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Dear Dr. Seckel, I have crow’s feet and want to get a botox injection. But I am scared of botox. A friend of mine had a botox injection and had a drooping eye. I also have heard you can get a headache after botox. Does botox really cause food poisoning? I want to have botox to get rid of my crow’s feet but I don’t want to get sick! Can you please tell me more about botox and its safety? Does botox really remove crow’s feet/? Thank you, Dianna, Boston, Massachusetts.

Dear Dianna,

Thank you for your question about Botox™. I will best answer your Botox™ question by using an article that I have written about Botox™.

Is Botox™ safe?

Yes when FDA approved Botox™ made by Allergan™ is used according to approved dosage by experienced licensed physicians, in my opinion.

What Is Botox™?

Botox™ is an injectable medication that relaxes facial muscles that cause lines or wrinkles. Technically called Botulinum Toxin A, this medication is synthesized in the laboratory by Allergan™, a major pharmaceutical company.

Contrary to stories in the media Botox™ is not food poisoning bacteria and you cannot get food poisoning from a Botox™ injection. Botox™ was discovered as a toxin created by the Clostridium Botulinum bacterium which is a cause of food poisoning which caused muscle weakness.

The synthesized, medical grade Botox™ used today has been safely used in medical practice for 30 years and is FDA approved. Its first use was in children with spastic legs-the spasms were relaxed by this medication. It has also been used in Toticollis-painful spasms of the neck, and in Oculogyric spasms-tics or involuntary movements or twitches of the eyes.

How Does Botox™ Work on Wrinkles?

The wrinkles caused by the pull of your muscles of facial expression are called “dynamic lines” because they are dynamic or move. That is these wrinkles and lines are caused by repeated motion of muscles of facial expression-each time the muscle moves it pulls the skin into a wrinkle. After years of repeated motion, these wrinkles or lines become permanent.

Botox™ relaxes or quiets the muscles of facial expression. When the muscle is relaxed, the line or wrinkle caused by the muscle disappears.

Which Wrinkles Are Removed with Botox™?

The lines of facial expression which are:

• Crow’s Fee
t-lines on the cheek around the eyes
• Frown Lines-the deep creases between your eyes at the base of your nose
• Worry Lines-the creases running across your forehead
• Bunny lines-the wrinkles at the base of your nose that wrinkle when you smile hard
• Lip Lines-the wrinkles around your mouth when you purse your lips
• Marionette Lines-the lines running from the corner of your mouth down to the jaw lie that pull the mouth down when you are angry or sad

How is Botox™ Given?

Tiny amounts of Botox™ are injected directly into the muscle that is causing the wrinkle or dynamic line. These injections are dosed in International Units (IU). Very small amounts of the solution are used.

Generally a treatment of 25 IUs of Botox™ is used to treat the crow’s feet and frown lines-5-6 IU in each side of the crow’s feet and 13-15 IUs in the frown lines. If the worry lines are also treated and additional 6.25 IU is placed into each side of the forehead for an additional 12.5 IUs.

Very small amounts of Botox™ are used around the mouth to avoid any interference with mouth function. Generally only 1 or 2 IUs are used on the upper lip for lip wrinkles-after treatment you may not be able to whistle or drink through a straw-but those lip wrinkles will be gone. Only 1 IU is used on each marionette line-this treatment can reduce the mouth line and help reduce the jowl.

Small amounts of Botox™ can also be used on the bands on the neck below the chin. 1 or 2 IUs in each band will reduce the folds or bands on the neck.

Does Botox™ Injection Hurt?

I use a topical numbing cream which is very effective. I also use a cold Titanium Roller to cool the skin which is very effective at numbing the skin and which also helps prevent bruising. My patients often do not even feel the injection. If the patient has had a previous injection without these measures in a different office they are amazed at the difference.

What Does the Injection Cost?

Nationally these injections cost $20.00 per unit injected. If you are offered a discount or deal be sure to ask how many units you are getting. Some low priced offers are using diluted Botulinum Toxin A which will not be as effective for removing wrinkles.

What Can Go Wrongwith Botox™?

Botox™ injections are safe when done properly by an experienced and licensed physician who is an expert in facial anti-aging therapy. However there are potential side effects which can occur-some are unavoidable-some are related to injection technique.

Generally there is about a 2% incidence of side effects with Botox™ in my current experience although initial studies years ago were higher. The more common potential side effects are:
• Headache
• Flu like illness
• Nausea
• Temporary eyelid droop

Eyelid droop is caused if Botox™ is injected too low in the forehead near the eyelid, and does not occur with the typical forehead injection.

Where Should I Go to Learn about Botox™ ?

See an expert in facial rejuvenation therapy. In my opinion experts are board certified dermatologists and plastic surgeons that specialize in facial rejuvenation procedures.

Study your doctors website and ask questions-especially ask how many Botox™ injections they have done and how many they do each week. Experience is very important in getting the best result and avoiding complications.

Don’t go to Botox™ parties-I have seen some unhappy results on patients who have had Botulinum Toxin A injections in a non medical setting.

My opinion is that you want an expert who is board certified in Dermatology or plastic surgery who is an expert at what causes facial aging and wrinkles, knows all of the various techniques for correcting facial aging, and knows which treatment is best for your unique face.

There are many wrinkles and lines that definitely should not be treated with Botox™.

For more information on Botox™ and other non-surgical facial rejuvenation techniques call 978-369-4499 or email us. Read our free newsletter to keep up with new aesthetic treatments. Read Save Your Face to leaqrn how to prevent facial aging.

Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts