Everything You Ever Wanted to Know About Botox™ (and then some)

Skin Care

Botox™ is an increasingly common phenomenon in American society.  From celebrities to CEOs, supermodels to soccer moms, women to men, everybody is looking, well, a little less crinkly and a lot more smooth lately.

Thankfully, lots of great information is available on Botox.  Here, I share everything I believe the savvy patient would want to know:

There are seven different serotypes of Botox.

They are lettered A to G, with A being the most commonly used serotype as Botox (by Allergan), and B being used as Myobloc (by Ipsen Products).  For more on the differences between the serotypes, please click here.

…But the person behind the needle ultimately matters as much as the chemical itself.

According to some records, Miami and New York City derm and “Baron of Botox™” Dr. Frederic Brandt™ administers more procedures per year than any other.  But the reason for his popularity isn’t just the fact he reportedly has Madonna as a client: Brandt pioneered “the Botox™ Face Lift,” a series of injections that result in a face so lifted, it looks like a face lift.  Botox is truly an art, so leave your face in the hands of a true master: according to DocShop.com, find a board-certified, fully licensed cosmetic dermatologist, cosmetic surgeon, or facial plastic surgeon who has conducted the procedure extensively, and do not be afraid to ask for photographs of other patients.  However, do be wary of over-instructing the physician; for instance, some patients instruct the physician which part of the muscle to inject or how much injectable to use, and even though the patient may be very savvy, sometimes, the doctor really just does know best!  In other words, once you find a trustworthy physician, let him/her do his/her job!

How Botox works:

According to Dr. Leslie Baumann’s Cosmetic Dermatology textbook, the most commonly used type of Botox™ is serotype A.  When Botox™ serotype A is injected, it cleaves a protein that is necessary for a neurotransmitter release, effectively preventing the neurotransmitter from binding to cellular membranes to cause muscle contractions.  (Hence your relaxed appearance afterwards!)  And, for you science geeks, the exact protein that is cleaved is SNAP-25, the complex is the soluble N-ethylmaleimide sensitive factor attachment protein receptor, and the neurotransmitter is none other than acetylcholine.

Results are not instant.

Results generally take between 12 to 96 hours to fully appear, with the optimal effect occurring 7 days after the procedure.

The price may vary by physician and by patient.

According to Baumann, “the amount of botulism toxin needed per site depends on the musculature of the individual patient.  Therefore, Botox™ and Myobloc should be priced by the number of units used, and not by the area treated…The price also varies according to the area of the country one lives in.”  So don’t always expect to pay the same price as a friend or family member, and definitely don’t expect to cough over the same amount in, say, Cleveland and New York City.

The recent Botox scare is nothing to raise your brow over.

(Pun alert!)  But seriously, no deaths in adults undergoing a cosmetic procedure have ever occurred from Botox™.  A 2008 FDA investigation questioning the safety of Botox™ found that all of the serious events were in children exposed to extremely high doses of botulism toxinThe doses ranged from 6.25 to 32 units per kilogram of bodyweight — that is the equivalent of 460 to 2,400 units for an adult — a huge dose. The approved dose of Botox for cosmetic purposes is 20 units.  Put simply, you would need to have a dermatologist inject you with 23 to 120 times the normal dose for toxic effects to occur.  Not only is that about as likely as it to start raining elephants, but it has never happened to date – a sign you can surely rest assured of the procedure’s safety.

But there are documented side effects in some individuals…

According to the Botox™ Cosmetic website, patients with certain neuromuscular disorders such as ALS, myasthenia gravis, or Lambert-Eaton syndrome may be at increased risk of serious side effects from Botox.  Aside from those patients, the most common side effects following injection include temporary eyelid droop and nausea.  In addition, localized pain, infection, inflammation, tenderness, swelling, redness, and/or bleeding/bruising may be associated with the injection.  Dr. Leslie Baumann recommends avoiding aspirin, green tea, nonsteroidal anti-inflammatory drugs (NSAIDs), and vitamin E 10 days prior to treatment, and topical vitamin K (as in one of my favorite formulations, Peter Thomas Roth Power K eye cream) afterwards.  Ice packs may also help.

…including addiction to Botox!

Believe it or not, according to über dermatologist Dr. Patricia Wexler, “People with addictive personalities can get addicted to anything, and it’s up to the doctor to say ‘no’. That word should be in their vocabulary.”

