When you smile, laugh, frown, or look puzzled, you contract the muscles of your face. Over time, these contractions produce permanent furrows and deep wrinkles in the skin, especially around the eyes and mouth, between the eyebrows, and on the forehead. These lines can make you look older, sad, angry, or tired. Botox, Dysport, or Xeomin treatments not only prevent these lines from deepening during natural facial movements, they can also erase these marks of aging, leaving you looking younger and more refreshed.


Botox, Dysport, and Xeomin are a family of neurotoxins which capitalize on the powers of botulinum toxin to weaken facial muscles by blocking the transmission of chemicals which tell the muscles to move, leaving your skin smoother and wrinkle-free. It is one of the most popular cosmetic treatments available, administered to over seven million individuals in more than seventy countries.


The injections are used on frown lines, forehead furrows, neck bands, lip lines, and crow’s feet around the eyes. With the utmost discretion, small doses of toxin are injected into your facial muscles to inhibit the nerve impulses that create wrinkles. The injections are performed in the office during your consultation visit. I perform all of the injections via the smallest possible needles which I specially import from Japan.


When injecting Botox it is crucial to use small concentrated doses as to not inappropriately inject the wrong muscle. A dilute concentration can diffuse to non-targeted muscles and affect their function. The dose and target of injection are paramount to preventing an “over paralyzed” face or an under-corrected face where multiple wrinkles still exist. When a very dilute concentration is used, it is possible to paralyze adjacent muscles secondary to the spread of the toxin, this can lead to eyelid ptosis (your eyelid does not fully open). If this occurs, it is transient and usually resolves in a few weeks. Most cases do not have to be treated but in severe cases, alpha-agonist eye drops can be used to reverse the effects of the Botox. After being injected, it is important to not massage the areas treated as deep massage can encourage toxin to travel to adjacent areas. Some physicians recommend avoiding activities which raise your blood pressure or places which raise your body temperature like saunas, spas and steam rooms for a few hours after treatment to help prevent the spread of the toxin.


Any patient who is unhappy with their wrinkles is likely a candidate for injection with the exception of pregnant women, nursing mothers, or individuals with a neuromuscular disease. After a series of tiny injections, you will look rejuvenated.


There is a fundamental difference between Botox and dermal fillers (Restylane, Juvederm, and Belotero). Botox is a neurotoxin derived from Botulinum toxin type A. The toxin temporarily inhibits the release of acetylcholine, preventing the nerve impulses which lead to muscle contraction and wrinkles. Fillers are a category of injectables commonly made of hyaluronic acid that are used to add volume to volume depleted regions of your face, filling deep furrows and lines. As a general way of thinking, Botox works well for the lines above your lower eyelids (crow’s feet on the side of your eyes, glabellar lines between your eyebrows, and forehead wrinkles) and fillers work well for below your lower eyelids (tear trough or junction between your lower eyelid and cheek, cheeks, nasolabial folds or smile lines, lip lines, jowls, and marionette lines).


Many patients have Botox in combination with dermal fillers to address the signs of aging in both the upper and lower face. People have referred to this combination as a “liquid facelift.”


The most common side effect is small bruises from the injections. Some patients are more sensitive to needle sticks than others. If you know that you bruise easily, it is a good idea to stop your multivitamin one week prior to being injected. You should also not take medications that may increase bruising like ibuprofen, Advil, Motrin, or aspirin for one week prior to being injected. Prior to your appointment, it is best to only take Tylenol for pain the week before. Some patients also elect to take arnica for 2-3 days starting the day prior to injection. Arnica is a homeopathic, over the counter remedy that has been shown to decrease bruising. You can buy it at your local health foods store or Whole Foods. It dispensed in very small pellets. You should place three pellets under your tongue to allow them to dissolve three times a day.


There are no serious allergic reactions to Botox so it is not necessary to have a patch test prior to the procedure. Possible side effects include a headache, nausea, flu-like symptoms, redness at the injection site, bruising, pain at the injection site, and droopy eyelids. All of these side effects are transient. Complications are often associated with the non-cosmetic use of Botox and when administered by non-qualified practitioners.


With cut-rate deals on Groupon and other internet sites and the ubiquitous nature of Botox, many patients ask if Botox really needs to be injected by a plastic surgeon or if medical spas, dental offices, and non-cosmetic physicians are an equal but cheaper option. Botox should be administered by a trusted physician or practitioner who has significant training in performing injections. My largest concern with a medical spa is not knowing who is injecting the patient, what type of supervision they have, and what is their training. To become a plastic surgeon, a doctor spends three years learning the art of plastic surgery, the anatomy of the face and body, and specialized techniques that have been proven over time. These three years occur after five years of general surgical training. Being affiliated with an academic institution, I am also exposed to the newest cutting-edge information. Being a plastic surgeon gives me an unusual appreciation for the facial muscles and the skin that covers them as I routinely perform facelifts, necklifts, blepharoplasties, and browlifts.


Botox, Dysport, and Xeomin can also be used to help combat excess sweating or hyperhidrosis in your underarms, hands and feet. I have authored several articles and a book chapter explaining my technique. Treatment with neurotoxins usually lasts for six to nine months when used for hyperhidrosis and has a very high satisfaction rate.

Hyperhidrosis is defined as sweating in excess of what is required to regulate body temperature. As many as 1.3 million Americans are diagnosed with severe hyperhidrosis. These patients are hampered in occupational and social situations, leading to diminished physical and emotional well-being, difficulty in personal relationships and social stigmatization. Neurotoxins have emerged as an important treatment option for patients plagued with focal hyperhidrosis, providing longer-lasting results than topical treatments without resorting to invasive surgical procedures. The toxin temporarily inhibits the release of acetylcholine, preventing the hyperstimulation of eccrine sweat glands that lead to excessive sweating.


If you have been thinking about having Botox injections or learning more, please call our office at (212) 600.4109 to arrange for a consultation. Our New York City practice accommodates out of town and international patients who need to travel in as well as those who are local to Manhattan.

I cannot say enough great things about Dr. Doft! I first met her when I wanted to have a little Botox. I was very nervous and she took a very long time with me to calm my nerves. I have been going to her for the past couple years and this year finally decided to have my eyes done. I felt that my eyes looked tired and my bags were getting bigger. I could no longer conceal them with make-up any more. I had surgery about a month ago and could not be happier. Dr. Doft is skillful, knowledgeable, and has an incredible bedside manner. She made the whole process so easy and I could not be happier with the results! Anyone who is considering having surgery should meet with Dr. Doft first.