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Q – What is BOTOX® Cosmetic?
BOTOX® Cosmetic, also referred to as BOTOX® Cosmetic Wrinkle Reduction, is an office-based injectable procedure which can reduce the formation of unwanted facial wrinkles. BOTOX® Cosmetic may be used on a variety of wrinkles and lines which are caused by underlying muscle contraction. Commonly treated areas include the following: horizontal lines across the mid to upper forehead that may be seen when the brow is elevated; glabella lines or frown lines, which are the slightly angled deep creases between the eyebrows; and the lateral orbit or fan-shaped lines commonly known as crow’s feet which are created by squinting and smiling and may also include similar lines extending over the upper cheek. The suprabrow is commonly treated as well and refers to the area immediately above the eyebrow that is a continuation of the glabellar lines on each side. The muscles of the suprabrow play a significant role in pulling the brow down (brow depressors) and, by selectively paralyzing these muscles and leaving the mid to upper forehead muscle alone, one can stop the activity of the brow depressors, leaving the brow elevators unimpeded. This can effectively provide a slight chemical brow lift when BOTOX® Cosmetic is used only along the suprabrow ridge.

Q – How does BOTOX® Cosmetic work?
BOTOX® Cosmetic works by paralyzing the muscle beneath the unwanted wrinkle. This stops the muscle from moving so that the wrinkle can no longer form.

Q – Are there any limitations to what BOTOX® Cosmetic can achieve?
BOTOX® Cosmetic is only effective on hyperdynamic lines, or those wrinkles caused by underlying muscle contraction, and will do very little for visible wrinkles or creases seen at rest. If  a resting line remains in the absence of muscle movement, this is a reflection that the skin has been wrinkled over a long period of time, thus developing an inherent crease. In these cases, BOTOX® Cosmetic will do little to improve the appearance of the line though it will prevent the muscle from creating an even deeper wrinkle. These lines may be treated with a combination of BOTOX® Cosmetic and a dermal filler.

Q – Who is a good candidate for BOTOX® Cosmetic?
The best candidates for BOTOX® Cosmetic include men and women who have unwanted wrinkles that appear with animation and emotional expression, termed hyperdynamic lines. These lines arise from underlying muscle contraction in areas of dynamic movement. Patients often describe a deep crease or line that forms as a result of certain facial expressions. BOTOX® Cosmetic may not be appropriate for patients with certain neuromuscular disorders.

Q – Where is the BOTOX® Cosmetic procedure performed?
BOTOX® Cosmetic is an office-based procedure.

Q – What type of anesthesia is used for the BOTOX® Cosmetic procedure?
A topical anesthetic can be applied to the skin of the treatment area thirty to forty-five minutes prior to treatment. For additional anesthesia, a cold compress may be used just prior to treatment.

Q – How is the BOTOX® Cosmetic injection performed?
Patients are asked to contract the muscle under the unwanted wrinkle or crease. This may mean elevating the brow, frowning, squinting or smiling. The BOTOX® Cosmetic is then administered using a very fine needle with the injections distributed equally and symmetrically across the muscle. BOTOX® Cosmetic injections should be strategically distributed directly into the desired location based on the presence and degree of hyperdynamic muscle movement. BOTOX® Cosmetic is given based on a ‘unit’ of measurement with a standard mixture of BOTOX® Cosmetic containing 100 units that is diluted in 3-4ccs of fluid. The average number of units per area is as follows: 10-25 units for the forehead area, 20-30 units for the glabella area, 10-25 units for the suprabrow area, and 5-15 units per side for the crow’s feet and cheek area. It’s important to note that if patients are charged for BOTOX® Cosmetic treatment based on a treatment area rather than a number of units, they will have no idea how much BOTOX® Cosmetic was actually administered since they could have received a syringe filled with a more dilute solution than recommended. In addition, charging based on the number of units given will provide patients with a better idea of how much BOTOX® Cosmetic is needed for effective change in a given area.

Q – How long does the BOTOX® Cosmetic procedure take to perform?
The BOTOX® Cosmetic injection usually takes just five to ten minutes to complete.

Q – Is the BOTOX® Cosmetic injection painful?
Discomfort is minimal during the BOTOX® Cosmetic injection. To maximize the patient’s comfort, a topical anesthetic can be applied thirty to forty-five minutes prior to treatment and a cold compress may also be used just prior to treatment.

Q – What is the recovery like after the BOTOX® Cosmetic injection?
There is minimal recovery or downtime associated with BOTOX® Cosmetic. Patients may notice some temporary redness and swelling for a few minutes after treatment and ice compresses will be applied for several minutes. Most patients are readily presentable in public upon leaving the office and can return to work and other normal activities. Prolonged bending and vigorous activity should be avoided for the rest of the day. Patients usually begin to notice an inability to create the unwanted wrinkle within twenty-four to forty-eight hours after treatment, and the effects will last approximately three to four months.

Q – Will I need to take time off from work after the BOTOX® Cosmetic injection?
Patients are usually able to immediately return to work and other normal activities after treatment, though exercise, prolonged bending and vigorous activity should be avoided for the rest of the day.

Q – Are there risks or complications with BOTOX® Cosmetic?
If excess BOTOX® Cosmetic is injected and/or treatment is done too close to the eyelid, a drooping eyelid can result. It is important to have a complete understanding of the muscle groups involved and to avoid injections that may promote leaking of BOTOX® Cosmetic into unwanted adjacent areas. This is fortunately a rare complication that is temporary if it occurs.

Q – Does insurance cover the BOTOX® Cosmetic procedure?
Insurance generally does not cover BOTOX® Cosmetic procedures which are performed for cosmetic reasons alone. Some coverage may be available when BOTOX® Cosmetic is used for medical purposes like migraine treatment. Patients should be sure to talk with their own insurance carrier.

Q – How long do the results of BOTOX® Cosmetic last?
The effects of BOTOX® Cosmetic last an average of three to four months.

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