Botox:
The Art of Botox
Dr Brian Maloney
 Imagine erasing a wrinkle line almost instantly without any down time. It is for this reason that botulinum toxin injection for facialwrinkles is the number one cosmetic procedure currently being performed in the U.S.A. Last year over 3.5 million people had BOTOX injections. It is quick and easy with generally no recovery. Since every face is unique, the skill of the person placing the BOTOX is very important to maximize the benefits. Dr. Brian Maloney has been selected by Allergan as a national training center of excellence. He instructs doctors from around the world on the proper technique of BOTOX to help their patients achieve the best results.
- Botulinum toxin is a purified protein made by a bacterium. It is not a live bacterium.
- There are seven different types of botulinum toxin. Each type varies in potency and length of effect. Type A (BOTOX) and type B (Myoblock) are used medically. Of the seven, BOTOX is most commonly used because it is the most potent. If someone does not respond to BOTOX, they may decide to try Myoblock.
- Federal Drug Administration (FDA) approval of botulinum toxin first occurred in 1989 for lazy eye, 2000 for dystonia, and 2002 for glabellar lines. Recent approvals for hyperhydrosis (excessive perspiration) and headaches have also occurred.
- The BOTOX comes in a dried powder and is mixed with four milliliters of saline (salt water). This gives the patient 25 units of BOTOX in each syringe. The FDA studies for facial wrinkles were performed in between the eyebrows on the frown lines or the “11”s. Twenty units were placed in this area. Additional tests showed if one uses more, the results tend to last longer and be more effective. Studies have also shown that diluted BOTOX is not as effective. For this reason Dr Maloney chooses to give his patients 25 units instead of the 20 units.
- Standard doses: Forehead lines 25-50 units; frown lines 25 units; crowsfeet 25 units; smile lines 2-4 units; neck
bands 75-100 units; corner of mouth 2-3 units; underarms and palms 100 units. Amounts vary according to the individual; therefore, follow up is important.
- Wrinkles of the face are caused by muscles inserting into the skin. As they contract, they break down the supporting elements in the skin. BOTOX is placed into the muscle with a very small needle after the skin is numbed with a cold spray or numbing gel. Most patients are surprised they do not feel anything Wrinkles present at rest may take months to soften. While the BOTOX is “resting” the skin, it is a great time to maximize the effectiveness of your skin care program.
- BOTOX takes two to thirty days to have an effect. The onset of action can vary from treatment to treatment.
- Do not expect complete resting of the muscle until after the second to third dose in patients with very strong muscles. Your follow-up is essential to help us learn your anatomy and plan future treatments.
- BOTOX works by temporarily paralyzing the muscle injected. The length of effect varies greatly from person to person, generally lasting up to three to four months. Occasionally, someone may have no effect. Some people have antibodies to botulinum toxin and the BOTOX will not have any effect. Others may acquire antibodies and notice that the injection results do not last as long. But for another, it may last up to six months.
- Studies have shown if one gets the next dose before all the activity completely returns, the effect will generally last longer the next time. It will never be permanent!
- BOTOX has a very wide margin of safety. One would have to receive approximately seventeen times the maximum recommended dose to get sick from BOTOX.
- BOTOX has been used medically since the 70's with no adverse long term effects.
- BOTOX is used to soften forehead, frown, crowsfeet, nose or bunny lines, drooping corner of mouth, lip lines, bands in the neck, sweaty palms and sweaty underarms. Many of our patients with migraines and headaches have noticed significant improvement with BOTOX.
- Complications: Headache; malaise; flu-like symptoms; drooping brow if forehead is too weak or if BOTOX is place too close to brow; drooping eyelid - though rare; skin irritation.
- Looking ahead to the future. Reloxin a type of botulinum toxin A will be available in the United States soon. It has been available in Europe as Dysport for many years. Early reports from my European colleagues imply it is not as potent as BOTOX due to the different manufacturing process. We will be watching the research closely to determine which one will be most appropriate. The good news is there is now competition and hopefully our patients will benefit from company discounts.
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