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Botox®, Dysport®, and Xeomin® are similar products containing botulinum toxin used to temporarily paralyze muscles. Botox injections are predominantly used to treat wrinkles or lines created by action of the facial muscles. The injections work by temporarily weakening the muscles that create the specific wrinkles. The three most commonly treated areas are the glabella (between the brows), the forehead and the smile lines at the corner of the eyes. Botox can also be used to elevate the corner of the mouth and smooth the pucker lines in the lips. Botox reaches its maximal effect 10 - 14 days following the injections, and most individuals continue to enjoy the results for three to six months.

When first starting botox treatments, Dr. Heher usually recommends receiving injections every 3 months in order to help keep the muscles in a constant state of weakness. Over time, the muscles will lose strength more permanently and the wrinkles themselves will improve as the body produces collagen that remodels the skin. After a year or two, many individuals note longer lasting effects and are able to increase the interval length between injections to every 6 to 12 months.

The best botox results are achieved when the treatment is carefully designed to treat the exact muscles that have led to aging. Dr. Heher as an oculoplastic surgeon, is able to carefully evaluate your face and customize your treatment. Everyone’s facial muscles work differently and injection sites and dosages will vary. While the goal is that you enjoy your results immediately, Dr. Heher recommends that everyone come back a few weeks after the first treatment for a complimentary visit to “tweak” the injections if need be. She is committed to devising the best treatment plan for you to maximize your satisfaction with your results.

Each area of treatment has its own specific features that require special attention:

Botox to the glabella

Botox injections in the glabellar region are directed at the vertical lines between the brows. The glabellar lines, in general, connote an angry, stearn or stressed expression. Most of us have a single central furrow or two lines, referred to as “11” lines. The dosage of botox injected is dependent on both the length and the strength of the muscles. Botox in this area can also affect the forehead muscle as it extends into the eyebrows. The site of the injections can be adjusted to diminish forehead lines or produce a “maximal brow lift”. The goal of botox in this area is to achieve nearly complete paralysis of the muscles so that there is minimal horizontal movement of the brow during an active frown. Due to the small size of the muscles in this area, most individuals achieve significant long lasting weakness in the muscles if they repeat botox injections every 3 months for a year or 18 months.

Botox to the forehead

Botox to the forehead is aimed at diminishing the horizontal forehead lines created when you raise your brows. These lines create a stressed, tired look, and when softened your appearance becomes more relaxed and well rested. While the goal of botox injections to the glabellar area is to achieve maximal paralysis, most wish to maintain facial expression and thus the forehead muscle is only partially weakened, allowing for a more natural appearance. The placement of injections along with dosing must be precise to achieve the desired result. Great care is taken to avoid the unnatural “Vulcan” or “Spock” look that occurs when botox is improperly injected, creating a sharp arching of the outer portion of the brows that appears very unnatural. The total dosage must also be carefully calculated as “too much” botox to the forehead can lead to drooping of the eyebrows causing the upper eyelids to look heavy and tired appearing.

Botox to the smile lines

Botox injections to the outer eye area is aimed at minimizing the “crow’s feet”, or smile lines extending from the outer corner of the eye that deepen with smiling. Many are self conscious of looking tired and old when they smile. The goal of botox in this area is to carefully weaken the muscles to soften the lines. Placement of the injections down into the lower eyelid towards the cheek must be titrated as botox in this area can be associated with temporary worsening of lower eyelid bags.

Botox brow lift

While most botox treatments are aimed at diminishing wrinkles, specially placed injections can elevate the brow achieving a more youthful appearance. The more youthful brow gracefully arches higher from the nose towards the ear. With aging, the eyebrow “tips” and the outer portion of the brow, “the tail”, droops downward creating a sad, tired appearance. Botox injections can be given along the brow to help restore this graceful arch, achieving the most natural browlift possible.

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