• Botulinum toxin (BOTOX®) 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.
  
  
• 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 Atlanta Georgia 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 cream. 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.
  
  
• 
  

Maloney Center for Plastic Surgery- Atlanta,GA
© Copyright 2000 American Academy of Facial and Reconstructive Plastic Surgery

.

What is Botox Cosmetic?

BOTOX® Cosmetic is a prescription medicine that is injected into muscles and used to temporarily improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) in people 18 to 65 years of age.

How Does Botox Cosmetic work?

BOTOX® Cosmetic is administered by a healthcare professional as a simple, non-surgical treatment that is injected directly into the muscles between the brows. It works by blocking nerve impulses to the injected muscles. This reduces muscle activity that causes moderate to severe lines to form between the brows. Individual results may vary.

When will I see results from a Botox Cosmetic Treatment?

Within days, you may see a marked improvement in the moderate-to-severe frown lines between your brows. Lines continue to improve for up to 30 days, and results can last for up to 4 months. Individual results may vary.

Visible results have been shown to last up to 4 months. Your own results may vary. Be sure to talk to Dr. Maloney about what you can expect and when to schedule your next appointment.

Discomfort is usually minimal and brief. Prior to injection, Dr. Maloney may choose to numb the area with a cold pack or anesthetic cream. The entire procedure takes approximately 10 minutes. Most patients are in and out without downtime following BOTOX® Cosmetic treatment.

Although the results are visible, a treatment with BOTOX® Cosmetic) will not radically change your facial appearance or make you look as if you’ve “had work done.” The muscle activity that causes frown lines between the brows is temporarily reduced, so you can still frown or look surprised without the wrinkles and creases between your brows.

Do not use BOTOX® Cosmetic if you:

• are allergic to any of the ingredients in BOTOX® or BOTOX® Cosmetic, or had an allergic reaction to any other botulinum toxin product such as Myobloc® or Dysport®
• have a skin infection at the planned injection site

• a disease that affects your muscles and nerves (such as amyotrophic lateral sclerosis [ALS or Lou Gehrig's disease], myasthenia gravis or Lambert-Eaton syndrome
• a breathing problem, such as asthma or emphysema
• swallowing problems
• bleeding problems
• plans to have surgery
• had surgery on your face
• weakness of your forehead muscles, such as trouble raising your eyebrows
• drooping eyelids
• any other change in the way your face normally looks
• if you are pregnant or plan to become pregnant. It is not known if BOTOX® Cosmetic can harm your unborn baby.
• are breast-feeding or plan to breastfeed. It is not known if BOTOX® Cosmetic passes into breast milk.

• dry mouth
• discomfort or pain at the injection site
• tiredness
• headache
• neck pain
• eye problems such as double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, and dry eyes
• allergic reactions. Symptoms of an allergic reaction to BOTOX® or BOTOX® Cosmetic may include: itching, rash, red itchy welts, wheezing, asthmatic symptoms, or dizziness or feeling faint. Tell your doctor or get medical help right away if you are wheezing or have asthma symptoms, or if you become dizzy or faint.

If you do not continue treatments, the moderate-to-severe frown lines between your brows will gradually return to the way they looked before treatment.

Yes, individual results may vary. To get the best results, it's important to go to a doctor who is experienced in administering BOTOX® Cosmetic.