As for any surgical procedure, prior to Botox you should not use drugs that can increase bruising. Review the list of medications that you should avoid. You should not have Botox if you are pregnant or if you have any neuromuscular disease, such as amyotrophic lateral sclerosis (ALS—Lou Gehrig’s disease), Lambert-Eaton syndrome, or myasthenia gravis.
Prepare yourself for an assault with six to thirty needle sticks. To do this, you may want to use a cream that numbs the skin. Several are available. I like EMLA cream, which is a mixture of the anesthetics lidocaine and prilocaine. Apply the cream thickly, like cream cheese, onto the skin. Do not let it dry out. To achieve this, you can cover the cream with Saran wrap. (You will look quite attractive when doing this.) The cream must be applied one hour prior to your procedure in order for it to work. Many of my patients come into the office and have my nurse apply the cream; they then sit alone and read until their procedure.
The surgeon removes the EMLA cream and cleans your skin with alcohol. I use gel ice packs to cool the skin, providing a little more pain relief and also shrinking the blood vessels to decrease bruising.
The surgeon administers the Botox. A series of carefully placed injections deliver the toxin directly to the muscle. The zone of action is nearly half an inch on either side of the injection. If placed too low on the forehead, it can spread to the eye muscles and cause double vision and problems moving the eyelids and face. Do not let a technician or nurse inject the drug. Botox is a ‘‘chemoknife,’’ destroying anything it touches. If your surgeon is too greedy to spend ten minutes to inject the Botox himself, find another doctor.
Proper injection of Botox is a true art form. Some patients require complete paralysis of a particular muscle while others just want a weakening of the muscle. Surgeons can ‘‘Botox’’ portions of a muscle, not necessarily the whole thing. They can look at stronger lines on one side of the face and weaken the muscles on that side of the face to create better symmetry.
The end result depends on many factors, including the injected dose. Botox can be used in concentrated or diluted solutions. It is not the amount of solution or the number of injections that is important—it is the number of units used. Botox is ridiculously expensive: I pay more than $500 for a vial of a hundred units. Unscrupulous doctors might use very dilute Botox to stretch out that quantity. Your result will be less profound if a lower dose is used. Beware.
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