What Botox Can Do for You?

Part 1 of 6: Factors that impact what Botox can do for your skin |

Botox can be used for many things (headaches, jaw reduction, excessive sweating, etc.), but the type of Botox therapy discussed here will be limited to cosmetic Botox treatments for reducing wrinkles. Most people think of wrinkles and automatically assume Botox is the best treatment. While cosmetic Botox therapy is very effective, it's important to keep in mind that it is not a miracle worker for all types of wrinkles.

This section discusses three important factors that impact what Botox can do for your skin. It also includes a picture of my mom's before and after Botox treatment to illustrate just what this injectable can do. So, let's begin with Part 1 and find out what exactly Botox does and how it can make you look younger, using my mom's own Botox treatment as a case study.

Botox Before and After Pictures

Botox is one of the most popular facial treatments for anti-aging and wrinkles. It's popular because it works and it works fast. A single treatment can give you immediate results. For real life proof of this, check out my mom's before and after Botox treatment in the picture below:

Botox: Before and After Pictures

Before and after pictures of my Mom's cosmetic Botox treatment

The above pictures were taken one day apart and you can see that there is a lot of improvement in her crow's feet.

(Note: I apologize for my poor photography and lighting skills - her wrinkles look more noticeably reduced than the picture actually shows. She is also smiling as big as possible in both pictures, but for her anonymity, the smile part has been cropped out. You're just going to have to take my word for it that I'm not doctoring the before and after pictures by making her smile big in one picture and smile less in the other.)

Before Botox, the wrinkles near her eyes extended down her cheek and past her nose. After Botox, while there are still some wrinkles, the deep set wrinkles around her eyes and cheeks are gone. As a result, her face has less shadows and looks plumper, fuller, and younger when she makes facial expressions, even though it really isn't. Even when her face is at rest, she looks more relaxed and rested.

Factors that Impact What Botox Can Do

What Botox can do for you and what kind of results you can expect from Botox will depend on the following factors:

  1. What kind of wrinkles you want to fix.
    Botox works for dynamic wrinkles, not static wrinkles. Dynamic wrinkles are wrinkles you get when you move your face, like the lines you get on your forehead when you furrow your brow or the wrinkles you get around your eyes when you smile. Dynamic wrinkles only show up when you make facial expressions, so you don't see them when your face is still.

    Static wrinkles, on the other hand, are wrinkles you have when your face is at rest. These are lines etched in your skin that are there all the time, whether or not you make facial expressions. For example, if you have 11s in between your brows without moving your face, those are static wrinkles.

    Botox works by blocking a muscle from moving, so Botox reduces the wrinkles that form on your face when your face actually moves. If Botox freezes the muscles around a static wrinkle, it wouldn't make that much of a difference in the appearance of that wrinkle since the wrinkle would still be there with or without any muscle contraction. However, with long-term use, Botox can help prevent shallow static wrinkles from growing deeper.

    Botox is more commonly used for wrinkles in the upper area of the face (i.e. forehead, glabellar, eyes), but with a skilled hand, it can be used to reduce wrinkles in other facial regions as well.
    Bottom line: Get Botox to reduce wrinkles in motion, not wrinkles at rest. Don't get Botox for lines deeply etched in your skin. For these static wrinkles, consider facial fillers or skin care (like retinoids) instead.

  2. How much Botox you get.
    Botox is not measured by weight or volume, but instead by unit. When your physician orders Botox from Allergan, it is delivered in an airless vial that contains either 100 Units or 200 Units of vacuum-dried Clostridium botulinum type A neurotoxin complex. This vacuum-dried Botox must be reconstituted (or diluted) with a sterile saline solution before the Botox can be injected into your skin. Some people get Botox injections and have them not work. This might be because the Botox was too diluted and not enough actual Botox was injected.

