Wrinkle Reduction (BOTOX)

Introduction

BOTOXⓇ Cosmetic is a prescription medicine that is injected into specific muscles to improve the appearance of wrinkle lines. In Toronto, BOTOX Cosmetic is a popular non-surgical option to reduce or eliminate frown lines between the eyebrows, forehead creases, crows feet (lines around the eyes), and muscular bands in the neck. Botulinum toxin (BOTOX ) also has been found to be effective in relieving migraine headaches, and excessive sweating (hyperhydrosis).

Toronto facial plastic surgeon Lawrence Tong, MD is highly experienced in the use of BOTOX Cosmetic for wrinkle reduction as well as the treatment of migraines and excessive sweating. As with all procedures he performs, Dr. Tong uses his superior skill to apply BOTOX in such a manner that patients appear naturally rejuvenated, never “overdone” or “frozen.”.

The Facts on BOTOX Cosmetic

BOTOX Cosmetic was introduced in 2002, and is the first botulinum toxin to be approved by the FDA to temporarily treat moderate to severe glabellar lines between the brows. With real, noticeable results, no surgery and no recovery time, there are many reasons why BOTOX Cosmetic has been chosen by millions of patients and their doctors.

BOTOX Cosmetic is administered by a healthcare professional as a simple, nonsurgical treatment that is injected directly into the muscles. It works by blocking nerve impulses to the injected muscles. This reduces muscle activity that causes moderate to severe lines to form.

Benefits of Wrinkle Reduction with BOTOX Cosmetic

Dr. Tong’s patients derive many benefits from treatment with BOTOX Cosmetic, such as:

• Elimination of fine lines and wrinkles without surgery
• Procedure is quick, comfortable, and minimally-invasive
• No downtime
• Reduction of migraine headaches
• Reduction of excessive sweating
• A more youthful, well-rested appearance
• Enhanced self-confidence
• Results last up to 6 months

Treatment with BOTOX Cosmetic: What to Expect

Preparing for BOTOX Treatment

We ask patients not to take medications that can thin the blood (eg. Motrin, aspirin) for 10 days prior to their injections.

BOTOX® Procedure Details

BOTOX Cosmetic injection is a straightforward procedure. Dr. Tong will first confirm that you are a candidate for the procedure. You will be asked to create the lines that trouble you by frowning, squinting, or raising the brows. A number of small injections with a very small needle are placed strategically, customized to your anatomy. The actual procedure lasts less than 5 minutes, and you can go back to your normal activities immediately following treatment.¹

Recovery after BOTOX®

We caution patients who have undergone BOTOX Cosmetic injection not to lay down for 2 hours after the procedure, and not to perform strenuous exercise that day. People may start to see the effect within 24 hours, but it may take up to 4 days for the full effect to be noticeable.

As expected, you will find it very difficult to contract the muscle(s) that have been injected, but you may still be able to obtain some minor movement, especially at the periphery. If the lines in the skin are fairly deep, it may take up to 4 weeks for the skin creases to fully relax, even though the muscles are frozen. In some cases, very deep lines may take several rounds of continuous Botox treatment to minimize their appearance.

The effect of BOTOX Cosmetic is temporary, and generally lasts for 4 months.

Specific Areas for BOTOX® Treatment

BOTOX® Between the Brows (Glabella Area)

When you frown, the vertical lines that form between the eyebrows are made from contraction of the muscles called the corrugators. In addition to these vertical lines, there are horizontal lines across the bridge of the nose that form when you wrinkle your nose. These are made by the procerus muscle. At Yorkville Institute of Plastic Surgery, Dr. Tong treats wrinkles in these areas by placing the BOTOX Cosmetic to freeze the corrugators and procerus muscles. The typical amount of BOTOX Cosmetic required is 20-30 units. You should expect the lines to be quite smooth, once the BOTOX Cosmetic effect occurs. As expected, you will find it hard to frown.

The effect lasts between 4-5 months. Patients interested in a more permanent improvement to the area should consider a surgical procedure. Either a Forehead Lift or Corrugator Removal will provide a long term improvement to this area.

