What is Botox^®?

Botox® and other botulinum toxin products, such as Daxxify®, Dysport®, and Jeuveau®, are highly effective treatments for facial paralysis and synkinesis, providing a targeted, non-surgical approach to managing these complex facial nerve disorders. Synkinesis is a neurological condition where voluntary movement in one muscle group triggers involuntary movement in another due to the miswiring of facial nerve fibers after damage. Often developing after conditions like Bell’s palsy or Ramsay Hunt syndrome, it can cause involuntary eye closure when smiling, cheek lifting when blinking, or neck tightening when whistling, significantly impacting facial expressions, emotional well-being, and quality of life. 

In treating facial paralysis, Botox® can be precisely injected into either the affected or unaffected side of the face to optimize muscle balance and reduce abnormal movements. The effects typically last 3–4 months, with many patients experiencing noticeable improvements in facial symmetry and reduced unwanted muscle contractions. Botox® is especially effective when integrated into a comprehensive rehabilitation plan that may include neuromuscular retraining, physical therapy, and surgical procedures like selective neurolysis, a technique pioneered by Dr. Babak Azizzadeh, to achieve optimal outcomes. 

Botox® (onabotulinumtoxinA) and other botulinum toxin products, such as Dysport® (abobotulinumtoxinA), Jeuveau® (prabotulinumtoxinA), Xeomin® (incobotulinumtoxinA), and Daxxify® (daxxibotulinumtoxinA-lanm), are highly effective non-surgical treatments for masseter hypertrophy, providing options to reduce lower face width and enhance facial contours. Clinical studies have shown that botulinum toxin injections into the masseter muscles can significantly decrease muscle thickness and stiffness, resulting in a slimmer, more balanced facial appearance. These treatments block nerve signals that trigger muscle contractions, leading to gradual muscle relaxation and atrophy. 

Research indicates that botulinum toxin injections can reduce masseter muscle stiffness by approximately 37% within three weeks of treatment. In addition to its aesthetic benefits, botulinum toxins can alleviate symptoms associated with masseter hypertrophy, such as facial pain, TMJ, headaches, and teeth grinding (bruxism). Results typically last 4–6 months, with some patients experiencing effects for up to a year. 

While botulinum toxins are effective, it’s important to consider potential functional implications. Studies have noted a temporary reduction in masticatory performance and bite force following treatment, and repeated injections may result in more pronounced muscle atrophy, potentially impacting long-term jaw function. For optimal results, patients should consult with experienced practitioners who can carefully balance aesthetic improvements with functional considerations, ensuring a safe and effective treatment plan. 

Dr. Babak Azizzadeh, an internationally renowned facial plastic and reconstructive surgeon, prioritizes helping you achieve your cosmetic and functional goals through a comprehensive consultation. During this process, he carefully evaluates your facial movements, aging patterns, and concerns to create a customized Botox® treatment plan. 

Dr. Azizzadeh takes time to educate you on the underlying causes of your cosmetic issues, such as how wrinkles form due to a combination of factors. He also explores whether Botox® or other non-surgical or surgical treatments may be most effective. He aims to give you the knowledge and confidence to make the best decision for your needs, ensuring natural, tailored, and effective results. 

Botulinum toxin products are available in two primary serotypes: type A and type B. Common type A formulations include Botox® (onabotulinumtoxinA) by Allergan, Dysport® (abobotulinumtoxinA) by Galderma, and Xeomin® (incobotulinumtoxinA) by Merz Pharmaceuticals. The only commercially available type B product is Myobloc® (rimabotulinumtoxinB) by Solstice Neurosciences. While all botulinum toxins work by reducing the activity of muscles, they differ in their molecular composition, mechanisms of action, and clinical characteristics. Type A toxins cleave the SNAP-25 protein, whereas type B targets synaptobrevin (VAMP), leading to differences in potency, duration of effect, and side effect profiles. For example, type B toxins are more commonly associated with dry mouth. 

Additionally, these products vary in preparation and dosing requirements. Type A formulations typically require reconstitution, while type B is supplied as a ready-to-use solution. Both types have demonstrated similar efficacy in treating medical conditions such as cervical dystonia. However, type A toxins are preferred for cosmetic applications due to their longer track record, greater clinical data, and widespread use in aesthetic treatments. 

The ideal age to start Botox® for preventative wrinkle treatment depends on your skin and aging process, which can vary significantly. Dr. Azizzadeh tailors each treatment plan to your unique needs, focusing on where you are in your aging journey. Preventative Botox® works by addressing fine lines and wrinkles before they become deeply etched into your skin. Typically, it’s most effective to consider Botox® when you notice “stage two” wrinkles—lines that appear with facial expressions and linger slightly when your face is at rest. 

