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botulinum toxin {BOTOX} for treating facial wrinkles
Information provided by American Academy of Ophthalmology (The Eye M.D. Association)


Indication: minimizing the signs of aging

The first signs of aging often appear as wrinkles around our eyes, forehead, cheeks and lips. While wrinkles are normal, defining features of the human face, they can sometimes falsely portray a tired or more aged appearance.
Wrinkles: how do you get wrinkles?
We develop two types of wrinkles on our faces:


We are born with dynamic wrinkles, which are associated with the muscles we use for facial expression. As we continuously use our facial muscles to smile, laugh and squint, mild wrinkles appear when we are young, but they become deeper and more noticeable as we grow older. The most common areas where we develop dynamic wrinkles are around the lips, the corners of the eyelids (where the wrinkles are known as crows' feet), between the eyebrows, and on the forehead. These wrinkles often make people look older and more tired than they actually are. BOTOX can be used to treat these dynamic wrinkles and make them less noticeable.


Crepe-paper wrinkles are caused by sun exposure and aging. As we age or are repeatedly exposed to the sun, collagen (the protein substance found just beneath and within the deep layers of the skin) begins to thin, causing facial skin to stretch and sag. Unfortunately, BOTOX can not treat crepe-paper wrinkles. However, there are other procedures that may be used to reduce the appearance of crepe-paper wrinkles.

How: how does botox work?

Botulinum toxin (brand name BOTOX) is extracted from the bacteria Clostridia botulinum. For years it has been used as a non-surgical treatment for uncontrollable facial spasms and disorders of the eye (such as misaligned eyes). Now it is used as a safe and effective way to reduce facial wrinkles without surgery.

BOTOX is targeted directly at the facial muscles that are causing dynamic wrinkles to form. The BOTOX protein injection blocks transmission from the nerve ending to the muscle. As a result, the skin muscle relax, significantly reducing the appearance of wrinkles and muscles on the skin above that muscle. This blocking effect on the nerves usually lasts an average of three to six months, at which time the muscle regains movement and wrinkles reappear.

Treatment: how is BOTOX administered?

Using a very fine needle, injections of BOTOX are targeted to facial muscles directly.  A topical anesthetic cream may be applied to your skin to decrease the sensation of the injection. BOTOX treatments only take a few minutes and are given during a typical office visit. You should be able to return to your normal activities immediately.

The effects of BOTOX-induced muscle relaxation begin to occur within about three days. By the end of the first week, you will probably notice a significant reduction of fine lines and wrinkles around the treated areas. Repeat injections of BOTOX may be given after the effects wear off.

Candidates: are you a good candidate for BOTOX?

The best candidates for BOTOX treatments are people who are physically healthy, with no history of neuromuscular disease (such as multiple sclerosis or myasthenia gravis), not pregnant or nursing, and who are at least 18 years old.

Some people who should not have BOTOX treatments include those with:

  • existing weakness in the targeted muscles;
  • ptosis (drooping eyelids);
  • deep facial scars;
  • very thick facial skin;
  • marked facial asymmetry;
  • skin disorders around the planned injection sites.

You should inform Dr. Pak of your medical history and all medications, vitamins and/or herbal supplements you are currently taking before having BOTOX treatments.

It is important to remember that the level of improvements in the appearance of wrinkles after BOTOX treatments can vary among patients. Some people respond better to BOTOX than others. Occasionally there is little improvements and another form of treatment may be recommended. It is important to discuss your situation and your expectations with Dr. Pak.

Risks: understanding the risks, complications and side effects.

Side effects and complications include but are not limited to:
  • Bruising
  • Under correction (not enough effect) or overcorrection (too much effect)
  • Facial asymmetry (one side looks different than the other)
  • Paralysis of a nearby muscle leading to: droopy eyelid, double vision, inability to close eye, difficulty whistling or drinking from a straw
  • Generalized weakness
  • Permanent loss of muscle tone with repeated injection
  • Flu-like syndrome or respiratory infection
  • Nausea or headache
  • Development of antibodies to BOTOX
  • BOTOX contains human-derived albumin and carries a theoretic risk of virus transmission. There have been no reports of disease transmission through BOTOX.

More serious complications are rare but possible. There is a chance that non-targeted muscles could be affected and weakened. This could cause dropping of the eyelids (ptosis) if BOTOX seeps below the eyebrow and into the muscle that controls eyelid function. Though the effect is not permanent and will eventually go away as BOTOX wears off, dropping eyelids may temporarily obstruct your ability to see.

In order to help reduce the possibility of side effects, you may have to use lubricating eyedrops, gel or ointment for a period of time after treatment. You may also be instructed to:

  • Sit upright and do not lie down for at least four hours after treaatment.
  • Avoid pressing on or massaging the treated area for four hours.
  • Avoid exercising for 24 hours following treatment.

Please call to schedule your BOTOX treatment today!
Most Insurance plans will not cover BOTOX treatment.

Copyright 2005 Wanda Pak, M.D., P.C. Designed & Developed by Ali Sadeghi