Background On Botox
Facial wrinkles have several causes including sun exposure, loss of skin elastic properties, skin atrophy, and excessive muscle activity. Some of the facial wrinkles we have are the result of skin pleating from the activity of muscles below the skin. Too much activity from these muscles can be bothersome because they can be misinterpreted as representing anger, anxiety, fear, fatigue, sadness and aging. Wrinkles that are directly related to muscle activity are those on the forehead and on either side of the eyes, often called crow's feet. As we age the amount of fat we have underneath the skin decreases, the skin gets thinner and wrinkles become more prominent. This process becomes noticeable in our late twenties to early thirties.

A number of surgical modalities exist to treat wrinkles on the forehead and face including browlift and facelift. While these procedures are very effective, not every person with prominent wrinkles needs surgery. Botox (Botulinum toxin) is a strong neurotoxin produced by bacteria. When injected into a muscle it causes temporary paralysis of that specific muscle. Botox has been used for many years for the treatment of facial tics and other problems related to muscle spasm. It is approved by the FDA for these uses and has a long history of safety. When Botox is injected into the muscles responsible for creating wrinkles on the forehead and around the eyes it is very effective in minimizing or eliminating these skin folds.

A candidate for Botox is an individual with reasonably good skin tone who has wrinkles along the forehead and/or around the eyes. For individuals in their 20's, 30's and older, Botox can effectively postpone or eliminate the need for more aggressive modalities to treat wrinkles such as surgery or laser resurfacing.


Consultation
At the initial consultation, Dr. Capella will perform a directed physical examination and review your medical history including, medications, prior plastic surgery and daily skin care regimen. He will discuss your facial lines with you in front of a mirror and determine the role of Botox in their treatment. A key element of the exam is assuring that the wrinkles of concern are related to muscle activity. If this is not the case, Dr. Capella may suggest other modalities of treatment including collagen injections, glycolic acid peels, microdermabrasion, laser resurfacing or even surgery. Photographs will be taken of you with your facial muscles relaxed and also with them stimulated, to accentuate the wrinkles of concern. A consent form will be reviewed and signed by you and our staff.


The Procedure
Dr. Capella will mark the areas of maximal muscle pull causing the wrinkles with you sitting in a reclined position. Botox is injected through the skin into the muscles to be treated with a very fine needle. Patients in general experience minimal discomfort, the procedure lasting just several minutes. Patients are ready to leave the office soon after the procedure.


Risks
The complications of Botox injections include mild bruising or local pain related to the injection. There also may be weakness of adjacent muscles related to diffusion of toxin. If local adjacent muscle weakness occurs, it will disappear with time.

There have been no long term complications or hazards associated with Botox use. Botox injections have been found to be extremely safe alone or in combination with other modalities. Woman who are pregnant should not be injected because of the lack of data regarding the effect on pregnancy.


Follow-up Visit
The effects of Botox become visible within several days and its full effect is evident at seven days. Dr. Capella will ask you to return to the office two weeks following the procedure. New photographs will be taken and your wrinkles will be reassessed. If the wrinkles are still bothersome to you, additional Botox may be injected at this time. When the facial muscles have been adequately weakened and a pleasing facial skin contour has been achieved, you will be instructed to return to the office when the wrinkles have become prominent again. In general, this is in about 3 to 6 months. For patients who have been treated multiple times, the effect of Botox seems to last for longer periods of time.