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Top 5 Things You Must Know About BOTOX®

With the advent of several new competitors to Botox, I’d thought I’d review some top things to know about Botox.  Botox was the first botulinum toxin to be used for cosmetic uses, and they still have a dominant hold on the neuromodulator market.  Now new botulinum toxin competitors like Dysport from Galderma, Xeomen from Merz, and the newest one Daxxify from Revance offer patients more choices.  However, all of these products act via the same mechanism, where the product blocks the signal from your nerve to the target muscle.  So you don’t have to consciously think about not moving your muscles…the muscle are weakened by the neuromodulator.

Believe it or not, botulinum toxin, or Botox®, as it is now commonly known, is a naturally occurring protein.  Although these naturally occurring proteins are widely known as toxins, they are better and more accurately described as neuromodulators.  Botulinum neuromodulator is produced by the bacterium called Clostridium botulinum.  When used medically, only the neuromodulator molecule is injected, never the bacteria itself.

Once injected, the botulinum neuromodulator exerts its effect by blocking the action of a signaling molecule, let’s call it “A.”  (for acetylcholine).  Molecule “A” normally stimulates a muscle to move, but since it is never released, the muscle can’t move. Over time the body naturally breaks down the protein. This all sounds scary, but the process of how botulinum toxin works has been heavily studied and published in the medical scientific literature. When used appropriately, Botox® injections can be quite safe.   

Now that we know how Botox® works, what are the 5 most important things you need to know about when considering BOTOX® cosmetic injections:

1. You will not stop breathing or contract botulism from your treatment.

When Botox® is used for cosmetic reasons the dosage does not come close to the amount needed to be considered a toxic dose. You would need to inject 2800-3000 units to reach a toxic level, and that is 28 or 30 vials! Needless to say, this is an excessive and expensive dosage!

2. You may develop some bruising.

The only way Botox® can be delivered for cosmetic surgery procedures is with a needle, so there is a risk of getting a bruise from Botox®. However, these bruises are typically very small and can easily be covered with makeup or concealer.

3. You should not exercise for up to three hours after your injection.

Botox® is transported as a powder and is reconstituted with sterile saline or lidocaine, a numbing medication. It is precisely placed in planned injection spots, and the goal is for the Botox® to stay roughly in these areas.  Although I don’t restrict patient’s activities after Botox® injections, it’s best not to exercise or lie flat in the immediate hours after treatment.  When you exercise or lie flat this can change the blood flow to these areas and may cause migration of the molecule.  You should also avoid massaging the injected areas after treatment.  This may also introduce a very small risk of migration of the protein to unintended areas.

4. You can wear make up immediately after your treatment

There is very little risk of infection after a Botox® injection. Ideally, if you can wait a couple of hours before putting on makeup, that would be ideal.  But in reality, there is no problem to use  make up after a Botox® treatment, as there can be a little bit of redness after an injection. I see many women and men over their lunch hour and a little camouflage can be helpful in the office.

5. There is a risk of developing a drooping eyelid.

In experienced hands, there is a very small risk of developing a drooping eyelid, and is due to migration of the neuromodulator to eyelid muscles.  However, this tiny risk is much higher if an inexperienced injector does the treatment.  Patients are also concerned about the risks of getting a drooping eyebrow.  If you visit a licensed physician who has been trained appropriately and does an individualized evaluation of your facial structure, with your heredity in mind, this risk can be easily avoided!

Regardless of whom you see for your first or thirtieth injection of Botox®, remember you have the right to have all of your questions answered. You should feel comfortable with your injector and his or her explanation of the process. If you are looking to consult with a board-certified cosmetic surgeon with an expertise in filler injections or are suffering from an unhappy Botox®-job, give Dr. Kenneth Yu of Dr. Kenneth Yu Plastic Surgery located in San Antonio, Texas a call at (210)-876-6868, email or, or read through to schedule a consultation.