BOTOX® for the Forehead

Foreheadlines form when you raise your eyebrows. The muscle involved in making these lines is the frontalis muscle. Over-activity of the frontalis muscle can lead to permanent and deep horizontal forehead wrinkles, and is often subconscious. Injection of BOTOX Cosmetic into this area is very effective in obtaining a smooth forehead appearance. Dr. Tong is very meticulous about the injection; incorrect placement of BOTOX in the forehead can cause the brows to droop, giving an undesired look. Typically 20-40 units of BOTOX Cosmetic are utilized; patients may need more or less depending on the anatomy and Dr. Tong’s evaluation.

The effect typically lasts 4 months. For patients who desire a more permanent smoothing of the forehead along with lifting of the brows, a Forehead Lift should be considered.

BOTOX® for the Crows Feet

The appearance of crow’s feet can be seen easily when the eyes are squinting or tightly shut. The muscle involved in producing the lines is called the orbicularis oculi muscle. Multiple factors can contribute to the appearance and progression of crows feet: significant sun exposure causing loss of skin elasticity, persistent squinting, and loss of facial fat with aging all contribute. The use of BOTOX can dramatically decrease the appearance of crow’s feet by freezing the muscle.

The duration of BOTOX to the crows feet lasts 4 months on average. There is no surgical option to eliminate crow’s feet as effectively as receiving BOTOX injections. A Facelift or Mini Facelift will help with crow’s feet but generally not as much as a BOTOX treatment for freezing the muscle.

BOTOX® for the Neck Bands

Changes to the appearance of the neck are often one of the first signs of aging. One of these changes is the appearance of ‘neck bands’. These are muscular cords that run vertically along the front of the neck. They become more visible as we age, and are more apparent in thin individuals. These bands are actually part of the platysma muscle, a muscle that covers the front of the neck. Changes in the muscle occur as we age, making the cords much more easily seen. One way to treat these bands is through the use of BOTOX . Typically, each band requires 15- 20 units of BOTOX and most patients have between 2-4 bands that need to be treated.

If you are looking for a more permanent solution, a Facelift, Neck Lift, or Mini Neck Lift will correct this problem on a long term basis.

BOTOX® for Jaw Reshaping

Patients may have increased width of the jaw/face due to overgrowth of the biting muscles (masseter muscles). These patients commonly have associated teeth grinding at night. A way to decrease the width of the jaw without resorting to jaw surgery is to inject BOTOX into the muscles.

BOTOX® for Excessive Sweating of the Underarms or Palms

Excessive sweating of the underarms or palms of the hands is often uncontrollable, unanticipated, and embarrassing. Ultimately, excessive sweating (hyperhydrosis) can lead to social anxiety and other damaging psychological and emotional side effects. Before the days of BOTOX , surgery was one of the only methods to help some of these patients. Nowadays, excessive sweating can be easily controlled with BOTOX injection, which freezes the muscles and blocks chemical signals from nerves that stimulate the sweat glands.²

BOTOX® for Chin Dimpling

Frequent or constant chin dimpling occurs when there is over-activity of the muscle located on the chin (called the mentalis muscle). It is usually subconscious, and is often related to having an under-projected chin (‘weak chin’), or a certain configuration of the teeth to the lips. BOTOX injection can correct this appearance. The surgical correction for chin dimpling would involve improvement of the weak chin usually with placement of a chin implant.

BOTOX® for ‘Smoker’s Lines’

Smoker’s lines are the contraction lines of the muscle around your mouth. Smokers can have over-activity of these muscles, leading to the appearance of vertical wrinkles lines. Women complain that these lines make them appear aged, and cause their lipstick to bleed. These lines may also be present in men and non-smokers, and could be caused by aging, sun exposure, loss of facial fat, and genetics. Whatever the cause, a small amount of BOTOX placed carefully in strategic areas can help relax the muscles and smooth the appearance. BOTOX administration in this area must be done carefully, as too much can cause a crooked mouth or smile. Dr. Tong has plenty of experience with injections to this specific area.

