It is fortunate that most of the side effects are uncommon, mild and transient.

The most common side effects are:

headache
a flu-like syndrome
pain, swelling or bruising at the site of injections

The side effect that is of most concern for the patient and the practitioner of botox injections is the effect on the muscles.  This comes on when there is too much botox, too little botox, or botox effect on other than the intended muscles.

Too much botox for the treatment of face wrinkles results in near paralysis of the target muscle, resulting in the production of a mask-like face which does not wrinkle no matter how much the patient tries.  Although this may be a desired effect on some western societies, especially in the area of film-making, this is not so in eastern societies, who prefer a minimization of wrinkles rather than complete absence of movement.

Too little botox obviously produces little or no effect on the target muscle, and the face wrinkle is only lessened slightly, needing further injections.

Wrong muscles: this results from either the wrong muscles being injected accidentally, or the unintended diffusion of the botox into adjacent muscles.  Thus we can see occasional double vision that results from diffusion of botox into the muscles of movement of the eyeball.

As said before, even these side effects wear off with time, and the patient is back to normal within 4 – 6 months.  Apparently recovery is speeded up by regular exercise of the affected muscles or the application of hot compresses which are supposed to increased the speed of breakdown of the injected botox.

Frown Lines Before and After Botax

The face wrinkle that is commonly deemed to be the most unpleasant is the frown line.  Imagine the eyebrows knotted together, as one would when one is facing the sun, but this time even when there is no sun. Imagine the frown lines present all the time whenever you are facing people. It gives people the impression that you are displeased with something or other. Ultimately people start avoiding you as they do not want to be the object of your displeasure or unhappiness.

In the beginning these frown lines are easily treated by the usage of botox injections. Also commonly referred to as Botax injections, these are purified toxins of a bacteria known as Clostridium botulinum type A. Injected into the muscles of frowning, they weaken or paralyze these muscles so the area of skin in between the eyebrows remains smooth as you talk to people, a most pleasant experience. A total of anywhere between 12 to 24 units of Botax is injected for an effect that lasts between 4 to 6 months.

Sometimes the frown lines have been in existence for too long, and the lines become permanent static wrinkles.  In this case the lines do not vanish completely even with Botax injection, and a face filler is needed to smoothen out the defect.

Take a look at yourself in the mirror.  Look carefully at your lower eyelids.  Smile at yourself.  Notice the fine lines that form under the outer corner of your eyes, radiating downwards and outwards to your cheeks.  These are the under eye wrinkles, a direct result of smiling.  Although these by right should be viewed favorably as they are an indication of cheerfulness, a lot of people feel that they reflect ageing.  In situations like these, there is just no choice but to do something about it.  So how does one treat under eye wrinkles?

The most obvious choice is Botax, also known officially as Botox, a commercially available purified toxin of the bacterium Clostridium botulinum.  Generally speaking, all that is needed is the injection of 1/2 to 1 unit (divided into 2 shots) of Botax rather superficially into the muscles just under the skin below the outer corner of the eye.  The muscles that cause these under eye wrinkles are rather thin and superficial.  Any deeper injection than that described above will be a waste of Botax.  Results show within 4 days and can last 4 to 6 months.

Another way of reducing under eye wrinkles is by superficially injecting a hyaluronic acid preparation (as in mesotherapy) into the skin of the lower eyelid.  Hyaluronic acid absorbs water and plumps up the skin, and this causes the disappearance of superficial fine under eye wrinkles for up to 2 months.

A third way is by the application of some commercially available plant extracts (for example Boswelox) which are claimed to counteract “facial micro-contractions”  that cause fine lines, and thus help reduce under eye wrinkles.

Forehead Wrinkles - The Surprised Look

Look around you at the number of people who are walking around with a permanently surprised look on their faces.  What you see is the forehead wrinkle – usually horizontal lines running from one side of the forehead to the other due to contraction of the muscle of the forehead known as the frontalis.  The look may have originally been intended to show surprise, but a surprising number of people with this look are anything but surprised.  What you see in an older person with forehead wrinkles, is an unconscious attempt to see better.  Age and gravity has a tendency to produce what is commonly called brow ptosis, that is, a drooping of the eyebrow, to the extent that the overhanging brow limits vision. The sufferer thus unconsciously lifts the brows for clearer vision, and in doing so, shows a marked forehead wrinkle.

Some others, however, especially younger people, do have this persistently surprised look out of sheer habit, and are often not aware of this rather unpleasant look until somebody points it out to them.  This is the group that will benefit most from treatment of the forehead wrinkle.

The most common form of treatment for the dynamic forehead wrinkle is the injection of Botax, commonly called Botx (but more correctly called Botox).  Multiple small injections of about 1 unit each of Botax into the muscles along the upper 1/2 of the forehead will relax the frontalis muscle and result in disappearance of the forehead wrinkle. 

Some caution needs to be exercised here. The elderly person with forehead wrinkles will not respond well, as noted above, because his brow will droop after injections, and he will have difficulty seeing due to droopy eyebrows.  The other scenario is where the forehead wrinkle has become a permanent feature due to prolonged contraction of the muscles, forming forehead creases.  These do not respond well to Botax, and instead one should opt for face filler injections.

