Frequently Asked Questions about BOTOX®
What should be expected after BOTOX® therapy?
BOTOX® is a remarkably safe therapeutic agent for wrinkles. Complications have been minor and only transient. Bruising may occur where injected and a brief pain or headache may follow. Bruising may be greater in patients who are taking aspirin or any blood-thinning medicines. These products should be avoided if possible prior to the injection. Ice applied immediately after injection can help prevent bruising. The BOTOX® effect may be gradual in onset.
How long does BOTOX® last?
The positive effects of BOTOX® last between 3 and 6 months for most patients. After the first set of injections, reinjection after two weeks allows for an accurate localization of any resistant functioning muscles. With this method, at least ninety percent or more patients do respond positively to BOTOX®.
How often is reinjection needed?
Reinjection is suggested every three or four months to keep the muscles paralyzed and allow the furrows to completely smooth out. Once an area is smooth, patients are instructed to return for therapy only when they notice a return of muscle movement that they find undesirable.
Who should not use BOTOX®?
- Although there have been no reports of birth defects with this medicine, no pregnant patients will be treated. It is also our policy not to inject BOTOX® in nursing mothers.
- Patients with a history of neuromuscular disease (multiple sclerosis and myasthenia gravis) or other types of diseases involving neurotransmission should avoid this medicine.
- Patients taking the following medicines should not receive BOTOX®: aminoglycoside antibiotics (Streptomycin, Tobmamycin, and Garamycin injections), penicillamine, and calcium channel blockers (Calan, Cardizem, Dilactor, Norvasc, Procardia, Verelan).
What are alternatives to BOTOX®?
Filling agents including fat, Collagen, Fibril and Gortex; resurfacing procedures with acids or lasers; and lifting operations of the forehead, temporal, neck and mid-face regions. If no treatment, the lines and wrinkles persist.
What unexpected benefits have come from the use of BOTOX®?
Tension headaches for some patients have disappeared. These occurred in patients who were recruiting forehead and brow muscles during periods of stress and tension. When these muscles were relaxed, the headaches faded.
Those who concentrate powerful expressions of frustration, anger, and consternation in the mid-brow occasionally report enhanced casual interpersonal relationships and can experience enhanced mood. Presumably, this effect represents a difference in how others respond to a face reflecting a placid countenance as opposed to a knitted brow rowbrow expression. This effect is not scientifically demonstrated and only represents anecdotal observation. No expectations can be formed from these subtle and occasionally noted benefits.
How exactly does BOTOX® inactivate the muscle?
BOTOX® inhibits the release of acetylcholine at the joining site of the nerve to the muscle so that the muscle never gets the message to contract. Remember, muscles only have the ability to contract: an opposing muscle contracts to produce movement in the opposite direction. To rejoin the nerve to the muscle the body organizes and produces new motor endplates that reestablish the connection.
Does the body make antibodies to the BOTOX® protein?
Yes, especially if enough toxin is injected often enough. Antibodies have been more of an issue for neurological disorders where larger amounts of BOTOX® are required. When significant amounts of antibodies are formed, the therapeutic effects of BOTOX® are greatly reduced. No other effects have arisen. The crucial amount is about 100 units (more than the usual cosmetic dosage).
Have there been any reported cases of allergic reactions or hives to BOTOX®?
No reported cases of a true allergic reaction in nearly 20,000 treatments. People who are known to be allergic to Botulism toxin or albumin should avoid BOTOX®.
What happens if a female patient becomes pregnant shortly before or after treatment?
A number of neurological and ophthalmologic patients have delivered normal children after receiving their injections. For safety reasons no pregnant or nursing females will be treated.
How painful are the injections?
The smallest needles are used and the medicine itself does not sting as much as the usual local anesthetic. Most patients feel it less than collagen. Pain can be minimized by the use of ice cooling the skin just prior to injections. Some patients find that two Tylenol tablets before the injections reduce the discomfort.
As a patient, after receiving my injections how can I help BOTOX® be more effective and avoid side effects?
First, do not massage the area of the injection. Second, do not lie down for a nap; keep upright. Third, use the muscle; intentionally making the muscle contract helps localize the protein to the selected muscle.
Will injecting muscles at one site affect muscles in other sites?
BOTOX® spreads along muscle fibers and does not spread distantly by way of the blood stream to any significant extent. The dilutional factor and miniscule quantity of BOTOX® assures the safety to the rest of the body.
Can BOTOX® be used to weaken, not totally paralyze a muscle?
Yes, in fact this is done so that the face will not be left expressionless. It can be also used to balance a weak muscle on the opposite side. By injections of the medicine into the subcutaneous tissue and not the muscle and by using a smaller dosage, a weakening of the muscles is more likely to occur.
For the deepest frown furrows what is the recommended best method to get this deep line to disappear?
In one study paralysis after the initial injection lasted 4-7 months. Reinjection every 3-4 months is recommended rather than waiting for the muscle to recover. This keeps the muscle paralyzed and the deep furrows resolve over approximately 12 months.
What accounts for the fact that no treatments may be necessary in some patients after repeated injection sessions?
What happens is that the patient is broken of the bad habit of excessive frowning and expression of negative emotions and may not relearn them for some time in the future.
BOTOX® is a registered trademark of Allergan, Inc.