1. Am I a good candidate for this procedure?

You may consider botulinum toxin injections for cosmetic reasons if you are developing lines and wrinkles on your face due to common facial movements. Depending on genetics, lines can appear on the face as early as your late twenties to as late as your early forties. If you are prone to developing lines and to making facial expressions that lead to wrinkles, we may also recommend using botulinum toxin as a preventative measure.

Certain wrinkles or creases in the face caused by the weakening or sinking of the soft tissue, such as the nasolabial folds, which extend from the sides of the nose to the corners of the mouth, are generally best treated with fillers, fat grafts or surgery (although occasionally Botox is used to soften or partially improve them).

If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.

2. What will be expected of me to get the best results?

There are many formulations of botulinum toxin; some are only appropriate for cosmetic use (Botulinum Toxin Type A). Here is a list of both cosmetic and medical conditions that botulinum toxin can help treat:

  • Lines and wrinkles
  • Facial asymmetry
  • Muscle spasticity
  • Eyelid spasms (blepharospasms)
  • Hyperhidrosis or excessive sweating (see perspiration reducer)
  • Chronic migraines
  • Cervical dystonia
  • Movement disorders
  • Crossed or lazy eyes

Dr. Hsu will help you determine which botulinum toxin will be best for you.

3. Where and how will you perform my procedure or treatment?

Botulinum toxin (Type A) is a cosmetic injection that blocks the nerve signals that cause muscles to contract. This effect relaxes and smooths the look of lines and wrinkles caused by repetitive movements on the face—most commonly, between the brows, crow's feet around the eyes, and horizontal forehead creases. Botulinum toxin is also used cosmetically to balance facial asymmetry and relax tight neck bands, as well as medically to reduce perspiration and to treat migraine headaches and muscle spasticity.

Botulinum toxin injections can usually be completed on the same day as the initial evaluation. They do not require hours to perform or days to recover. Once you and Dr. Hsu have decided on an appropriate treatment, he will prepare medication for the procedure. The injection site will be cleansed and will usually not require anesthesia prior to injection though we do offer numbing cream prior to the injection. The needles used are very short and thin, causing minimal pain. Depending on your specific concerns and condition, a number of injections will be needed to achieve the desired result. Slight pain, short-lasting swelling, and minimal redness and bleeding will likely occur as a result of your procedure.

4. How long of a recovery period can I expect?

After the injections you can return to your regular activities immediately; however, strenuous activity is discouraged for the remainder of the day. Redness and swelling that occur at the time of injection usually resolve quickly. Any bruising that might occur will usually resolve over a week or two. Some quick tips for the best results:

  • Avoid massaging or touching the injected area afterwards; this may inadvertently cause the botulinum toxin to spread to an unintended area.
  • Lying down or inverting the body shortly after injection can also cause complications.
  • Avoid strenuous or vigorous activities for the rest of the day.
  • Ask or call the office before taking painkillers or medication.

5. What are the risks and possible complications associated with my procedure?

Although all procedures have some degree of risk, FDA-approved injections of botulinum toxin are relatively low risk in the hands of an expert injector. The most common side effects are:

  • Temporary muscle weakness.
  • Redness, irritation and swelling at the injection site.
  • In rare instances, patients may experience dry mouth, headache, dizziness, nausea and fever.

If you have a symptom that is more serious, such as a rash or trouble breathing, please call us immediately.
You can help minimize certain risks by following our advice and instructions, both before and after your botulinum toxin injection.

6. How can I expect to look over time? What results are reasonable for me?

Depending on your age, skin condition and habits, effects of botulinum toxin could last anywhere from three to six months.

A follow-up appointment in weeks or months may be scheduled after the injection for re-evaluation, touch-up or additional treatments as indicated. You are of course encouraged to schedule your own follow-up sooner if you have any questions or concerns. Because the effect of the botulinum toxin is not permanent, it is best to develop a good relationship with Dr. Hsu and set a schedule for additional injections.