For many, this occurs in their late 20s or early 30s, especially if they have expressive faces, a genetic predisposition to wrinkles, or lifestyle factors like excessive sun exposure or smoking that accelerate skin aging. However, starting Botox® before age 25 is uncommon and generally unnecessary, as expression lines often don’t become prominent until the early 30s for most people. Additionally, no studies show significant long-term benefits to starting Botox® excessively early. 

Ultimately, the decision to start Botox® should be guided by your skin’s condition and aesthetic goals rather than a specific age. A consultation with an experienced dermatologist or plastic surgeon, such as Dr. Azizzadeh, can help determine the best timing and approach for your preventative Botox® treatments. 

Botox® and other botulinum toxins such as Dysport® (abobotulinumtoxinA), Jeuveau® (prabotulinumtoxinA), Xeomin® (incobotulinumtoxinA), and Daxxify® (daxxibotulinumtoxinA-lanm), work by blocking nerve signals to muscles, effectively preventing muscle contractions. It achieves this by cleaving a protein called SNAP-25, essential for releasing acetylcholine, the neurotransmitter responsible for muscle contraction. This temporary muscle relaxation begins within 24 to 72 hours after injection, reaching its peak effect in 4 to 7 days. The effect is reversible, lasting approximately 2 to 3 months, until new nerve terminals and synaptic connections form. 

In addition to its muscle-relaxing properties, Botox® also inhibits the release of pain mediators such as substance P, glutamate, and calcitonin gene-related peptide (CGRP), making it effective for pain management in conditions like migraines. In cosmetic applications, Botox® reduces the appearance of dynamic wrinkles, such as forehead lines and crow’s feet, by minimizing the repetitive muscle contractions that lead to skin creasing, resulting in a smoother, more youthful appearance. 

The onset of action for botulinum toxin injections varies slightly depending on the formulation and individual patient factors. Generally, effects appear within 3–7 days, with full results typically visible by two weeks. Botox® (onabotulinumtoxinA) usually takes 5–7 days to show initial effects, while Dysport® (abobotulinumtoxinA) may work slightly faster, with results appearing in 2–4 days. Jeuveau® (prabotulinumtoxinA-xvfs) typically shows effects in 3–5 days, and Xeomin® (incobotulinumtoxinA) has a similar timeline to Botox®. The newest FDA-approved neurotoxin, Daxxify™ (daxibotulinumtoxinA-lanm), reportedly begins working within 1–2 days. 

Several factors influence the onset time, including the treatment area, dosage, and individual metabolism. Finer lines, like crow’s feet, may respond more quickly than deeper wrinkles. While some effects are noticeable within the first week, it’s generally recommended to wait 10-14 days to evaluate maximum results before considering any touch-ups. 

Eyelid drooping after Botox, known as ptosis, is common and typically temporary, lasting anywhere from a few weeks to three months, depending on the individual and the severity. Treatment focuses on mitigating symptoms while waiting for the effects of Botox to wear off. Prescription eye drops containing apraclonidine may be recommended to temporarily stimulate the muscles that lift the eyelid, improving the drooping. It’s essential to avoid manipulating the injection site immediately after treatment to prevent further spreading of Botox to unintended areas. If eyelid drooping occurs, consult your physician to discuss options and ensure proper management. 

Botox® and other botulinum toxins typically provide results lasting 3–6 months, with most patients experiencing effects for 3–4 months. The duration can vary based on the treatment area, dosage, patient characteristics, and the specific formulation. For example, Botox® often lasts 3–5 months in women and 4–6 months in men for glabellar lines, while Dysport® offers a similar duration with an average retreatment interval of about 3.9 months. Myobloc® (type B) generally lasts 2–3 months. Lifestyle factors like muscle strength, metabolism, sun exposure, and habits can also influence how long results last, and repeated treatments may lead to longer-lasting effects over time. 

Daxxify™ (daxibotulinumtoxinA-lanm) is a newer formulation potentially offering extended longevity. Its longer effects are partly attributed to a proprietary peptide that enhances stability and to a higher effective dosage compared to traditional Botox®. For glabellar lines, Daxxify uses 40 units per session versus the 20 units typical for Botox®. While these treatments differ in duration and dosing, individual responses vary, and consultation with Dr. Azizzadeh is essential to determine the best plan. 

The goal of Botox® treatment is to create a balanced, natural-looking facial appearance while preserving the ability to express emotions. When performed by an experienced practitioner, Botox® should soften dynamic wrinkles without significantly impairing natural facial mobility. Modern techniques focus on strategic placement and appropriate dosing to avoid the “frozen” look often associated with overtreatment. For example, treating forehead lines with lower doses and diffuse injection patterns helps maintain some movement for a more natural result. 

