3 different ways to use Botox

  • Botulinum toxin, or Botox, is a muscle relaxer that can reduce wrinkles as skin matures.
  • Common treatment areas include the forehead, eyebrows, eyes, jaw, lips, and neck.
  • Dr. Onyeka Obioha and Dr. Ohara Aivaz demonstrate how botulinum toxin injections work.

Following is a transcript of the video.

Onyeka Obioha, MD: Botulinum toxin is a substance that basically disrupts the signaling between nerves in the muscle. "Botox" is often synonymously used with "botulinum toxin." However, Botox is a brand, and it was the first brand of botulinum toxin. Ohara Aivaz, MD: So, there's Botox, Dysport, Xeomin, and the newest one, Jeuveau, that are all forms of botulinum toxin.
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Obioha: By relaxing the muscles and injecting Botox, for example, in between the eyebrows in these three muscles that work together, it helps relax the muscle, so you're not contracting and thereby causing a wrinkle there. Same thing with the forehead and raising the eyebrows. By relaxing those muscles and minimizing them contracting, you reduce the wrinkles.

Aivaz: We sometimes numb patients before we do Botox based on their preference. We use the tiniest needle possible, so they feel a very small poke. There's no burning or stinging as it's done, but patients will sometimes say they feel, like, a crunching as the needle's going through the muscle. It sounds worse than it is, I think. You inject the fluid of the Botox, and patients will have a little bump in the skin, which is actually the fluid under the skin, and that absorbs after about an hour.

Obioha: So, we often tell our patients, "You're going to leave with some mosquito bites," and then by the time that they get to their car, it's down.
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Aivaz: A lip flip is a great way of augmenting the lips, so to make them a little bit bigger without using fillers, and we achieve this by placing just a few units of Botox around the borders of the lip. And what that does is it relaxes the orbicularis oris muscle, which is around the mouth, and that causes an eversion, or outward rotation, of the lip, where it flips out, which is where the name "lip flip" comes from. And it creates the illusion of a larger lip without really adding too much volume.

Obioha: Botox in the jaw area, we use it both cosmetically and also for muscle pain. So, this big muscle that you have here that's responsible for chewing is also responsible for teeth grinding. So when you inject the masseter muscle, this big muscle here, what it does is it causes thinning of the muscle, so that your face can be more contoured. And then in terms of the muscle pain from TMJ, same thing. When you're relaxing the muscle, you're reducing your ability to grind your teeth at night, thereby alleviating the symptoms of the TMJ. Aivaz: Hyperhidrosis is excessive sweating, and our body's natural response to an elevation in body temperature is to sweat. It helps cool us off. In people with hyperhidrosis, they sweat all the time, whether or not their body temperature goes up. It can be pretty psychologically difficult for people to deal with, you know, to have sweaty armpit stains all the time or shake someone's hand and have wet hands. And so, luckily, we have Botox, which helps stop sweating in the areas where it's injected. And our nervous system controls our sweat glands, and so when we inject Botox into an area, it paralyzes the nerves only in that area. And if the nerves can't signal to the sweat glands, then the sweating stops. Whether Botox is used for cosmetic purposes or for other reasons, like hyperhidrosis, the botulinum toxin lasts about three months. Our body naturally metabolizes it after that time period.
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As far as pricing for Botox, it really depends on the person and what result they're trying to achieve. So, some people need not very many units; other people need a lot more because their muscles are stronger or they want to be more frozen. So, honestly, it can range if you want to do just one area. For example, just the eyes or just the forehead, it can be anywhere from $200 to $400, but if you want to do full face, maybe $600, $700, $800.

Obioha: And then also the indication. So basically for sweating, you know, some insurance companies can cover most or some of the cost, which could be upward of $1,000 per area.

A common adverse reaction to Botox would be if it was improperly placed on the forehead, then it can cause your eyebrow to droop, or what we call ptosis.
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Aivaz: And then if it's done in other areas, for example, around the mouth, and it's placed too close to the corners of the mouth, there can be problems moving the mouth or sucking out of a straw. So it really is important to see a board-certified doctor to have your Botox placed.

Obioha: In terms of a treatment plan, it's often that once you start doing it, so when you do one treatment, I do advise that you maintain and continue the treatment every three months, so that we can maintain our results.

Aivaz: But if they decide not to, they're going to go back to looking just the way they looked prior to doing the Botox. It's not going to age them more if they do it once and then decide not to do it again.
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