    The dilution per vial of Botox can vary between 1-10 mL or cc (1 mL = 1 cc) of saline. If you dilute a 100U vial of Botox with 10 mL of saline, it will be 1/10 as strong as a 100U vial of Botox diluted with 1 mL of saline solution. This difference in strength simply means that a physician using a 10 mL dilution will have to inject more product (10x as much) compared to a 1 mL dilution to achieve the same unit dose of Botox. Different dilutions lead to different amounts of Botox per volume injected, so it would be erroneous to assume that all syringes of Botox have the same amount of Botox in them.

    Why doesn't everyone just use the same dilution? Well, different physicians use different dilutions of Botox to achieve different results. Some physicians like to use more diluted Botox on certain areas of the face and more concentrated Botox on other areas that require greater precision. It really depends on the physician's technique, preference, and practice.
    One dilution is not necessarily better or worse than another, as long as enough product is injected to get the proper dosage (or unit) of Botox.

    Remember that when more saline is used (i.e. the Botox is more diluted), you need to inject more to get the same number of Botox units. Injecting more means the Botox can spread to other muscles and cause unwanted side effects. However, this is not very common and can be avoided by selecting an experienced physician. Keep in mind that some less reputable physicians will used diluted or "watered down" Botox to make more money off of you without giving you the proper injection volume, which is what leads to poor Botox results.
    Bottom line: The dosage of Botox will vary depending on what specific areas of your face you want to treat, as well as on your physician's technique. Ask your physician how many units (not syringes) of Botox you will need to get your desired results and make sure you are paying for and getting that many units. Remember, a diluted product is not a bad product as long as you get enough of what you need!

  3. Who is giving you the Botox.
    Where you get your Botox and who does the injecting matters a lot. Aside from the protocols mentioned above (i.e. dilution, storage) that vary across physicians, not all physicians have the same skills and use the same techniques. I took my mom to several doctors for Botox to reduce her eye wrinkles and even though the physicians were all reputable and board-certified, their Botox application was different.

    Before the Botox was injected, my mom's face would be cleaned with some rubbing alcohol (you probably should avoid wearing makeup if you are going to get Botox because they'll just wipe it off). After cleaning, her skin was iced to reduce bruising. Some of the doctors she went to would inject large amounts of Botox in one area. Other physicians would spread the Botox around (for her crow's feet), injecting multiple mini dosages at several different sites. Some of them also used different sized needles. I cannot stress how important it is to get Botox from a good doctor because what Botox can do for your skin will depend on the skills of the injector.

    Not only are the techniques important, the quality of the clinic also matters. Botox should be administered in a medical setting, not at a party or at the mall. Sterile dilution, proper Botox storage, good hygiene, legal use of Botox, and honest practices are all factors that influence the quality of a Botox treatment. You don't want to go to a clinic that uses Botox that is old. It's also important to realize that Botox degrades after being reconstituted and before being injected, so you want to make sure your doctor's office manages your Botox therapy in the most efficient way.

    You want to get Botox from an experienced physician (usually not a nurse) who has been well-trained in facial anatomy and operates clean facilities. Ideally, your Botox injector should have already performed this procedure hundreds of times. You want your physician to be honest and not try to rip you off by getting you to purchase more Botox than you actually need (because this does happen a lot). If you get any sort of inkling during your consultation that something is up with the doctor, trust your hunches and get a consultation from another physician instead.
    Bottom line: As with many things in life, you get what you pay for. So don't get cheaper Botox injections from spas, salons, or the mall. You don't have to pay an arm and a leg, but at the very least, go to a reputable, board-certified physician for the best and safest results. Well-trained dermatologists and plastic surgeons (ENT) are good doctors to consider.

As you can see, there are many factors that affect what Botox can do for your wrinkles. First, your wrinkles have to be a good candidate for Botox (wrinkles that show up when you move your face) or you'll end up disappointed with your results. Second, the dilution of Botox leads to different amounts of Botox being injected, so you want to make sure you are getting the proper amount. Third, different injection techniques can give you different Botox results.

Now that you know the basics about what Botox can do for your skin, continue to the next section to learn how much Botox costs, how long the results last, the effects of long-term Botox use, and whether or not it'll be worth your money.

Last updated: November 15, 2012

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Part 2: How much does Botox cost and how long do results last?