Botox Cosmetic: Consider all the Factors


Botox Cosmetic: Consider all the Factors


As we age, it is natural for us to experience the signs and symptoms on the place we use most often for interacting with other people: the face. In decisions about cosmetic treatments such as dermal peels, fillers or Botox Cosmetic injections, we should probably try to remember that the changes that age brings to the face are natural and normal. While we might not be overjoyed by this news, it’s important to keep our expectations on the side of reality rather than fantasy.

What is Botox?

Botox Cosmetic ™ (Allergan) is a purified form of the botulinum toxin type A that is made from human blood plasma and the bacteria that causes botulism food poisoning. It is a potent neurotoxin that causes paralysis of the muscles by blocking signals that would normally cause them to work.

In addition to its use for cosmetic purposes, Botox is also used to treat severe muscle spasms in the neck, arms or hands, and to treat certain eye muscle conditions such as excess blinking, eyelid spasms, and even some types of strabismus, where the eyes do not aim together properly. It also has uses in the treatment of overactive bladder in spinal cord injury and in multiple sclerosis to relax muscle spasms.

Uses of Botox

In both Canada and the US, Botox Cosmetic is approved to temporarily reduce the appearance of facial wrinkles commonly known as the “elevens,” those small, vertical creases that often appear between the eyebrows when we frown or scowl. In addition, it is used “off-label” to treat crow’s feet or “laugh lines” that appear to radiate out from the outer corners of the eyes, and to treat wrinkling across the forehead. It can also be used to reduce the appearance of small wrinkles that appear around the nose and mouth.

In general, Botox is injected into the muscles that cause the wrinkles; for example, in the frown-line area, the muscles that cause this go across the forehead between the brows causing those little vertical creases.


The key word for Botox treatments is “temporary.” Botox will not result in the permanent disappearance of facial skin wrinkles.

Realistically, treatment with Botox should result in a gentle reduction of skin creases in the targeted areas. In some patients, Botox effects show an increase over time and repeated treatment, so it may be that smaller amounts of the drug will be needed; in others, however, the body can become adapted and will show fewer results instead.

The maximum effects of Botox treatment appear in two to four weeks, and usually disappear in three to four months, so maintaining its effects will require repeat treatments. Treatments are not recommended more frequently than about every three to four months.

Side Effects and Possible Adverse Events

Common side effects of Botox injections around the eyes include poor eyelid closure, drying of the ocular tissues, light sensitivity, excessive watering or tearing, irritation and drooping upper eyelids. More serious side effects can include deviation of an eye which can result in double vision, and the accumulation of blood and other fluid under the skin surrounding the eyes. The cornea can become inflamed, mostly due to incomplete blinking or poor eyelid closure.
Non-visual side effects include fever, infection, neck or back pain, flu-like symptoms, rash and headaches.

Luckily, most of these complications and adverse effects from Botox are temporary and diminish over time.

It is always possible to experience an allergic response to a medication, and this is also true for Botox. If you have had an allergic reaction to previous Botox injections, or a known sensitivity to any of its active or inactive ingredients, avoid Botox altogether. Allergic reactions can cause redness, swelling, itching, skin rash and trouble swallowing or breathing. If you experience any of these, tell your physician immediately, as severe allergic reactions can be deadly.

It is always possible to experience an allergic response to a medication, and this is also true for Botox. If you have had an allergic reaction to previous Botox injections, or a known sensitivity to any of its active or inactive ingredients, avoid Botox altogether. Allergic reactions can cause redness, swelling, itching, skin rash and trouble swallowing or breathing. If you experience any of these, tell your physician immediately, as severe allergic reactions can be deadly.

Things to Consider Before Botox Cosmetic

If you are considering Botox Cosmetic injections, you should certainly be aware of its possible side effects and possible adverse events such as eyebrows that are too arched, giving a person a perpetually surprised look, or the Botox migrating into other areas where it was not intended to go.

An online search through a dozen or more sites listing possible side effects and what to look for in a surgeon resulted in a distillation of factors which can reduce the possibility of unwanted effects.

