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BOTOX®

Botulinum toxin type A injections (BTXA), often referred to by the product names BOTOX® Cosmetic (Allergan), Dysport® (Galderma), or Xeomin® (Merz), are biological toxins (botulinum toxin type A) that are processed and purified to produce a sterile therapeutic neuromuscular blocking agent suitable for injection. They act by temporarily relaxing the treated muscles which causes a smoothing effect of the lines on the overlying skin by inhibiting the release of acetylcholine. BTXA is most effective in treating the lines and wrinkles caused by muscle contraction during facial expressions such as frowning or squinting.  These include the “Bunny” lines, “11” lines, or “Worry Crease” in the central forehead (glabella), the horizontal lines of the forehead, as well as the “Crow’s Feet” (lateral canthal) lines.

BTXA has been approved to treat certain conditions involving crossed eyes (strabismus), eyelid spasm (blepharospasm), cervical dystonia (spastic muscle disorder with the neck), spasticity disorders in children with cerebral palsy, and motor disorders of the facial nerve (VII cranial nerve). BTXA has also been used to treat migraine headaches, colorectal disorders, excessive perspiration disorders of the armpit and hands, and musculoskeletal pain disorders.

BOTOX® Cosmetic (cosmetic form of onabotulinumtoxinA, Allergan) has FDA approval for the indication in adults of temporary improvement in the appearance of: 1) Moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity since 2000 (20 units), 2) Moderate to severe lateral canthal lines associated with orbicularis oculi activity since 2013 (12U/side, total 24 units), and 3) Moderate to severe forehead lines associated with frontalis muscle activity as of 2017 (20 units).

Dysport® (abobotulinumtoxinA, Galderma) was given FDA approval in 2009 for the treatment of glabellar lines (50 units) and Xeomin® (incobotulinumtoxinA, Merz) was FDA approved in 2010 also for the treatment of glabellar lines (20 units).  While BOTOX® Cosmetic is the only BTXA with FDA approval for all three treatment areas (forehead, glabella, and lateral canthi), both Dysport® and Xeomin® are routinely used for these areas as well.  Treatment of areas such as the peri-oral area (around the mouth) and neck bands, while commonly performed, are not specifically approved by the FDA, and are therefore considered “off label”.

Dr. DiBello personally performs all of the BOTOX® and other BTXA injections at DiBello Plastic Surgery.  You will consult directly with Dr. DiBello and receive an individualized treatment plan from him, tailored to your needs, goals, and budget.  Dr. DiBello has found BOTOX® to be very reliable and predictable, with a gradual onset of effect (3-5 days).  Dysport® is very similar to BOTOX®, but with a quicker onset of effect (1-3 days) and a different dosage (2.5 units of Dysport® to each unit of BOTOX®).  Xeomin® has one less protein side chain than Dysport® and BOTOX® making it potentially effective for patients who have developed tolerance or immunity to Dysport® or BOTOX® but with a slightly shorter duration of effectiveness.

Dr. DiBello will inject the BTXA directly into the muscles in the chosen areas in a series of injections with extremely small needles. The procedure takes approximately 10 to 15 minutes to perform and the expression lines in the treatment areas will usually appear noticeably softer within a few days. While most patients are very pleased with the results, they are however not permanent and generally last for approximately three to four months. Generally, optimal results for smoothing the wrinkles/lines is seen after cumulative (repeated) injections, followed by maintenance. A minimum period of three (3) months should be waited between injections of BTXA to avoid the development of immunity to the product. Dr. DiBello will personally advise you as to the recommended treatment, as well as a maintenance program, that he individualizes for you.

Benefits:

  • No downtime. Patients can immediately resume normal activities, although exercise/exertion should be avoided for 4-6 hours after treatment.
  • Long experience has proven BTXA to be safe. To date, no systemic complications associated with BTXA injections have been documented.
  • Treatment is reversible within several months.
  • May be beneficial for treatment of migraine headaches.

Other Considerations:

  • BOTOX® injections are a temporary solution for the treatment of wrinkles. The effects last from 3- 4 months and require repeat treatments to maintain results.
  • Possible side effects include local numbness, swelling, bruising, or a burning sensation during injection. Some patients have reported temporary headache and nausea.
  • Since flu-like symptoms are a rare, but possible side effect of BOTOX® injections, you should avoid receiving a flu shot (vaccination) within one week of treatments.
  • Very rarely, the toxin can spread beyond the treatment area, which can cause botulism-like signs and symptoms such as breathing problems, trouble swallowing, muscle weakness, and slurred speech.
  • Most complications are of short duration and can be avoided with proper injection techniques.
  • A small percentage of patients are reported to experience no improvement at all.

The American Society for Aesthetic Plastic Surgery (ASAPS) maintains that BTXA injections for aesthetic purposes appear to be safe and effective.  Patients who show early signs of aging, as well as those who may not be suitable candidates for more extensive aesthetic facial surgery, may be good candidates for this procedure. Certain medications (some antibiotics, anti-inflammatories, or aspirin) and even some vitamins and herbs may increase the potency of BTXA and may increase bleeding and bruising at the time of injection. Therefore, patients should be candid with their surgeon about all medications and supplements. Pregnant or nursing women should postpone undergoing this procedure. It is not known whether injection of BTXA has any effect on a fetus or whether it is found in breast milk.

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