…and there is the remote possibility that Botox use may change your brain structure.

This Italian study in the Journal of Neuroscience found that Botox™ injected into rats is not localized in the rats’ skin, but rather, travels to the rats’ brains, shutting off nerves there.  My retort to this matches that of dermatologist Dr. Benabio, of the Derm Blog: “The study was done in rats, not people. We do not know if it would do the same thing in humans. Even if some botox did get into the brain, there is no evidence at all that it has any meaningful effect, good or bad.”  Still, if the idea of Botox™ potentially altering your brain structure freaks you out too much to keep using the stuff, Dr. Benabio recommends retinoids as tretinoin, and I particularly love non-prescription retinol formulations.

And you should NEVER make your own Botox.

I got this one from The Derm Blog as well: don’t try to make your own homemade Botox from WikiHow, as this only leads to trouble.  Remember, Botox is a prescription drug, and must be administered by a responsible physician!

No creams that are “better than Botox” work quite as well as Botox.

For instance, a 2006 study compared the efficacy of botulinum toxin type A (Botox™), placebo injection, StriVectin-SD®, Wrinkle Relax™, and HydroDerm™ (with palmitoyl oligopeptide), and found that none of the topical preparations were better than Botox in efficacy and overall patient satisfaction. This is most likely due to the fact that topical preparations of peptides increase collagen production over time, whereas Botox relaxes muscles and makes wrinkles very much less apparent within 1-7 days and stimulates collagen production over time.  Another type of cream contains a GABA (inhibitory) neurotransmitter.  Although companies claim that “100% of women” in their study experienced the 50-90% reduction in fine lines and wrinkles, the main ingredient, gamma aminobutyric acid, does not always have these types of results. GABA, an inhibitory neurotransmitter, may temporarily inhibit nerves and reduce the appearance of wrinkles when applied topically, but this effect varies from woman to woman, and is not usually anywhere comparable to Botox or other professionally-administered wrinkle reducers, particularly because topically applied GABA cannot affect synaptic transmission at the cellular level, whereas injected Botox certainly can.

Botox™ is only getting more popular…

According to Science, it’s one of the fastest growing cosmetic procedures in the world in 2008, with an estimated 1 million Americans undergoing the procedure.  Before making the decision, find an experienced board-certified, licensed dermatologist or plastic surgeon or cosmetic surgeon, and, of course, stay informed with the latest news on FutureDerm.com, 😉  (Shameless, I know…)

Photo source: DailyMail.co.uk

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  • Emma

    I notice this is an old thread. But I would love to contribute here my inputs, coz i loved this discussion. I’ve got facial sculptra and juvederm fillers from a surgeon ( Dr. Kris Conrad ) of Toronto. The transformation is awesome guys but the post op recovery time is very sad though. You will have this all kinds of restrictions like don’t go in the sun, don’t go to the beach kind of stuff. My husband took care of all the household chores for the first few months.
    You can come out of this pretty safe and beautiful if and only if you will listen to the guidelines of the surgeon. Because he knows your skin type and the type of treatment that will suit you the best.

  • I’m very happy with the result from Juvederm and Botox. It took about one week before I could see the full difference from the Botox. I experienced no swelling or bruising at all. I was extremely impressed by the high standards of professionalism and courtesy shown to me during my visit to SKIN medical spa. I will definitely be returning for further treatments. I love the new look that Botox has given me. I look rested and this has dramatically improved my self-esteem and how I feel about myself. As long as you attend a reputable and medically professional practitioner, I see no real problems with this method

  • Nicki, I know that retinoids and Fraxel are supposed to stimulate collagen production, but are you serious, Botox increases it, too? I may have to reconsider being injected with Botox if that’s the case. Thanks for the very informative post.

  • If only it was easier to train our facial muscles naturally. I started noticing forehead lines about age 25 so I tried to stop myself from raising eye my brow(s) which seem to have helped. It’s getting harder though so I may have to resort to this….I probably would have already if not my fear of needles.

  • naom

    Maybe we can do what my mom preaches? Go the natural way… be less expressive when laughing or showing emotions to decrease recurring expression lines.

  • Jean

    Thanks for sharing your experience, Christine! I’m 27 and have been considering Botox for a couple years. I have a deep furrow in between my brows (like half of an “eleven”). It’s an expression line that I’ve had since I was a kid, but it’s gotten much worse the past few years. I think I want to get Botox to stop it in its tracks and keep it from further cementing itself smack dab in the middle of my face.

