What is a Wrinkle?

Wrinkles (Hyperdynamic Lines) Wrinkles are the most common and usually the first indicator of an aging face. Wrinkles, however, are not a problem confined to older patients. Wrinkles can be due to either skin laxity with loss of tone or over-activity of the underlying muscles. Many factors have been found to compound wrinkling of the facial skin; these include sun exposure, smoking, and poor skin care. These are, of course, additive to the uncontrollable effects of gravity and genetics. Many products and habits can help in reducing these wrinkles. These include good skin care products, the use of sun blocks, and smoking cessation. These, however, cannot stop the activity of the underlying muscles producing the deep wrinkles and folds.

What is a glabellar furrow?

There are Text Box: AText Box: Bmultiple muscles in the forehead and around the eyes that function to give the upper one third of the face character and appearance. These muscles are oftentimes overly active and produce deep furrows (or folds). In the region between the eyebrows, lies a pair of muscles called the corrugator supercilii muscles. These muscles primarily work to lower the inner brows to give the appearance of anger, solemn, or inquisitiveness. These muscles are responsible for the vertical lines that you see in the region between the eyebrows. Botox is the only FDA approved injectable medication used to treat the furrows that are due to over activity of this muscle.

Arrows indicating both glabellar furrows (black arrows) and orbital lines (white lines). Before Botox® Cosmetic (A) and after treatment (B).

Before we go any further...

Find a mirror and look into it closely. You will find that at rest, you have few, if any, wrinkles and that your facial skin may actually look good. Now raise your eyebrows or frown, or smile, or squint your eyes. You now see that there are lines developing that you may not have known existed. These are lines that we like to call hyperdynamic lines, meaning that they only occur with facial movement. These lines were once completely unnoticeable when we were young, but with repeated action, have left permanent marks on the skin. There are two solutions to the problem of thin wrinkles in terms of injectable materials. Botox® Cosmetic is a substance that relaxes the muscles that cause hyperdynamic lines while the filler materials such as Juvederm® and Radiesse™ "fill in" those wrinkles and flatten their appearance.

What is Botox® Cosmetics?

Botox® Cosmetic (Allergan Inc., Irvine, CA) As stated earlier, the aim of Botox® Cosmetic is to eliminate wrinkle lines by temporarily relaxing the underlying muscles.

Botox® Cosmetic is the purified form of Botulinum toxin Type A that is produced by the bacteria Clostridium botulinum. When small doses of this material are injected into a muscle so as to temporarily relax it, there is interference in the action of the muscle, making folds and wrinkles become much less noticeable.

This product is simple to administer with minimal discomfort to the patient. Maximal results are usually seen between three to six days after injection.

Botox® Cosmetic has a usual duration of action of three to four months.

What can I expect on the day of my injection?

When you come in for your injection, you will be seen only by a Double Board Certified Facial Plastic Surgeon. Photographs will be taken and you will visit with Dr. Garcia so that you may have ample time to discuss with him your areas of concern and what you expect from your botox treatment.

Dr. Garcia will have you make several facial animations to properly decipher where the major animation lines are located.

A topical anesthetic is placed on the skin to minimize any discomfort that you would have from the injections.

Several tiny injections of Botox® Cosmetic will be injected into the small muscles of the forehead and around the eyes that are making those deep lines pronounced.

A cold pack is placed directly on the injection sites to help with any discomfort and redness. You can actually return to work right after your treatment!

You may notice a scant amount of redness at the sites of injection, but this will subside by the time you return home.

The whole process takes less than 30 minutes from the time you walk into the consult room!

When Can I begin to see the Results?

You can expect to see some results by the 4th or 5th day after your injections. You will notice a gradual improvement and by one week, what you will see the most is how open your eyes appear to be. Friends and family may comment that you have done something different with your hair or that you are wearing different makeup...

Will I be able to make normal facial expressions?

Botox® Cosmetic does not change the way your face looks at all. To dispell a common misconception, it does not "freeze" your face. It simply prevents certain muscle groups from over acting and thus creating folds in the upper thirds of the face.

How do I know if Botox® Cosmetic is right for me?

The areas that we will address are outlined above. If you are tired of looking tired and do not want to invest neither the time nor the money in a surgical procedure, then this non-surgical, no downtime procedure is just right for you.

A word on who is NOT a candidate.

• Known allergies to Botox® Cosmetic or any of its preservatives
• Pregnant women
• Lactating women
• Eaton-Lambert Syndrome
• Myesthenia-Gravis Syndrome

Before and Afters