Dr. Inessa Fishman, Artisan Plastic Surgery’s Facial Plastic & Reconstructive Surgeon, gets asked about Botox® often.  While this medication has been around for decades and sees many uses–from pesky frown lines to migraines and overactive bladder–there are still many myths and misunderstandings about Botox®, and its cousins Dysport® and Xeomin®.  Here are the questions Dr. Fishman fields most often:

Botox®, an injectable muscle-relaxing and line-smoothing medication
Botox®, an injectable muscle-relaxing and line-smoothing medication

How does Botox® work?

Botox® and the similarly-acting medications Dysport® and Xeomin® relax the muscles into which they’re injected.  Once overly active muscles relax, they can no longer crease the overlying skin–and this allows for these medications’ cosmetic purposes:  relaxing the between-the-brows frown lines, horizontal forehead lines, crinkly smile or “crows feet,” and a variety of other unwanted facial expression lines.  Botox®, Dysport®, and Xeomin® are related medications with slightly different molecular structures; they all work in a similar fashion to relax muscles, and are all FDA-approved for cosmetic purposes in the United States.  It is important to highlight that Botox® does not add volume or fill in creases; if lines are etched into the skin and appear at rest, Dr. Fishman often recommends a filler like Juvederm® or Volbella® to smooth or fill-in these lines.

What does Botox® treat?

The FDA-approved areas for the use of Botox® Cosmetic include the frown lines between the eyebrows (the so-called “11s”) and the “crows feet,” or smile expression lines at the outer corners of the eyes.  Dr. Fishman also uses Botox® in an “off-label” manner to treat the horizontal forehead lines, the “bunny lines” that sometimes appear with crinkling of the nose, the “orange peel” texture some people develop on their chins, and the vertical platysmal bands that can appear in the neck.  Botox also works well to improve a gummy smile, decrease the downward pull on the mouth corners, slim an overly square jawline, decrease tooth grinding, and reduce excess sweating in some areas.

Botox® is not a filler, and does not add volume.  Dr. Fishman frequently uses both Botox® and fillers (like Juvederm®, Voluma®, and Restylane®) together to achieve a desired aesthetic goal.

How long does it last?

In terms of timing, Botox® takes 2-4 days to start working, and generally lasts 3-4 months for the majority of people.  Most patients come in to get Botox 2-3 times a year, says Dr. Fishman.  If you’re planning around a big event like a wedding or graduation, it’s best to get Botox a month prior; that way, it can be tweaked if needed, and you will look great on the big day.

Before and after photos of Botox treatment of the frown lines
Before and after photos of Botox treatment of the frown lines

When is the best time to start Botox® treatments?

The so-called right time is different for everyone, says Dr. Fishman, because each individual patient has different anatomy, genetics, and environmental exposures.  That being said, once you start noticing lines becoming etched into your facial skin, you would do well to check in with a Plastic Surgeon or Dermatologist who has a lot of experience does aesthetic injectable treatments.  Some patients are ready for baby doses of Botox® in their 20s, while others try it for the first time in their 30s, 40s, and beyond, explains Dr. Fishman.  “I like the idea of Botox® as a preventative measure, and feel like it’s much easier to prevent a permanent line than it is to erase a line already present,” she says.

When researching Botox®, look for a physician who can give you an overall view and treatment plan for your face–protecting your skin, putting your beast features forward, and treating your concerns, says Dr. Fishman.  “Botox® is a very powerful tool, but it is just one tool in a large toolbox of cosmetic treatments,” explains Dr. Fishman, “it’s important to talk about good diet and hydration, inflammation, sun protection, retinols, and resurfacing–among others–for looking and feeling your best.”

What are the risks and complications of Botox®?

Despite the occasional Botox® celebrity horror story, Botox is actually a fairly low-risk medication.  The most common risks are bruising and bleeding, and those risks are associated with any injection (fillers, steroid injections, etc).  There are small risks of an overly heavy brow or a droopy eyelid when treating the forehead; these risks are minimal in the hands of an experienced treating physician.  Because Botox® has temporary effects, its side-effects are temporary, too.  “The safety of Botox® is very, very good and time-tested,” says Dr. Fishman.  “This is a medicine with which I treat my family members, and use myself.”

“Botox is a great medication, with a long history of safety and success,” says Dr. Fishman.  “It’s an awesome tool to have in the aesthetic toolbox, because it does things surgery and lasers often cannot do.  Most people really like what it does for their appearance and overall well-being, and it’s one of the few treatments I perform every day at the Artisan practice.”