    Personally, I think Botox is hardly any different from using any anti-aging product. In the right hands, it’s VERY safe, and if you don’t like the results, no big deal because its effects are temporary.

  • Debi

    Thank you for all the great information! I wonder how I find the ‘best’ surgeon to do this in my local area? Word of mouth? Again…I am so glad to have found your blog. It is great!

  • Elaine

    I appreciate the research you have done on this, and it confirms for me even more, that I just do not want to undertake this kind of cosmetic surgery. I do feel, however, that it isn’t wise for me to never say “never” about it because there may come a day when I decide I want to have it done, but for now, I will remain in the camp of those who don’t.

  • After having a few Botox injections (over time), it seems that you don’t need to have the injections as often, which is a bonus when considering the upkeep. Doctors prices can vary widely even in a particular city. For best results (for any procedure) go with a doctor that has done the procedure many, many times and with one that you feel comfortable and follow their after care directions to a “T”.

  • Danielle

    Great post. Talk of Botox is all around. It is so expensive. What is the best way to find the right doctor to give you Botox?

  • sofi76

    The maintenance scares me, too. I just can’t see myself doing this. all that money going to injections-ahh.

  • Joe

    I was interested to see you post that Botox, in addition to relaxing muscles, helps build collagen over time. This was the first I’d read of it but when I went to your link it only brought up a blank box, no abstract. Do you have any other sources that your readers can reference?

  • After giving considerable thought to using Botox, I went to an experienced dermatologist in the Princeton area. The results were wonderful, but soon afterwards I began to have severe headaches daily. Even when I cried I could feel a strange throbbing in my forehead area where I received the Botox. I was prescribed Topamax for migraines, and an antidepressant for anxiety. The Topamax never worked as it turned out I did not have migraines. The headache took about seven months to subside. Whether it was caused by the Botox, I cannot say for sure. If I had to guess, I would say definitely. Nevertheless, I would never again risk injecting something into my body that was not necessary.

  • Christine

    Botox, my favorite beauty product ever! I had my first Botox at 26. It was amazing. I have deep eye crinkles when I smile, and at 26 I had the start of crow’s feet. My eye’s didn’t crinkle when I smiled, my brows were more relaxed, and my whole face just seemed more awake. My motto is prevent now and save later; the cost of Botox and creams now is nothing compared to the other treaments/surgeries I’d need if I developed deep wrinkles. When the article appeared in Allure with the twins (one who received regular Botox and one who did not), and I was even more conviced that regular Botox is a great way to prevent wrinkling as we age.

    I’m now 29 and while finances have prevented me from keeping up with the Botox lately, I go back to work July 28, and my first paycheck will go towards Botox. If at all possible, I highly recommend going every 3-6 months and starting in your mid to late 20’s.

    Yes, it stings when going in. I got a few little bruises. A headache is common. It does take a few days to start working and up to 7 days to be complete. A good Doctor will include a touch-up after 7 days because its not always possible to get symetrical results the first time. The full effect doesn’t last much more then 2-3 months. And its expensive- about $400-750 a treatment in my area, depending on how much is needed.

    Still, its all worth it in the long run. 🙂

  • Sarah

    I appreciate your research on our behalf, but personally I’ll never use the stuff. I love this column because I can learn about all the ways to treat my skin extremely well–healthy habits and products!–without turning to more invasive procedures (and if there’s even the remotest chance it can seep into my brain, well, that’s a no brainer for me!). I grew up loving the way that some of my female relatives looked *with* wrinkles! Aging is inevitable–I want to stay as young-looking as I can, but I also want to accept the process with some grace. Thanks for helping me do that, Nicki.

  • naom

    The only downside to botox in my opinion is the maintenance aspect :)… I think my main concern is laugh lines…
    I’ve also heard that botox is popular in reducing jaw lines/slimming facial structure. Is this really possible and is it safe?

  • I’m glad you asked – Other readers and I actually addressed this in a survey that is pertinent to this post! https://www.futurederm.com/2008/03/28/controversy-should-you-get-botox-starting-at-25/

    It seems that most women do not feel you need Botox before 35. I personally will probably start when I can comfortably afford to (sometime after medical school)! 🙂

  • naom

    Do you recommend women in their 20’s to get botox? It seems that the trend these days is to get injectables at such a young age…

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