An alternative mode of treatment for the permanent forehead crease is a thread lift (which is basically a hooked thread inserted under the skin of the forehead and is used to exert a traction force that gets the skin to be lifted upwards and thus eliminates the face wrinkle on the forehead, or forehead wrinkle.  The last resort to treat the forehead wrinkle, especially in older persons, is the surgical facelift.

No Crows Feet On A Beautiful Face

Crows feet, commonly also called the eye wrinkle, is the term given to the face wrinkles situated at the outer corner of the eyes when a person is smiling.  They start just at the corner of the eye and radiate in three directions, at an angle upwards, outwards and angled downwards, much like that of the feet of a crow. These are formed by the contraction of the muscles around the eyes and tend to disappear when the person stops smiling.  However, with age and frequent excessive smiling, other factors come into play, such as a permanent buckling of the skin because of frequent contractions.  These are then called static wrinkles and have to be treated differently from the dynamic wrinkles which occur earlier.

Treatment of dynamic crows feet or eye wrinkles is by the injection of a few units of botox (sometimes known as botax) into the muscles of the skin at the outer corner of the eye.  These are rather superficial muscles and are quite easily accessed in trained hands.  However one has to be careful in the injection process not to nick the sometimes not-so-obvious superficial facial veins that run in the same area, as these will cause some inconvenient bruising in the injected area that lasts up to 2 weeks.  Also, in untrained hands, the botox may be inadvertantly introduced into the muscles of the eyeball, causing temporarily a problem of double vision.

No Crows Feet When Not Smiling

Crows Feet When Smiling

Aside from these above noted rare side effects, the actual intended effect of removal of crows feet is a marvellous restoration of smooth skin around the eyes and a much more youthful look, essential for conveying that all important first impression when you meet a potential client or partner.

The effect of botox injection comes on within 2-3 days, and lasts up to 4-6 months.  The cost of this particular injection for eye wrinkles is rather low, as the amount of botox or botax needed is much less that that used for, say, the frown lines or forehead lines, there being less, and thinner, muscle to inject.  Suffice it to say that one usually does not need more than 12 units of botox for the treatment of crows feet.

Square Jaw - Can Be Corrected With Botox

The causes of square jaw are a few.  One of the causes is bony, where there is increase in the angle of the jaw because of bony development.  This is usually genetic, and treatment, if possible, will include surgical shaving of the bone.  The other, more common cause, is a marked development of the masseter muscles of both sides of the jaw, causing the face to form a squarish shape when viewed from the front.

The treatment for this square jaw is simple.  All that is needed is the injection of botox (also referred to as botax) into a few points in the masseter muscles on each side.  The botox causes the muscle to become weak, and as a result of underactivity of the jaw, tends to shrink, allowing the facial profile to become pearshaped.

This effect lasts anywhere between 9 months to a year, after which the muscles regain their strength and volume.  Re-formation of the square jaw is delayed if one avoids exercising the masseters by chewing on hard or chewy foods such as chewing gum.

You can thus see that the cosmetic uses of botox have graduated from the original anti-aging uses (treatment of face wrinkles) to esthetic uses (treatment of square jaw and eyebrow reshaping).  More on eyebrow reshaping later.

Bunny Lines

These bunny lines are, in some people’s opinion, rather cute, especially as they serve to accentuate the smiles on pretty girls’ faces.

However one can also find them rather irritating over time, especially if they present in older people.  Sometimes it is said that they appear due to too much of Botox (commonly called Botax), which is commonly used to treat face wrinkles, where there is compensatory contraction of remaining muscles to cover the paralysis of other facial muscles of expression by Botox.  Most times they do occur independent of any botox effect.  The interesting thing is that Botox can be used to treat bunny lines.

Just 1 – 2 units of Botox on the nasalis muscle on each side of the nose.  That’s it.

The effect can be seen in 4 days and last up to 4 to 6 months.

Early treatment of the face with Botox was concentrated on the removal of the forehead wrinkles, the frown lines and the crows feet.

Now researchers are increasingly looking at the use of botox in the lower face.  One such usage is the injection of botox to improve the look of the jaw line, by playing on the opposing muscular forces on the muscles that drape the lower jaw.  This is known as the Nefertiti lift, after Nefertiti, an Egyptian queen of eons ago famed for her beauty and in this instance, her well defined jaw line.  With age, the platysma muscle complex which runs over the jaw drags down over the jaw line, causing a loss of the definition of the line and the formation of jowls.

The principle of the procedure is this: if you give a certain number of units of Botox into the muscle under each mandible, and to the upper part of the platysmal band, there is an immediate and visible release of the downward pull of the platysma muscle.  When followed 2 to 3 weeks after this procedure, one can notice an obvious re-contouring and elevation of the skin at the jaw line.

jawline before botox

As usual, the number of units used and the position and depth of injection of the toxin need to be carefully controlled, as excess or inappropriate placement of Botox can lead to side effects.  Known side effects are minor such as some difficulty swallowing, or some difficulty smiling normally.

jawline after botox

Nasal Flaring

No Nasal Flaring

Treatment for nasal flaring is by the injection of a unit of Botox or Botax on each nostril into the levator alae nasi muscle.  Some pain may be expected  during the Botox injection, as there is very little space for even that small amount of Botox to move into just above the nasal alar cartilage.  This injection effectively weakens the muscle and the nasal flaring is considerably reduced for about 4 to 6 months.