What is Botox®?

Botox® is a drug created from a bacterial neurotoxin called botulinum. In small doses, Botox® can cause paralysis in spastic or overactive muscles. It has gained popularity over the last 30 years in the cosmetic world for the treatment of wrinkles.

Facial wrinkling occurs for several reasons in addition to aging.  Loss of skin elasticity and sun damage can hasten the formation of wrinkles in addition to a person’s genetics. Smoking and other lifestyle choices can also speed up this process.

Botox injection areas diagram.

Wrinkles can be static or dynamic. Static wrinkles are those that are present even when the face is relaxed. Dynamic wrinkles are wrinkles that appear with various facial expressions, but go away when the face relaxes.  Botox® is highly effective in preventing wrinkles from setting in, but typically does not eliminate static or deep wrinkles. For static wrinkles, fillers are used.  Botox® typically lasts an average of 3 months and will require repeat treatments when desired.

Aside from treating wrinkles, Dr. Panossian performs Botox® injections in cases of facial asymmetry. Specifically, individuals who suffer from facial paralysis or have recovered incompletely from facial paralysis (Bell’s palsy) will occasionally require intervention for asymmetric facial movement. In addition, some patients may develop unwanted facial twitching (synkinesis) while recovering from facial paralysis. This twitching can be relentless and possibly permanent. Botox® injection, placed precisely into specific muscle groups, can balance the face and relieve involuntary twitching.

Dr. Panossian also performs Botox® injection into palms, feet, and armpits in people suffering from excessive sweating, or hyperhidrosis. This is a very effective treatment for sweating and, for many people, life changing.

There are alternatives to Botox®. These include Dysport® and Xeomin®. Consult with Dr. Panossian regarding the best option for you.


When should I use Botox®?

Botox® is used most frequently when facial wrinkling increases. Once the effect wears off in approximately 3 months, you can then repeat the treatment indefinitely. There is a growing trend to begin Botox® treatments when patients are in their 20’s and 30’s as a preventative measure. This may or may not be a good strategy for you. Dr. Panossian will go over the pros and cons of this approach and provide you with the best option.


What are some risks of Botox®?

It’s important to note that Botox® injection is extremely safe in experienced hands. Even so, there are some potential risks that should be noted. Being a paralytic agent, Botox® will paralyze any muscle with which it comes into contact. This can include adjacent muscles that are not necessarily the intended targets. One example of this is the possibility of a droopy upper eyelid from injection or migration of Botox® from forehead injections. Another example is sagging of the lower eyelids or smile with aggressive injections into crow’s feet or laugh lines. The unintended effect is temporary and will allow for function to return as the Botox® wears off.

Bruising may occur if a blood vessel beneath the skin is pierced.  This problem typically occurs in the setting of recent use of anti-inflammatory medications such as Advil, ibuprofen, Motrin, Naprosyn, and aspirin. As a general rule, these medications should be discontinued 10-14 days prior to injection to avoid this potential problem.

In rare instances, Botox® injections may not fully have the effect one desires. There are several reasons why this may occur including inadequate amount of product injected. Some individuals may also metabolize Botox® more quickly resulting in a shorter duration of effect than the average 3 months. And rarely, a vial of the product may contain inactive or denatured Botox®. Dr. Panossian is committed to rectifying these issues so that you may have the anticipated result.


What is Dr. Panossian’s technique for injection of Botox®?

Injection of Botox® is more art than science. It should not be taken lightly. Dr. Panossian does not believe in handing off these procedures to other staff members to perform. He performs all injections with an eye for artistry and a deep knowledge of facial anatomy. This is as vital to the safety and comfort of his patients as well as for the final results.

Dr. Panossian is an advocate of the conservative approach to administering Botox®. While other physicians in the cosmetic world may elect to use large quantities, Dr. Panossian believes in injecting only as much as necessary for achieving the intended results. This not only limits complications but makes these treatments more affordable for patients. For Botox® injections, he administers a baseline amount of product and re-evaluates the effect in 2 weeks. If necessary, he will perform additional smaller quantity injections at the second visit. Dr. Panossian’s passion and extensive experience in this area stands out. Trust your face only to the best!