
syringe. Some may refer to this is as the dilution process, but it is
actually called “reconstitution.” So now, while each practice got the
same product from the manufacturer, when they reconstitute it to
make it possible to inject, they can add saline at the recommended
standard or they can add more saline than recommended.
Table A: Recommendations for Reconstitution and Handling**
Diluent (saline) added to BOTOX vial
(0.9% sodium chloride injection) Resulting dose/
Units per 0.1 (1/10) mL
1.0 mL 10.0 U
2.0 mL 5.0 U
2.5 mL 4.0 U*
4.0 mL 2.5 U
8.0 mL 1.25 U
* Approved dose is 4 units per 0.1 mL at each of the 5 injection sites
for a total dose of 20 units in 0.5 mL.
** Data from the Supplement to Plastic and Reconstructive Surgery,
provided by the American Society of Plastic Surgeons.
With this in mind, you should be cautious when practices offer
BOTOX® at bargain prices. Everyone pays the same price to get the
product from the vendor (Allergan). So how can prices vary so
much? That’s where the “reconstitution” question becomes very
important. Below, Diagram A illustrates the recommended starting
doses of the frequently injected areas.
Diagram A: Recommended units per area:
Botox Recommended Usage
You may think you are getting a “good dose” of BOTOX® because
the physician is injecting a large amount, but don’t confuse the units
of saline with the units of actual BOTOX®. Physicians who add more
saline than suggested by the manufacturer (or such organizations
as the American Society of Plastic Surgery) are giving you a less
effective injection of BOTOX®. So no matter where you go for
BOTOX®, always ask this question: “What is your reconstitution
Also, many facilities quote a price based on a particular area. Now,
besides your “reconstitution question,” you need to ask, “How many
units do you inject in that area?” And that begs the next question—
what is their definition of an “area.” For instance, a practice may
advertise $99 per area, but may be actually breaking up the crow’s
feet area into two areas when in most practices, it is considered one
So buyers beware! At Cosmetic Laser Clinic, we charge “by the unit”
for BOTOX®, so you only pay for the exact number of units you
receive. Also, we follow the American Society of Plastic Surgery
(ASPS) guidelines on “reconstitution,” so you are assured of the
efficacy of the product. Our doctors will discuss with you which areas
on your face should receive injections to best meet your concerns,
and they will tell you how many units of BOTOX® you will need to
attain your desired result.
Call for complimentary consultation