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By Dr. Alex Eshaghian, MD, PhD
May 27, 2018
Category: Services
Tags: Botox  

Botox before and afterBotox is one of the most popular cosmetic treatments performed worldwide. As the popularity of Botox has grown over the past decade, the interest has grown significantly. Many people have questions about what Botox is, how Botox works, etc. Here we discuss a specific question about why people see new wrinkles after a Botox treatment.

What is Botox?

Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment with Botox are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.

When patients present with concerns about specific wrinkles in the upper face such as the frown lines, it is important to assess and treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles between the brows (glabell) which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead (frontalis) which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, Dr. Alex recommends that patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.

Will the results of my Botox treatment look natural?

Many people are concerned about how their appearance will change after a Botox treatment. This is understandable given the amount of both positive and negative publicity there has been around Botox and other cosmetic treatments. When done properly, Botox will provide a natural appearance that makes a person look more youthful and rested. With the increase in popularity of v treatments many offices now provide such treatments. It is important to find an office where the injector has experience and expertise in Botox injections. Dr. Alex recommends looking for experience, before and after photographs, and testimonials.

Does a Botox treatment hurt?

One of the most common questions regarding v is whether the treatment is painful. We use a painless technique to maximize our patients comfort during the treatment. This starts by reconstituting the Botox with preserved saline, which contains benzyl alcohol, to decrease the discomfort with the injection. We use a tiny needle, similar to the size of the needle used for TB test on the forearm. During the Botox treatment, we provide a relaxing environment by playing a calming video with gentle music. We provide stress balls to our patients to hold during their Botox treatment. We blow cold air on the area which serves to numb the skin. We also use the Beauty Bar, which is a vibration device which distracts the patient from the Botox injection itself. Finally, with experience, Dr. Alex has developed a technique to inject Botox to minimize pain. This includes pinching the area, pushing the skin into the needle (as opposed to pushing the needle into the skin), using a slight rotation, and using gentle pressure. Most patients are surprised at how comfortable the Botox treatment is.

How long does a Botox treatment take?

The Botox treatment is very fast. Depending on the area, only a few injections are required and each injection takes a few seconds. For example, the most common technique for treating the frown lines with Botox uses five injections between the brow, one in the center and two on either side. This is usually accomplished in less than 30 seconds. The most common technique for treating the crow’s feet involves three injection points per side. Most patients are surprised at how fast the treatment is.

Is Botox safe?

The safety record of Botox is well established. Botox has been used for over 20 years for a variety of treatments with minimal side effects. Botox is amongst the safest treatments for treating facial wrinkles.

While Botox is one of the safest treatments offered, there are some situations where it is not appropriate. These include anyone who has an allergy to any of the inactive ingredients or who has had an allergic reaction to any botulinum product including Botox, Dysport, Xeomin, or Myobloc. The safety and efficacy of Botox has not been established in women who are pregnant, trying to become pregnant, or breast feeding. Therefore, women in these categories are advised to wait until breast feeding is completed prior to having a Botox treatment. Botox should not be placed in the skin on the site of an infection. Those who are taking an aminoglycoside antibiotic, an anesthetic, D-penicillamine, antimalarials, or immunosuppressants should not be treated with Botox, nor should those who have undergone chemotherapy within the previous six months. It is important to avoid blood thinners before and after a Botox treatment. These include both prescription and non-prescription medications such as warfarin (coumadin), aspirin, ibuprofen, alcohol, fish oil, vitamin E, and ginko biloba. Those with conditions that affect muscles and nerves such as amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), myasthenia gravis, or Lambert-Eaton syndrome should not undergo Botox treatments.

What are the risks of a Botox treatment?

With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless Botox technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.

What should I do after a Botox treatment?

After a Botox treatment, Dr. Alex recommends that patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids.

Botox Treatment Demonstration

Why am I seeing new wrinkles after a Botox treatment?

A phenomenon seen with Botox is called muscle recruitment and compensation. When a muscle has been relaxed with Botox, sometimes other muscles are recruited and contract when one attempts to make the facial expression. This serves to compensate for the inability of the primary muscle to contract. A common example is the bunny lines (caused by contraction of the nasalis muscle) that are seen on the sides of the upper nose after treatment with Botox in the glabella or for the crow's feet. Since the muscles in the treated area are relaxed, the nasalis muscle contracts in an attempt to compensate for this loss when one frowns or smiles. In such a situation, the bunny lines can be treated with a small amount of Botox (2-4 units per side). In the lower face, compensatory recruitment can occur when the platysma muscle in the neck contracts after muscles in the lower face have been relaxed with Botox. Similarly, this muscle can be relaxed with Botox as well. Dr. Alex usually uses approximately 10 units of Botox per band. If placed properly it does not affect other muscles. Relaxing the platysma muscle may also lead to an improvement of jowls and jawline definition. When such recruitment occurs, Dr. Alex recommends preventive (prophylacitc) treatment of the recruited muscles at the next treatment.

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Dr. Alex has performed over 10,000 cosmetic treatments with many satisfied patients. Contact us to schedule an appointment for a free consultation with Dr. Alex in our Encino, CA office.

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