What is Botox®?

Botox® has been used for medical conditions that are caused by muscle over-activity for over 25 years and has an excellent safety record. In the aging face we use it to change the interplay of forehead and eye muscles to relax the overlying skin wrinkle. We also raise the eyebrows, diminish the appearance of Crows’s feet around the eyes. After correct application of this product, patients report looking less tired without having a “frozen” face. In addition, applying conservative amounts of Botox® to younger faces and those without deep lines PREVENTS the appearance of deep lines in the future. This treatment usually lasts 3-5 months.

Botox® is one of the most commonly used injectable treatments for facial enhancement. Dr. Stefanacci and clinical injection specialist Maureen Barrett, RN, bring over 37 years of combined medical experience to achieve maximum results for each patient. Treatment plans are individualized to help maintain high patient satisfaction. Both women take great care to avoid the "frozen" or artificial look that concerns many prospective patients.

Botox®, (botulinum toxin type A) is a purified protein derived from the bacterium Clostridium botulinum. It works by blocking nerve impulses that trigger wrinkle-causing muscle contractions to create a smooth and relaxed appearance. It was approved by the FDA 20 years ago for strabismus (crossed eyes) and blepharospasm (uncontrollable blinking). In 2000 the FDA approved its use to treat the abnormal head position and neck pain associated with cervical dystonia. It works to temporarily paralyze the affected muscle, and thereby soften the facial imbalance or release the spasm.

In recent years Botox® has been used successfully for various cosmetic indications. The same principles that make Botox® effective as a medical treatment make it effective as a cosmetic treatment. It is commonly used to relax the active facial muscles that over time create almost indelible creases between the eyebrows, (glabellar complex), across the forehead, (frontalis muscle) and the "crow's feet" around the eyes, (orbicularis oculi).

The muscles of the glabellar complex, responsible for vertical frown lines, is the most common site for Botox® injections. The exact number of injections and amount used is tailored for each individual patient with men generally requiring more injection points and a higher dose as men have larger muscle masses on average. A general starting point is 5 injections for women using 20 to 30u (standard units of Botox®) and 7 injections for men using 30 to 40u. An adequate dose is necessary to achieve effective correction.

The frontalis muscle of the forehead elevates the brow and is associated with the formation of horizontal wrinkles. The goal in treating the forehead is to maintain some movement of the muscle for a more natural look while smoothing the lines for a more rested appearance. This area presents significant challenges for the inexperienced clinician. The most common problem is ptosis or “droopy” eyebrows. Care must be taken to avoid over-treating and producing a “frozen” expression. Another common problem is the creation of a “quizzical” or “Mr. Spock” look. Guidelines from the American Society of Plastic Surgeons suggest 4 to 8 injections using 10 to 20u for women and 20 to 30u for men.

Lateral orbital wrinkles, commonly termed “crow’s feet”, result from muscle activity in combination with photo-aging. The goal is to soften wrinkles and to provide a relaxed look, not to cause immobility. The usual number of injection points is 3 to 5 per side using 2 to 3u per injection for a total of 12 to 30u per treatment. Injection in this area should be superficial to minimize bruising and applying ice before and after the injection can be helpful.

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