BOTOX® Injections Treatment Questions and Answers

Question:

I just had a baby one month ago and I'm breast feeding. Can I get botox injections in my face if I'm breast feeding?

Answer:

Dear Renee, Although all of the toxin is bound locally, I would suggest that you stop breast feeding for two days following a Botox injection.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

What do you know about "neck banding"? Is botox used for this?

Answer:

Dear Deborah, Vertical neck bands are caused by a division between the large platysma muscle which supports the skin and soft tissue of the neck. The best repair for this is directly reappoximating this muscle with or without an associated removal of excess skin and resuspension of it (facelift). If surgery is not desired, the central muscle can be weakened with botox so that the bands do not stand out so definately. After performing the botox procedure a number of times, both my patients and myself do not think that it helps very much ( maybe 10 to 20% ).

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

I just recently got Botox injections. I have this done 3 other times. But this time I felt alot of pain and swelled up every where she injected the botox it did not have any of the right effects and now a week later I can feel small lumps under the skin where she injected the botox I believe the stuff was bad and Im worryied about long term effects. Thank you, Polly

Answer:

Dear Polly, You may be having a reaction to the Botox although this is very rare. I doubt you will have any long-term effects from it. See what it does over the next few weeks and if it does not improve, revisit your physician.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

What it the consensus of opinion for the use of Botox in treating TMJ pain and tight muscles caused by very hard gritting during sleep?

Answer:

I am not familiar with the use of Botox in treating TMJoint dysfunction.

Question:

Is hair loss a side effect of botox injections? I've had just one appt. two weeks ago and my hair loss is alarming.

Answer:

Dear Kat, I cannot imagine any theoretical or real relationship between the two and I have never read anything associating the two.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

Where can I find the cheapest botox injection?Thankyou.

Answer:

Dear Jen, Perhaps you should ask where can I find the best and safest Botox injection. It was reported in the last two issues of Plastic and Reconstructive Surgery the Botox injections caused prolonged paralysis of the entire side of one woman's face and the drooping of the lower and upper lid of another woman. This paralysis could last 4 to 6 months. I would think that the difference between $250 and $300 would matter little in this light. You should call around to the different offices of dermatologists and plastic surgeons in your area to find the best prices. Be sure to ask about complications as well.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

Thank you for your information.My hope is that the botox will have softened the lines and broken my frown habit by the time I have the brow lift or facelift.My two year divorce goes to trial next month and an unreadable face is an asset! My Restylane injections were performed in NYC.My doctor gets the Restylane from Canada.They are injected in the nose lines and in my chin around the lower lip where there are lines from sun damage.

Answer:

The botox will help with facial expressions but the long-term cure of removing the minor muscles of frowning should be done at the time of the brow lift. Be careful using non-FDA approved drugs since you would not be covered in any way from long-term possible complications.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

I have been using restylane and botox for 6 months with good results.I am considering a facelift.Do the botox and restylane interfere with the surgery?Thank you.

Answer:

Dear Lainie, I would suggest that you consider a brow lift so that you no longer require the botox injections. These should have no interference with face or brow lift procedures. The restylane is a different story. As long as a large amount been injected for a long time, there should be little problem as long as the surgeon stays very deep to the plane where it is present in your skin. There can be problems with infection and extrusion after the procedure with areas so treated. I thought that Restylane was only available in Canada so far?? Where did you have the injections performed.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

I am interested in having botox injections in the lower half of my face to eliminate the frown lines on the sides of my mouth. Is this procedure successful and can you recommend a MD in my area?

Answer 1:

Like lots of things in cosmetic surgery, you can probably find somebody to perform what you want. Very few plastic surgeons I know will inject botox in the lower perioral area for fear of smile muscle paralysis. I won't inject around the mouth for fear of having a paralyzed smile.

Answer 2:

Dear Susan, Botox is not useful for the animation facial muscles at the sides of the mouth. You do not want to paralyze the major muscles of the face. Sometime, small amounts can be injected into the upper lip or lower lip areas to help with constant frowns or some wrinkles but not for the folds that you describe. They can be corrected by surgeical procedures.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

How much Botox is needed for an injection between the brows? Is one cc enough? What is a cc? Approximately what is the average cost of this injection to this area? If injected in the forehead, will the eyebrows fall?

Answer:

Dear Nancy, The amount is actually relatively unimportant since the Botox injection is made-up by the person doing the injecting. Each vial contains 100 units of the toxin. For most people, about 20 units is all that is necessary for long-term paralysis of the muscles. Most of us make the volume to contain that amount about 0.5 or, at most, 1.0 cc. If the volume is too large, not only does it hurt more to do the injection but there is also more risk to the Botox migrating to where it is not wanted or needed (usually the levators of the upper eyelid leading to drooping eyelids for a few months). Most of us have an intrinsic tension on the muscles of the forehead (like the muscles elsewhere) and if completely paralyzed, the brows will fall. Most of us to paralyze the forehead, however do so to only a limited extent, ie. where the wrinkles are most prominent. No one wants an inanimate forehead. For severe wrinkles and to permanently remove the frown muscle, a brow lift is the procedure of choice.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

when I was in Hawaii, I had botox injected in my forehead and upper lip. It took twice to have it be great, but I loved it. Now I'm in New York City and it's four months later and I want to get injected again, but none of the doctors I've come across here will inject in the upper lip. I can't imagine why, it worked so great and erased those awful purse lines. Do I have to go all the way back to Hawaii to find a doctor?

Answer:

WAS THE DOCTOR IN HAWAII A BOARD CERTIFIED PLASTIC SURGEON? MOST PLASTIC SURGEONS I KNOW WILL USE BOTOX IN THE FOREHEAD, BETWEEN THE EYES, AT THE CROW'S FEET AREA. I DO NOT INJECT THE UPPER LIP. I CAN'T SPEAK FOR MY COLLEAGUES WHERE I PRACTICE, BUT I DO NOT THINK THAT THEY INJECT THE UPPER LIP ALSO. DID YOU KNOW THAT YOU CAN PARALYZE THE UPPER LIP FUNCTION FOR UP TO SIX MONTHS WITH AN INJECTION TO THE UPPER LIP?

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