BOTOX for Migraine Headaches

Research has indicated that migraine headache sufferers can benefit from BOTOX injection. Approved by the FDA for the treatment of chronic migraines (15 or more headache days a month), BOTOX is used to block the release of chemicals that transmit pain. While BOTOX for migraines does not provide immediate reduction in headache days, many patients note that their headaches decrease by half by the time treatment is completed.³

BOTOX Cosmetic FAQs

Is BOTOX right for me?

If you are troubled by wrinkles and fine lines caused by repetitive facial movements (like squinting), you may be a good candidate for wrinkle reduction with BOTOX Cosmetic. Before performing BOTOX injections, Dr. Tong carefully evaluates each patient. You may not be a good candidate for treatment with BOTOX if you are:

• Pregnant
• Breastfeeding
• Diagnosed with a neurological disease
• Allergic to the preservative used in BOTOX Cosmetic⁴

What is the difference between BOTOX Cosmetic and dermal fillers?

BOTOX temporarily relaxes the muscles whose contractures lead to the formation of wrinkles, effectively softening the appearance of those wrinkles. However, BOTOX does not actually “remove” wrinkles: for this, a dermal filler is more appropriate. Dermal fillers are used to restore volume to creases and wrinkles, literally “filling” that area to create a plumper, more youthful look.⁵

Many of Dr. Tong’s patients prefer to use a combination of BOTOX Cosmetic and dermal fillers or collagen injections to achieve their desired results.

Is BOTOX safe?

BOTOX is approved by the FDA for the treatment of wrinkles and fine lines, and is safely used by millions of people every year. Fortunately, complications from BOTOX Cosmetic are fairly unusual. However, when they do happen the most common side effect is that the BOTOX is working too well or in areas that it was not intended to freeze.

• BOTOX Cosmetic working too well: Some patients may complain that their forehead feels or looks too heavy after BOTOX Cosmetic injection; this occurs in patients who are used to habitually elevating their brows, and can no longer do so because of the BOTOX effect. This results in the sensation or appearance of brow heaviness. Dr. Tong will identify these patients, counsel them on the risk, and place the injection in a manner that minimizes the risk.
• BOTOX Cosmetic working in unintended area: Rarely, the BOTOX can affect adjacent muscles, causing unwanted relaxation in other areas. One example is a slight droop in the upper eyelid that can be associated with injections for lines between the eyebrows. Fortunately, this rare complication can be treated with eye drops, and is generally very temporary.

Will BOTOX make me look “frozen?”

This should not be the case if it is used in an appropriate manner, and administered by a properly trained healthcare professional.

Will my wrinkles come back worse if I stop BOTOX Cosmetic treatment?

No. If you choose to stop your BOTOX Cosmetic treatments and allow the effects to wear off completely, the muscles will ‘wake up’, and function just as they did before. There is no ‘rebound’ effect to the muscles which makes the lines worse.

Your BOTOX Consultation

Dr. Lawrence Tong has helped countless patients achieve a more youthful, refreshed appearance using BOTOX Cosmetic. If you are interested in reducing the appearance of fine lines or wrinkles on your face, or would like to learn more about BOTOX for the treatment of migraines or excessive sweating, please contact our Toronto office today to schedule your personal consultation with Dr. Tong.

¹ American Society of Plastic Surgeons. What are the steps of botulinum toxin injections? Available: https://www.plasticsurgery.org/cosmetic-procedures/botulinum-toxin/procedure. Accessed July 2, 2020.
² Ada Regina Trindade de Almeida, MDa, Suelen Montagner, MDb. Botulinum Toxin for
Axillary Hyperhidrosis. Dermatol Clin. 2014 Oct;32(4):495-504. doi: 10.1016/j.det.2014.06.013. Accessed July 2, 2020.
³ American Migraine Foundation. Botox for migraine. Available: https://americanmigrainefoundation.org/resource-library/botox-for-migraine/. Accessed July 2, 2020.
⁴ Cleveland Clinic. Botulinum toxin injections: risks/benefits. Available: https://my.clevelandclinic.org/health/treatments/8312-botulinum-toxin-injections#risks-benefits. Accessed Aug 27, 2024.
⁵ Cleveland Clinic. Botulinum toxin injections. Available: https://my.clevelandclinic.org/health/treatments/8312-botulinum-toxin-injections. Accessed July 2, 2020.