I get a lot of feedback from patients regarding what the actual treatment with Botox feels like. First of all, for those people who are afraid of needles let me reassure you – the needle is really small. Botox is injected using a 30 gauge needle (approximately 0.3112 mm or 0.01225 inches) that is only 1/2 of an inch long. Most patients tolerate the injections very well. Surprisingly, when I ask people who have had Botox injected into the forehead, the glabellar area and the crow’s-feet they say that the injections just above the eyebrow are the most uncomfortable, while the injections into the crow’s-feet are the least uncomfortable. In order to minimize pain cold packs can be placed on the areas to be injected before and after injection. Topical numbing cream is an option, but unfortunately it must sit on the skin for a minimum of 30 minutes in order to be effective.
Unlike on television sitcoms, the effects of Botox are not seen right away. Typically, the results start becoming apparent 2-3 days after injection with full results seen at one week. For this reason I typically have new Botox patients return to the office 7-10 days after their injections to make sure that the injections had the desired effect. At that time adjustments and touch ups can be made which will allow me to have a better idea how to optimally inject the patient at their next visit. The expected duration of action of the Botox injection is about three months. The results will not all wear off overnight – you will see a gradual return of function in the muscles that were injected. Usually, by four months or so patients are back to their baseline level of muscular function.
Side effects and complications due to Botox injections are rare. The most common side effects that I see in my practice are discomfort and redness or bruising at the injection sites. Another complication that is possible, but not common is drooping of the upper eyelid. This occurs when the Botox diffuses away from the site of injection and effects the muscle that elevates the upper lid. I take great care in placing my injections at least 1.5 cm away from the upper orbital rim to decrease the chance of this happening. Although it is theoretically possible for there to be a distant spread of the effects of Botox, according to the manufacturer’s website “There has not been a confirmed serious case of spread of toxin effect away from the injection site when BOTOX® has been used at the recommended dose to treat severe underarm sweating, blepharospasm, or strabismus, or when BOTOX® Cosmetic has been used at the recommended dose to treat frown lines.”
If you have any questions or would like to see if Botox is right for you visit my website www.signatureplasticsurgery.com or call 281-616-8800 to schedule a free consultation.
The next post will conclude this series on Botox. I will discuss patient selection and who benefits from Botox.