Botox is one of the most popular cosmetic treatments. A common concern is what to do if results are not seen. Here we discuss what Botox is, how Botox works, and what to do if you don’t see results from your Botox treatment.
What is Botox?
Botox is a purified protein used to address wrinkles associated with facial expression. Botox was first approved for cosmetic use to treat the vertical lines, sometimes called elevens, seen between the brows when people frown. These are called frown lines. Botox was later approved to treat crow’s feet. Crow’s feet are the lines seen around the eyes when a person smiles or squints. Earlier this month Botox was approved for the treatment of horizontal forehead lines. These are the lines that are seen when a person raises the eyebrows. There are also many other areas on and off the face where Botox is used, but these three areas in the upper face are the most common areas for treatment with Botox.
When Botox is injected into the skin it relaxes the muscles used to make these expressions and smoothens out the overlying wrinkles. With any injection there are risks such as pain, bleeding, bruise, redness, swelling, tenderness, and infection. Other rare side effects with Botox include headaches and the temporary appearance of droopy eyelids (which can be treated with prescription eye drops). At A E Skin we take special precautions to minimize the risk for these side effects. For example, we use cold air and a vibrating distractor during Botox treatments to maximize our patients’ comfort and to decrease the risk for bruising. We also treat bruises with a laser as early as the day after a Botox treatment which makes the bruise resolve more quickly. The pivotal studies have demonstrated that the peak effects of Botox are seen two weeks after a Botox treatment. Our clinical experience has confirmed this as well. Most people enjoy the results of their Botox treatment for three to four months, at which point a maintenance treatment is recommended. After a Botox treatment avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and maintain an upright posture for four hours.
Wait two weeks before assessing results
As mentioned above, the full results from a Botox treatment are seen two weeks after a treatment. Therefore, it is important to be patient and wait the full two weeks prior to assessing the results frmo the Botox treatment. Most people start seeing their results in less than two weeks after their Botox treatment. However, this can be variable. In some cases, results may be seen faster after one Botox treatment but more slowly after another Botox treatment. This is due to small variability from one Botox lot to another.
Use the full dose
The does for a Botox treatment goes by the unit. Depending on the person and the area being treated, the dose of Botox ranges from 10 units to 24 units in the areas in the upper face. The pivotal studies used these doses and found that a good clinical effect was seen with these Botox doses, but when decreased Botox doses are used less of an effect is seen. Additionally, when people receive a lower dose of Botox they do not enjoy their results for the full three to four months. One of the most common reasons that people do not see full results after their Botox treatment is because the dose used was too low. Although many people have fears of Botox treatments, the recommended doses are provided to give natural and full results.
Take before and after photographs
In order to assess the results of a Botox treatment, one must be able to see the wrinkles formed with facial expression before and after the treatment. For this reason, we always take photographs of our patients making facial expressions in five different angles before the Botox treatment. We have patients return two weeks after their Botox treatment and take the same pictures. When these photographs are compared, the wrinkles should be reduced. Most people look in the mirror every day and often times people remember what they looked like the day before and forget what they looked like two weeks ago. This is why it is important to take photographs before and after Botox treatments.
Wrinkles at rest
Some people have wrinkles at rest, that is, without making any facial expressions. Often times these wrinkles get deeper when they make facial expressions such as frowning, smiling, or raising the eyebrows. In these cases, a Botox treatment may not completely smoothen out these wrinkles that are seen at rest. However, after a Botox treatment the wrinkles will not get as deep when people make the facial expressions. For full correction of wrinkles at rest, a series of Botox treatments at three to four month intervals for a period of at least one year is required. Other treatments such as laser resurfacing will provide further benefit.