Botox® effects are gradual and dose-dependent, allowing skilled injectors to tailor treatments to each patient’s unique facial anatomy and goals. Practitioners often start conservatively and adjust during follow-up sessions as needed. Studies, such as a 2008 publication in the Journal of Cosmetic Dermatology, have shown that appropriately administered Botox® does not significantly affect the ability to convey emotions through facial expressions. Clear communication with your provider and realistic expectations are essential to achieving a rejuvenated yet expressive look while avoiding overtreatment. 

Botox® is widely considered safe when administered by a qualified professional, but like any medical treatment, it carries the potential for side effects. Common mild side effects include pain, swelling, or bruising at the injection site, as well as temporary eyelid or brow drooping. Rare but more serious side effects can include muscle weakness, difficulty swallowing, speaking, or breathing, smile dysfunction, vision problems, and allergic reactions. Dr. Azizzadeh’s expertise in facial muscle anatomy, facial aesthetics, and managing facial palsy is essential for minimizing these risks and ensuring optimal outcomes. 

To reduce the likelihood of complications, it’s crucial to seek treatment from an experienced, licensed healthcare provider who can administer the appropriate dosage and use precise injection techniques. Patients should avoid rubbing or massaging the treated areas immediately after injection to prevent the toxin from spreading to unintended areas. Serious adverse effects are significantly less common in cosmetic applications compared to therapeutic uses. Additionally, patients should disclose their full medical history, including medications and medical conditions, to their provider before treatment to further enhance safety and effectiveness. 

Yes, Botox® and other botulinum toxin products, such as Dysport®, Xeomin®, Jeuveau®, and Daxxify®, are derived from botulinum toxin, a neurotoxin produced by the bacterium Clostridium botulinum. Though this toxin is naturally potent, its use in medical and cosmetic treatments involves a highly purified, diluted, and carefully controlled formulation, ensuring safety for therapeutic purposes. Botox® undergoes rigorous laboratory processes to sterilize and dilute the toxin, eliminating the risk of botulism and making it suitable for safe application. 

When administered by a qualified healthcare professional like Dr. Azizzadeh, Botox® has a proven safety profile for various cosmetic and medical uses, including synkinesis, facial paralysis, migraines, and more. Its safety is supported by FDA approval for multiple conditions and millions of treatments performed worldwide, with a low incidence of serious side effects. Proper administration techniques, accurate dosing, and adherence to recommended treatment intervals are crucial to maintaining this safety. Although Botox® is technically a toxin, its therapeutic use leverages its muscle-relaxing properties in a controlled manner, providing significant benefits while minimizing risks. 

Botox® treatments are not permanent. The effects typically last 3 to 6 months, and most patients experience results for about 3 to 4 months. This temporary effect occurs as the body gradually metabolizes the botulinum toxin, allowing muscle activity to return in the treated areas. Factors such as age, muscle size, treatment area, dosage, and individual metabolism can influence the duration of results. 

Repeated treatments may lead to slightly longer-lasting effects, with some patients reporting results lasting up to a year between sessions. However, Botox® remains a temporary solution for facial rejuvenation. For those seeking more permanent results, surgical procedures such as face-lifting or facial reshaping may be more appropriate. Consulting with an experienced practitioner like Dr. Azizzadeh can help patients explore both temporary and long-term options to achieve their aesthetic goals. 

Yes, Botox® and other botulinum toxins can be effectively used alongside dermal fillers, and experienced practitioners like Dr. Azizzadeh often recommend this combination for optimal facial rejuvenation. Botox® and fillers complement each other by targeting different aspects of facial aging: Botox relaxes the muscles that cause dynamic wrinkles, such as crow’s feet and forehead lines, while fillers like Juvederm® or Voluma® restore lost volume and smooth static wrinkles in areas like the cheeks, nasolabial folds, and lips. When combined, these treatments provide a comprehensive and harmonious rejuvenation effect, addressing multiple signs of aging simultaneously. 

For example, Botox® can smooth upper-face wrinkles, while fillers can add youthful volume to the mid and lower face, creating a balanced and natural look. This synergistic approach can be further enhanced by incorporating treatments such as RF microneedling (SylfirmX™, Morpheus8™), lasers (DEKA fractional CO2 laser), chemical peels, or customized skincare regimens. However, it’s important to note that some laser and energy-based treatments are best performed separately from Botox® to ensure optimal outcomes and avoid interfering with the neurotoxin’s effects. Consulting with a highly skilled practitioner like Dr. Azizzadeh ensures a personalized, multi-faceted approach to facial rejuvenation that achieves natural, long-lasting results.