Article designed for non-physicians to answer BOTOX® questions , including safety, appropriateness, choosing an M.D., frequency of treatments, cost and treatment strategies to achieve the best results.



If you are one of the few adults who have not yet experienced BOTOX®, BOTOX Cosmetic® (BOTOX), or other astounding innovations like Fraxel Laser, you may be wondering whether it’s time you did.  Treatments like BOTOX and Fraxel laser have proven to have incredible results for our patients here in Orange County.

You may also be reluctant to use a drug that used to have “toxin” in its name.  After all, doesn’t that mean it is a poison?  Another fear you might have is of needles, especially in your face!  As one of the top Orange County BOTOX injectors, I can assure you that BOTOX is a safe and extremely popular treatment.

Don’t be afraid

Before deciding whether BOTOX is appropriate for you, let me allay your fears.  BOTOX is the most popular cosmetic treatment being performed in the United States.  Men and women from age 18 and up have not only tried it, but continue receiving it on a regular basis.  The results, if performed by an experienced injector, are usually good to excellent and the low side effect profile makes BOTOX one of the safest drugs available.  Many drugs, including aspirin, acetaminophen (Tylenol®), and Digitalis are all toxic and potentially lethal if consumed in doses higher than what is recommended.  BOTOX can actually be given in doses many times what would normally be given to treat facial wrinkles and not be toxic to your body.  For example, patients with cerebral palsy and back pain are often given 300 units* and up of BOTOX per treatment, while the wrinkles on your face may only require 15-50 units.  Secondly, needles need not be painful if used gently and carefully by an experienced caring physician.  When BOTOX is very concentrated (not too diluted), injected with a very small needle, and the hand injecting it is gentle, it can be a pain-free experience.

But is BOTOX the right procedure for you?

BOTOX, when used appropriately, is one of the safest and most effective treatments for relaxation of facial lines and wrinkles.  When injected into certain facial muscles it relaxes these muscles, thus smoothing out the wrinkles.  This relaxation typically lasts 3-6 months. 

BOTOX is typically used for expression-related wrinkles in the upper face: frown lines between the eyebrows (angry lines), forehead wrinkles and crows feet.  More experienced physicians can also lift eyebrows, raise the corners of the mouth, smooth out lip lines and even smooth out necks with BOTOX, all of which are regularly accomplished in our Orange County office.

Choose where you get your BOTOX wisely

Results with BOTOX are based 50% on technique.  Your results will vary depending on how much is used and who does your treatment.  In other words, who you go to for this treatment is extremely important.  Make sure the injector has a great reputation in using BOTOX and a lot of experience with it.  He or she should be treating at least 10 patients (using about 3 bottles of BOTOX) per week, every week, avoid someone who only opens up a bottle of BOTOX once a week or once a month.  There are many wonderful physicians who do great surgery or who practice in a beautiful setting, but their BOTOX technique may not always be the best.  There are also many med spas who offer BOTOX and other cosmetic procedures.  Remember, it’s who injects the BOTOX that matters, not how relaxing the environment is or how great a deal you are getting.  Most specialty physicians, such as dermatologists, plastic surgeons and facial plastic surgeons have had extensive training in facial anatomy, physiology and experience in treating the face surgically. They are usually the best BOTOX injectors because this experience gives them the background to understand how BOTOX works best and how it should be customized based on how each face differs.  Their experience with other facial procedures and treatments also allows them to choose and combine the best treatments for each individual’s problem.  BOTOX is not the only tool for anti-aging, nor is it the appropriate tool in every case.

When choosing a physician, make sure you find out what they are board-certified in.  Any physician can advertise they “specialize in” cosmetic surgery or dermatology but to be board-certified they had to have completed a residency and passed a test in that specialty. (Note: the author, Dr. Lorrie Klein is a board-certified BOTOX physician and trainer in Orange County, CA.)

How often are treatments?

BOTOX injections can be kept up like a great haircut and color, or used for special occasions only if desired.  Regular maintenance for BOTOX requires treatments every 3-6 months.   Always plan on having your treatment at least 2 weeks before a special event, as it can take up to 2 weeks for the results to fully kick in.  Also, if a needle-induced bruise occurs it could take 7-10 days to heal. Planning your first BOTOX treatment at least 4 weeks before an event is even better, as touch-ups may be necessary in the beginning to determine your “perfect” dose.

Customizing BOTOX is important to achieve great results

In my practice and spas I customize each patient’s dose. My goal is to find the lowest “perfect” dose that will smooth out the wrinkles, look natural, last at least 3 months, and not make the patient’s face look “frozen.”  To accomplish this I initially treat on the low end of the range, which I estimate will work for each individual patient, for each area treated.  I will then add more BOTOX after two weeks if necessary.  Once the “perfect” dose is achieved, touch-ups are no longer necessary and each patient will have his or her own customized dose to refer to in the future.

Don’t shop by price

Deciding if BOTOX is right for you also depends on your budget.  Check prices before you have your treatment.  Keep in mind however that this drug is expensive, even for the physician purchasing the product.  Find out the price per unit as this is the only way to find out the value of what you are getting.  If you will be charged by site or “syringe”, find out how many units will be given per site or syringe, otherwise you have no idea how much BOTOX you are actually getting.   If the price sounds too low, you are probably not getting many units in your treatment.

Experience and reputation also count. Many med spas and primary care physicians offer discounted BOTOX because that is the only way they can attract patients. Getting your BOTOX based on cost alone is akin to getting your hair done at a chain salon, with a stylist right out of school, for $15.  If that is all you can afford, that’s understandable, but remember, you get what you pay for.  Most experienced cosmetic specialists currently charge $12.00 to $15.00 per unit for BOTOX.  Units required typically vary for women from 15-40 units for the frown lines between the eyes, 16-30 units for crows feet (both sides), and 9-16 units for the forehead wrinkles.  Some women and most men may require more units than this.  If you can’t afford these costs I would recommend not having BOTOX treatment.  If you don’t receive enough units you will be wasting your money. You may not see results and it won’t last very long.

Combining BOTOX with other treatments

BOTOX is also commonly combined with other cosmetic treatments and products.  Fillers, such as Restylane®  and Radiesse®, laser treatments, such as Fraxel®  Laser and also physician-strength rejuvenation skin care products, such as Prevage®  and Prevage MD®, are often used with BOTOX to enhance anti-aging results.

Conclusion

BOTOX Cosmetic® treatments are a popular, quick and easy solution to relaxing many facial expression lines.  It is safer than many other drugs commonly sold over the counter.  Who you go to is one of the most crucial factors in achieving great results, so it is important not to choose based on price or convenience alone.

*BTX is measured in units, not weight or volume.  One bottle of BOTOX Cosmetic® contains 100 units.

Prevage®, PrevageMD®, BOTOX® and BOTOX Cosmetic® are trademarks of Allergan.

Restylane® is a trademark of Medicis.

Radiesse® is a trademark of Bioform.

Fraxel® is a trademark of Reliant Technologies.