The hottest topic in plastic surgery right now is Botox?, even though there is, in fact, very little about it that's truly noteworthy. It is being used in exactly the way plastic surgeons and others have been using it for years. The only difference is that that FDA has finally officially "authorized" its use in this manner.

Essentially, Botox? (which is derived from the toxin that causes botulism, although there's no need to go into those details here) weakens and relaxes muscles on a temporary basis. The effects on facial muscles typically last for about 4-6 months. Though originally intended for use in several medical conditions (such as persistent spasm of the muscles around the eyes) patients - and their doctors - quickly noticed that the lines around their eyes (e.g., the "smile" lines) were softened and, often, eliminated when the involved muscles contracted. This means that when you smile, or frown, the lines that would otherwise form as a result are diminished or eliminated entirely.

The frown lines are the ones that appear in between the eyes, on the lower forehead, and they are actually the lines that I treat most often. They seem to be the lines that people hate the most, and they are treated particularly well with these injections. If you must frown for some reason, you might as well not have it be so obvious. Botox? also softens lines at rest, so when these lines are fairly prominent even at rest, then treatment with Botox? is an excellent option. The third area that is commonly treated is the forehead itself, specifically the fine, horizontal lines. It is important to note, however, that treatment of forehead lines may lower the eyebrows a bit, as the forehead muscles function, partly, to raise the eyebrows. Weakening those muscles may, therefore, lower the eyebrows. Treating just the frown lines between the eyes (without also treating the entire forehead) often provides, as an added benefit, a slight lift to the eyebrows. This is because the muscles that cause the frown lines to appear also pull the eyebrows down a bit; weakening them allows for the relatively unopposed upward pull of the forehead muscles.

Botox? is administered by a wide variety of practitioners, including doctors (such as plastic surgeons, dermatologists, and ophthalmologists), nurses in the various doctors offices, and non-medical personnel in spas and similar settings. It is important to know who will be administering the BotoxR, which consists of a series of needle injections into the regions being treated. While it is not exceedingly difficult to give these injections, there is, as always, a range of capabilities among the people giving them.

Finally, there is the cost of Botox?. In New York, it typically ranges from about $500 - $1000 for a treatment but the thing to know is how many UNITS one will be receiving as part of the treatment. Botox? comes as a powder that must be reconstituted (mixed with) a liquid, such as saline. There are 100 units in a vial. If you're getting the whole vial, you're getting 100 units. Since, however, the vial can be diluted with various amount of liquid, just being told how many syringes, or how much solution you're getting does not tell you the whole story. If you're planning to get Botox? injections, you might as well know what you'll really be getting.

More articles from Alan Engler, M.D., F.A.C.S.