Botox Before and After
Botox is used to eliminate the wrinkles in the forehead, brow area, and crow’s feet around the eyes. With Botox, you can achieve a smoother, more youthful appearance without the bruising, swelling, and downtime of invasive cosmetic surgery. We think you will be amazed and delighted to see what Botox can do to rejuvenate your appearance!
At our office, Board-Certified Ophthalmologist Dr. Neal Nirenberg offers state-of-the-art Botox injections. Since the FDA first approved Botox for use around the eyes, Dr. Nirenberg has been perfecting his treatment of lines and wrinkles. He takes the time and interest in each patient to achieve the desired effect.
If you are considering Botox, it’s essential to conduct some research on it. By being well-informed, you can help to ensure the safety of your treatment and your satisfaction with the results. Be aware of precisely what is being used in your treatment, whether the person administering it is qualified, and, last but not least, you need to know if Botox is appropriate for you as an individual.
Botox Cosmetic is a purified protein produced by the Clostridium botulinum bacterium, type A (onabotulinumtoxinA). It is a prescription medicine manufactured by Allergan Pharmaceuticals. Botox is a non-surgical, physician-administered injected treatment that can temporarily reduce moderate to severe crow’s feet lines and frown lines between the eyebrows in adults.
Botox has been used in the field of ophthalmology since the 1980s, and over a million people have been treated with Botox Cosmetic since its FDA approval in 2002. Today, Botox is at the forefront of the ever-evolving field of non-surgical aesthetic enhancements.
This simple procedure, completed in just a matter of minutes, can help restore the youthful appearance of your face. While the results vary according to your unique physiology, they are typically seen within 3-7 days and can last up to 4 months, or even longer. Plus, unlike cosmetic surgery, Botox is safe and virtually non-invasive.
Wrinkle lines form over time due to muscle activity. During treatment, very low doses of Botox are administered via a few tiny injections directly into the muscles that create the wrinkles. Botox works by blocking the transmission of nerve impulses to the muscles. The muscles become paralyzed.
When Botox is injected into the muscles surrounding the brow area, for instance, those muscles cannot “scrunch up” for a period of time. Any wrinkles in that area, often referred to as furrows or frown lines, temporarily go away. The treatment typically takes about 10 minutes, with no recovery time required.
Botox is not magic. It’s medicine. Botox will not radically change your appearance or make you look 20 years younger. Because it’s highly localized and administered into the muscle, its effects are usually confined to the region of injection, and Botox does not remain in your body indefinitely.
Unfortunately, the Botox you receive at one practice may not be the same amount or potency as that at another. The adage is still true: “If it sounds too good to be true, it probably is!” Do not shop for the cheapest price for Botox® treatments. Poor results are not a bargain.
Botox is a medical-grade toxin derived through a safe process that will never cause botulism. However, please consult a reputable Medical Doctor (MD) who purchases Botox directly from Allergan, the manufacturer.
There currently are NO regulations concerning how much dilution solution can be mixed with Botox before it is sold or injected. Many physicians dilute Botox by a significant amount to lower the cost, sometimes at the expense of reducing the effect to nearly zero. Although there is an excellent variation in toxin dilution used by practitioners, in our opinion, this particular aspect of the technique remains crucial: using the appropriate amounts of Botox in very low concentrations of saline solution to reduce side effects while maximizing results.
Dr. Nirenberg mixes your Botox solution himself, ensuring you receive the medically appropriate amount and never get shortchanged. When you receive Botox injections from our office, you can rest assured of getting the absolute most value for your dollar. Minimum dilution means less volume is needed for the results you want – every precious drop works for you.
Dr. Nirenberg prepares and administers your Botox on the same day. No patient of ours ever receives Botox that has been stored for days or even weeks. Though this may not be the most convenient for office scheduling, it assures the maximum and best results for our patients. You can be assured of receiving fresh, high-quality Botox treatments.
Ask the question: “What is your reconstitution ratio?”
Botox is supplied to physicians in a manufacturer’s vial containing a vacuum-dried neurotoxin complex. To inject Botox, a physician must first dissolve the dried material into a liquid form by adding a saline solution. The Botox® can then be extracted from the vial into an injection syringe.
There are 100 units of vacuum-dried Botox in every vial. As shown in the table below, the more saline (in mL) added to the Botox vial, the fewer active units are present in each 1/10 mL extracted into the syringe. Some may refer to this as the dilution process, but it is actually referred to as reconstitution. Now, while each practice receives the identical product from the manufacturer, when they reconstitute it, they can add saline at the recommended standard or add more saline than recommended to “make it go further”.
