To Botox or Not To Botox? Ask the Plastic Surgeon

by Julie on January 28th, 2010 at 4:35 pm

Ask the Plastic Surgeon with Jennifer S. Lee, MD.

Question: Can you explain what Botox is exactly?

Answer: “The best place to start a discussion on Botox is to describe what it is and what it can do. Botox is a brand name for a form of botulinim toxin. Yes, this is the same toxin that causes botulism. Botox, Dysport and Myobloc are the brand names of the different forms of botulinim toxin on the U.S. market. Botulism?!! Yes, botulism. The bacterium Clostridium botulinum produces a toxin that blocks nerve signals to the muscle. That is why you have weakness and trouble breathing with botulism.

Although the drug forms of the toxin are carefully processed and are injected in amounts far too small to cause botulism, these potential side effects are present on the drug labels. That is why you should to go to a doctor who knows these possible side effects on a patient, someone who knows where – and where not – to inject the toxin.

Since most people recognize the word Botox, I will use this term to describe the toxin and the technique of injecting the toxin. Since Botox blocks nerve signals to the muscle, it can block certain facial muscles from moving. I had a Botox sales representative tell me never to say this to a patient, but that’s what it does: Botox paralyzes the muscle into which it is injected. This is the one and only effect of Botox, and why it is so helpful treating wrinkles in certain parts of the face. Botox will treat wrinkles caused by facial expressions. Smiling, frowning, laughing, talking—all these expressions produce wrinkles in the forehead, between the eyes, and around the eyes and mouth.

Now that you know what Botox does, it is easier to understand what it cannot do. I am frequently asked if Botox can get rid of a deep wrinkle or whether it can be used as a facelift alternative. Botox can help soften a deep wrinkle if it is located over a muscle of facial expression. It is not doing anything to the wrinkle itself, just keeping the wrinkle from forming by paralyzing the muscle underneath it. If the wrinkle is shallow or a fine line, then it can get rid of a wrinkle by preventing it from ever forming.

A deep wrinkle usually does not go away entirely, because the overlying skin is permanently creased. Botox cannot perform a facelift. In fact it does the opposite of lifting. If you think of a paralyzed face, it droops. No amount of Botox can tighten your face.

So back to the initial question: to Botox or not to Botox? Botox can be a great help to treat wrinkles in certain parts of the face. The best places to get Botox are between the eyebrows, the middle of the forehead and the crow’s feet area of the eyes. These are all areas that wrinkle when we move our face. As a patient, you can decide whether you want some or no movement in the area. Some patients want a totally smooth look, which means the area is fully paralyzed. Others like to have some movement in order to look more natural, but then they will still have some wrinkling in the area.

Everyone’s facial muscles lie over the bone and under the skin and fat. This may seem basic, but it should be remembered when injecting Botox. I had someone try to teach me to listen for the needle hitting the bone to find the right level to inject. Wrong! That will inject into the layer under the muscle and on top of the bone, which really hurts! Some inject just under the skin. Also wrong. You don’t want to inject into a blood vessel or into a nerve. That is why I so strongly recommend to get injected by someone appropriately trained in anatomy, physiology and pharmacology.

The amount of Botox used will determine the overall price. Most practitioners charge per unit of Botox. There is a standard amount that is usually used first. It can then be adjusted on subsequent visits to fine tune the result you want.

Make sure you talk to your practitioner in detail. Be wary of unrealistic promises. I have recommended against Botox almost as much as I have proceeded with injections. It really depends on the result you want. You may do better with a topical treatment, laser, fillers or surgery. Don’t be shy about seeking out more than one opinion on how to address those wrinkles. After all, it’s your face!"

Submitted by Springfield Moms sponsor and plastic surgeon Jennifer S. Lee, MD. For more information on her new location on Montvale Drive, visit our Mom's Choice Directory.