One of the most amazing advances in cosmetic treatments has been BOTOX.

Botox works by blocking the nerve stimulation to the muscle so that the muscle relaxes.  As you age your skin weakens and can no longer counteract the effect of the muscle contraction giving you those unsightly wrinkles in your forehead and around or between the eyes.  By injecting a small number of units, the muscle becomes more relaxed and the wrinkles are improved or go away.

The majority of the treatments have traditionally been the Glabella (area between the eye brows and above them), the forehead, and the “crows feet” around the outer eye area.  I determine the number of units needed in each area and the injections are done with a very tiny needle.  An ice pack can be applied to the site to partially numb the area but is usually not necessary.  The Glabella region usually takes about 5 or 6 injections, the forehead anywhere from 5 to 10 depending on the height from the brow to the hairline, and the crow’s feet usually 3 injections per side.  Botox takes about 3-7 days to start working but may take as much as 2 weeks for the full effect in some patients. Botox is slowly metabolized so that it lasts about 3 months in the majority of patients.  I have noted that with repeat injections over time that some patients are getting longer durations even up to 6 months between treatments.

Botox is now being used in other areas besides those described above.  These include the “pucker lines” on the top lip, the corners of the mouth and the wrinkles in the neck.  With careful injections of very small amounts the pucker lines do very well with Botox.  If there is a lot of skin damage to that area it may not be as pronounced and a thinner filler would be needed to correct it.  By placing a small amount of Botox in the muscle that makes you frown, the corners of the mouth can be made to even out and not be on a permanent frown.  You would still be able to frown but it would not be a permanent fixture of your face.  Injection in the vertical bands on the neck and in those unsightly horizontal wrinkles has resulted in smoothing of the neck in a lot of patients.  Much of the results there depend on the amount of sun damage to the neck but even then improvement is evident in most patients.

What is the treatment Like?

BOTOX injections are typically administered at these sites.

Botox Cosmetic is a quick and minimally invasive procedure consisting of a few tiny injections. Your doctor will determine exactly where to administer these injections to achieve the best results for you. No anesthesia is required, though he or she may choose to numb the area with a cold pack or anesthetic cream prior to injecting.

Unretouched photos before and 14 days after BOTOX Cosmetic treatment.




One breakthrough use of Botox recently has been in Migraine and tension headaches.  Not all migraine headaches can or should be treated with Botox, as many do not involve muscle spasm.  So many patients, however, describe an onset of extreme muscle tension in the temple region or above the eye that then progresses to a full-blown migraine headache.  By carefully mapping the muscle tension origin Botox can be injected to that area and give a long-term relaxation to the muscle.  I have injected the muscles in the back of the neck also if that is the origin of the headache.  TMJ syndrome is also successfully treated by injecting the Masseter (chewing) muscle at strategic resulting in a partial relaxation of this very large muscle. This reduces the tendency to clinch your jaw at night and lead to a headache. For patients with really thick Masseter muscles Botox can be used to give enough relaxation so that you will get a thinner facial appearance.  While cosmetic doses of Botox on the face may need repeating every 3 months or so, injections in the muscles to reduce headaches tend to last longer.

One exciting area we are using Botox is to reduce excessive sweating, a condition known as hyperhidrosis. After a numbing cream is applied, multiple small doses of Botox spaced about a centimeter apart are injected in the armpit.  The small muscles that help expel sweat are partially paralyzed and cannot continually push out the sweat.  This results in a marked reduction of sweating to mostly normal levels.  It usually lasts as long as 8 months.  I have also injected the palms of the hands and soles of the feet to stop that embarrassing wetness.


I have heard that Botox is a form of Botulism and could paralyze you.

While true Botulism poisoning from infected food or other sources could paralyze you, Botox is produced under very stringent and controlled conditions so that it is extremely pure and not dangerous in the doses used for cosmetic treatments.

I am afraid of the frozen face look that is often joked about on TV.  What can I expect?

Most of the patients I see do not want to be completely frozen in their expression.  Therefore, I have adjusted the doses so that the wrinkles go away at rest but not your ability to make some expression where appropriate.  One area that I do like to “freeze” is the area between the brows where you have the “11’s”.  By completely paralyzing this area you can avoid that constant angry look.  I do have some patients that request to have no forehead movement and that is achievable with the dosing.

Why does it only last about 3 months?  Can I do something to extend it?

Botox is a neuromodulator that partially blocks the nerve signal to the muscle.  The body has a tendency to break it down over a period of time and that is why it disappears.  Other products have tried to extend that time frame but they also can only get about 3 months before needing re-injection.  I feel that re-injection before it fully wears off does lengthen the time out longer for subsequent injections.

Can the dose migrate to adjacent muscles and mess up my results?

This has been reported but does not result in long-term harm.  I tell my patients not to rub or lie down on the injected area for at least 3 hours.  By that time the Botox is incorporated into the area and migration is less likely.

Can I get a filler such as Juvederm at the same time as my Botox injection?

Dermal fillers such as Juvederm can safely be done at the same appointment.  We prefer to know you desire for filler ahead of time so that appropriate time can be allotted for both injections.

It’s all about Freedom of Expression!

Millions of men and women of all skin colors and ethnicities have realized the benefits of being treated with BOTOX® Cosmetic. You can too! When administered by an experienced physician, you can still smile, frown, and look surprised without those lines between your brows. For more information, visit






We offer a complimentary consultation to address your individual needs and treatment options. Call Genesis Cosmetic Laser Center at (843) 669-2220 today and let us design a personalized program to fit your needs.