Recommendations for Reconstitution and Handling*
| Diluent (saline) added to the Botox vial (0.9% sodium chloride injection) |
Resulting dose/ Units per 0.1 (1/10) mL |
| 1.0 mL | 10.0 U |
| 2.0 mL | 5.0 U |
| 2.5 mL | 4.0 U** |
| 4.0 mL | 2.5 U |
| 8.0 mL | 1.25 U |
* Data from the Supplement to Plastic and Reconstructive Surgery, provided by the American Society of Plastic Surgeons.
** Approved dose is four units per 0.1 mL at each of the five injection sites for a total dose of 20 units in 0.5 mL.
You may feel that you are receiving a good dose of Botox because the physician is injecting a large amount, but don’t confuse the units of saline with the units of actual Botox. Physicians who administer more saline than recommended by the manufacturer or the American Society of Plastic Surgery are providing a less effective injection.
Botox is available only by prescription. Botox injections are medical procedures that should be performed in a controlled medical environment by a qualified physician.
The Food and Drug Administration (FDA) has issued warnings about the potential hazards of “Botox parties.” According to the FDA, administering this treatment during a cocktail party greatly diminishes the gravity of this medical procedure. There is always a risk of adverse reactions or side effects after a Botox injection, so patients need to be in a capable medical setting that is equipped to handle such a situation. The ingestion of alcohol at or around the time of injection could worsen any bruising at the injection site.
Botox was initially introduced to the world in the 1980s by ophthalmologists as a treatment for uncontrollable facial and eyelid spasms, as well as for eye muscle dysfunctions, such as strabismus (crossed eyes). As a remarkable side benefit of these treatments, many patients noticed that the wrinkles around their eyes were diminished and began asking for further treatments specifically to achieve this effect.
More than any other medical specialty, eye surgeons are specifically trained to address the eye and the delicate tissues surrounding it, which is precisely where Botox injections are administered. Dr. Neal Nirenberg is Board Certified, with extensive experience in plastic surgery involving the eyes. You can be sure you are in highly skilled hands.
At East Valley Ophthalmology, Botox treatments are performed as an office visit. A fine-gauge needle is used to inject a small amount of diluted Botox under the skin, next to the muscle responsible for creating the targeted wrinkle. The Botox that is injected causes the muscle to relax, softening or removing the wrinkle. Botox treatments are quick, safe, and effective when performed by an experienced physician.
Botox is approved for use in adult patients between the ages of 18 and 65 years.
Botox should not be used by women who are pregnant, might be pregnant, planning to be pregnant soon, or are breastfeeding. Botox should not be used in the presence of infection at the proposed injection site(s) or by any individuals with known hypersensitivity (or allergies) to any ingredient in the formulation.
Patients with neurological disorders such as ALS, Myasthenia Gravis, or Lambert-Eaton syndrome may be at increased risk of serious side effects. Be sure to tell Dr. Nirenberg if you have any diseases that affect your nerves and muscles. These diseases may increase your risk of side effects from Botox treatment.
Be sure that Dr. Nirenberg knows all the medicines you are currently using, including: antibiotics, such as gentamicin, tobramycin, clindamycin, and lincomycin; medicines used to treat heart rhythm problems, such as quinidine; and medicines used to treat different conditions, such as myasthenia gravis or Alzheimer’s disease. You should also tell Dr. Nirenberg if you are taking any over-the-counter medicines or herbal products. This is not a complete list of medicines that can interact with Botox® Cosmetic, so be sure to discuss everything you are taking with Dr. Nirenberg.
Discomfort is usually minimal and brief. The entire procedure takes approximately 10 minutes. Many people return directly to work or their regular activities following Botox treatment.
Within days, you may see a marked improvement in the moderate to severe frown lines between your brows. Lines continue to improve for up to a month, and results can last for up to four months. In clinical trials, nearly 90% of men and women rated the improvement in their appearance as moderate to better one month after treatment. Results may vary.
Results from treatment with Botox typically last two to four months. If you discontinue treatment, the frown lines between your brows will gradually return to their original appearance.
Administered regularly, Botox can help prevent deeper wrinkles from forming.
Although the results are visible, a treatment with Botox will not radically change your facial appearance or make you look as if you “had work done.” After treatment with Botox®, you may look in the mirror and see a marked improvement in the frown lines between your brows. The muscle activity that causes frown lines between the brows is reduced, so you can still frown or look surprised naturally, without the wrinkles and creases between your brows.
Botox is contraindicated in the presence of infection at the proposed injection site(s) and in individuals with known hypersensitivity to any botulinum toxin preparation or to any of the components in the formulation.
Possible side effects include headache, respiratory infection, flu syndrome, temporary eyelid droop, and nausea. Less frequently occurring (<3%) adverse reactions include facial pain, erythema at the injection site, and muscle weakness. These events are thought to be associated with the injection itself rather than the Botox® and occurred within the first week.
Possible but unlikely side effects include:
For detailed information on risks and side effects, please visit BotoxCosmetic.com.
