Botox Blog Part I: Facts and Myths

Health Professional

I've been intending to write about Botox for some time. Of all the procedures I perform in my office, Botox is the most popular, and sometimes the most misunderstood. In 2006, the American Society for Aesthetic Plastic Surgery (ASAPS) ranked Botox number one on its Top 5 list of cosmetic procedures. But some of the men and women who consult with me about the procedure express the concern that they will end up with "face freeze" - that deer-caught-in-the headlights look that the media seems to consider synonymous with Botox treatment.

Ironically, many celebrities who are pilloried in the media for being "over-Botoxed" are actually victims of over-zealous surgical brow or face lifts, rather than Botox. When properly performed, Botox treatment smooths out your frown lines and other facial wrinkles while preserving your normal facial expressions, so you don't look permanently surprised. A recent survey of approximately 1000 patients who had received Botox for cosmetic purposes found that 97% of them were satisfied with their results[1].

The FDA approved Botox in 2002 for the temporary treatment of moderate to severe frown lines between the eyebrows in adults aged 18 to 65. These vertical lines are often referred to as "the 11" because they resemble the number 11. Since its approval, Botox has been used for more than 13 million cosmetic procedures in the United States. Some are for the FDA-approved indication - to relax frown lines. Botox is also used "off label" for other wrinkles, such as forehead lines, crow's feet, lines around the mouth, chin dimpling and lines on the neck...

Frown Lines and Forehead Lines


Frowning before and 3 weeks after Botox.

I especially enjoy employing advanced techniques to restore a youthful arch to flattened eyebrows, fade vertical pucker lines around the mouth (often referred to as "smoker's lines" although non-smokers can develop them too) and turn up a downturned mouth (or "mouth frown") so that its owner looks more positive and happy. I've developed my own technique to relax horizontal lines on the forehead without changing the shape of your eyebrows, even when you raise them. This avoids the telltale, sharp-angled brows that are a sure giveaway of having had Botox...

Crow's Feet


Before and 2 weeks after Botox.

Margarita*, a 39-year-old graphics designer who's been my patient for the past four years, is delighted with the results of her Botox treatment, describing it as "the best thing that's ever happened to my face. And it's not just women who are having Botox.

I'm treating increasingly more men these days too - like Larry, who's 48 and works for the Federal Government. Besides Botox, I've also injected Perlane and Restylane into Larry's smile lines and under-eye hollows, faded sun spots and prominent pores with Vitalize chemical peels and tightened his jawline non-invasively with StarLux infrared skin tightening. Larry's goal is to project a youthful and energetic image in his office where, as he puts it, "a lot of my team-mates are younger, and I don't want to look as if I'm too old to be fresh and creative". Statistics from the American Society for Aesthetic Plastic Surgery (ASAPS) echo what I'm seeing in my office: 300,000 men received Botox treatment for cosmetic purposes in 2006.

How can you maximize the chances that, like Larry and Carla, you'll be one of the 97% who are satisfied with their cosmetic Botox treatment? You can assure yourself of the best results by selecting a board certified, appropriately qualified, experienced doctor to perform your treatment in a medical setting. You can find qualified doctors in your area by visiting, an informational web site set up by Allergan, the manufacturers of Botox. Make sure you provide an accurate medical history and discuss your aims and objectives thoroughly with your doctor before treatment, so that you are both on the same page regarding the desired results...

So how does Botox work? Botox is the brand name for botulinum toxin A (BTX-A), a purified protein that binds to the junctions where nerves meet the muscles that they activate (the neuromuscular junctions). BTX-A has been very well-studied over the past century and there are about 3000 publications to date on it in medical and scientific journals. When Botox is injected just beneath the skin into overactive muscles such as those that cause frown lines, it prevents these overactive muscles from contracting (tightening) too strongly and thus removes the undesired wrinkles.

Botox works in the same way when it is injected into the armpits to block overactive sweat glands that cause primary axillary hyperhidrosis - excessive sweating for no known reason. Botox was approved for this purpose four years ago. The effects of Botox begin to wear off after several months, as your body manufactures new neuromuscular junctions, at which point you need to touch up your Botox...

Forehead Lines


Raising eyebrows before, and 2 weeks after Botox. With the right technique, Botox smoothes out fore head wrinkles without changing the shape of your eyebrows.

Perhaps it's not surprising that any news about Botox spawns an explosion of media reports. After all, Botox is now the best known medication in the world, having surpassed even Viagra in media mentions and public recognition. In my next blog, I will focus on a petition about Botox. As you might expect where anything Botox-related is concerned, it's garnered a lot of media attention in recent weeks. We will step behind the headlines and examine the reality behind the rhetoric.

I'll be updating this blog at regular intervals with news about Botox. I welcome your thoughts and feedback regarding the topics I discuss. The more interactive this blog is, the more informative and interesting it will be!

*Patient's names have been changed to protect their identity.

Read Health and Beauty Writer Sue Chung's Blog Not Botox: Smoothing Away The Wrinkles.

[1] Aesthetic Surgery Education & Research Foundation press release 4/28/06: First-of-its-kind Survey Finds That BOTOX Cosmetic has Gone Mainstream.