  • Choose a practitioner who is very experienced in giving Botox and be sure he or she is a medical professional. Active certification by medical specialty boards in cosmetic, aesthetic, or plastic surgery or dermatology is a must. Search for a practitioner who has a large number of previous and current patients and is actively practicing. A practitioner who has done Botox injections for at least five years and who is listed at the top end of Allergan’s website doctor search engine would be a good choice. (Figure 1 shows logos of several certifying bodies that have examined and tested doctors who have undergone proper training in the use of Botox Cosmetic.)
  • Tell your practitioner about any and all health problems you may have, any history of allergic reactions, any and all medications and supplements you make take, (even those sold without a prescription) and if you have had previous Botox injections and when. In particular, injected antibiotics may cause interactions with Botox.
  • Follow all pre- and post-treatment instructions completely and carefully. Report any and all side effects you notice right away.
  • Do not choose a practitioner just because they have a recognizable name, because they have treated celebrities, or because they have a line of skin care products.
  • Be very clear about your expectations when discussing possible treatments with your practitioner. Be open to other options besides Botox; it may be that other treatments might be better for your particular situation.
  • Stop taking all aspirin, ibuprofen and fish oil supplements at least two weeks prior to your treatment to reduce the effects of swelling and bleeding.
  • Be very clear about what the practitioner is charging and what you are paying for. Fees for Botox injections are either calculated by the zone being treated or by the number of units injected. Allergan, the maker, supplies Botox in small bottles or vials of 50, 100 or 200 units. Some web sites advice that the practitioner doing the injection should open the vial in front of you so there is no risk of cross-contamination from another vial.
  • Costs for Botox treatment vary from one place to another; this means that treatment in Manhattan, New York, will probably cost more than the same treatment if it was done in Dallas, Texas, or Toronto, Ontario, Canada. Also, as in the case of other cosmetic surgeries or treatments, Botox Cosmetic is almost never covered by any medical insurance plan.
  • Botox Cosmetic treatment is not a case of more being better; more is just more: more expensive, more chance for adverse events, more chance of drug interactions or allergic reactions.
  • Keep in mind that mistakes happen, even with the best practitioners in charge. If the injection goes too deep or hits a nerve, the result may be a droopy eyelid or one eyebrow lifted more than the other, resulting in a look that implies skepticism.

Individual Faces

A certain amount of asymmetry in our faces is normal and natural; in fact, it is part of what makes our faces unique among humankind. Almost all of us have one eye slightly lower than the other or one cheekbone slightly higher.

In an interesting experiment several years ago, photographic negatives of face-on portraits of famous people (film stars, presidents, other national leaders, for example) were split down the midline and one half of the negative was flipped over to make the face appear perfectly symmetrical. Surprisingly, most of the people in the photos were barely recognizable. In a further test, the other side of the face was flipped in the same way, making the faces symmetrical again but using the alternate side of the face as the template. The results were so different from the first set of photos that it was very difficult to tell that they were even of the same person.

We usually think faces that are more symmetrical are more attractive, as has been shown in several studies, but we should not be too eager to completely remove all traces of individuality in pursuit of an artificial ideal, especially since the effects of Botox Cosmetic are only temporary.

This is not to imply that all such impulses to improve or enhance our looks are inadvisable; after all, eyecare practitioners do provide contact lenses for people who don’t always want to be seen in their eyeglasses, as well as work with surgeons who perform LASIK and other refractive surgeries in an effort to reduce their dependence on vision correction.

There is some evidence, also, that Botox may have a significant beneficial effect on depression. A recent study from Germany looked at symptoms of depression in patients before and after a single Botox injection in the forehead between the brows where those vertical frown lines form. Patients were asked to assess their level of depression before receiving one treatment with Botox, and then asked to repeat that assessment when the Botox had taken effect, about three weeks later. Interestingly, there was an almost 50% reduction in symptoms of depression. The researchers tentatively concluded that facial expression actually does have an effect on mood and outlook; in other words, smile and the world really might smile with you. Depression is a serious problem and patients who don’t respond well to anti-depressant medications might get some benefit from reducing their frown lines.

It is an interesting area for further study. We know that when we are depressed or angry, our faces reflect those emotions very effectively, but now it seems there is a distinct possibility that it also works in the opposite direction as well. By producing a facial expression that appears less angry or unhappy, we apparently FEEL less angry and unhappy as well.

Due Diligence and Patient Compliance Issues

Before undergoing any cosmetic surgery or treatment, it is important to research our and assume responsibility, to at least some extent, for these actions. Always follow these rules:

  • Share ALL information about vitamin supplements, any history of allergic reactions and all medications currently being used. This information is extremely important to avoid problems.
  • Never use more than one practitioner in an effort to decrease the waiting period between treatments of Botox Cosmetic.
  • NEVER allow unlicensed persons to inject Botox. A stylist at a spa or salon is not an appropriate administrator of this treatment.
  • Avoid “Botox Parties” where a group of people gather to get treatments at someone’s home or at a spa without medical equipment or expertise in case of an emergency.
  • Get Botox Cosmetic only from board-certified, active practitioners with a lot of experience in this and other treatments.


Undergoing surgical or injected treatments of any kind is serious business; it is important to carefully consider all the possible risks and complications. It is not a matter for casual impulse, but something to carefully evaluate for your own individual personality and circumstances.

Is Botox Cosmetic a good idea for you? Only you, and the practitioner you choose, can make that decision, based on factors too numerous to list. Search out experienced practitioners and talk to several to find the one you are most comfortable with, then listen to his or her advice and follow all instructions carefully for the best outcome for your beautiful face.

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