BOTOX® is the most popular injectable in the world, effective in the use of smoothing dynamic wrinkles and fine lines caused by repetitive muscle movement. Botox temporarily relaxes the facial muscles where it is applied blocking signals from the nerves to the muscles.

BOTOX® has been proven effective with more than 16 years of cosmetic use, and 30 years meeting FDA quality and safety standards, since it was first introduced for therapeutic use in 1989. Over 100 million vials of BOTOX® have been distributed globally.

Botox® for Cosmetic Use: Botox neurotoxins are injected in microscopic doses into certain small muscles that are used in facial expression (furrowing the brow, smile lines around the eyes or frown lines between the eyes).  These muscles are tiny muscles that relax as the Botox neurotoxin inhibits the muscle from firing.  Relaxing the facial muscles will soften the expression lines and over time the habit is broken of making that frequent expression therefore the furrows, frowns and deep expression lines get more relaxed over time 

Botox® for Medical Use: Botox neurotoxins are injected into larger skeletal muscles for specific medical conditions. Performed by physicians. 

1. Botox injection into the masseter muscles of the jaw for treatment of Bruxism (which is jaw clenching and grinding of teeth).  Bruxism causes problems such as ground down teeth, broken teeth, jaw pain, temple pain and headaches.  Wearing a night guard on the teeth can protect the teeth from grinding down, but does not get to the root cause.  Botox interrupts the unconscious habit of clenching the jaw muscle while asleep, which breaks the habit of clenching and grinding.  The benefits of Botox can last for 3-4 months or longer.  Typically when the Botox wears off and the habit of clenching resumes, the degree of clenching and grinding is less intense.  Patients are recommended to repeat the medical Botox injection if symptoms return.  Many patients have broken the habit of clenching and grinding altogether with Botox injections in the masseter muscle
2. Botox injection into hand muscles for hand contractures in neuromuscular and degenerative conditions such as Cerebral Palsy. 
3. Botox injection into posterior neck muscles for headaches from occipital neuralgia. 
4. Botox injection into head, scalp & temple muscles for Migraine headaches.  

Most people’s Botox injections will last 3 months. 

Since Botox blocks neurotransmitters from the brain, it takes some time for the full effects of the first injections to take place: sometimes up to two weeks. Early results tend to be seen in the first two or three days, and most have full effect within 5-7 days after injections. 

Cosmetic Botox is FDA approved for use on: 

Forehead wrinkles 

Eyebrows 

Eyes – crows feet/laugh lines 

Neck cords – platysmal bands 

Medical Botox is FDA approved for use on: 

Neurologic conditions – Muscle contractures 

Bruxism – Muscle contractures from clenching and grinding and jaw pain 

Migraine Headache – Muscle contractures leading to pain 

Cosmetic Botox is NOT FDA approved  for use on: 

Lip lines/smokers lines (*off label-not FDA approved) 

Bunny lines/upper nose (*off label-not FDA approved) 

Frown lines at corners of mouth (*off label-not FDA approved) 

Chin (*off label-not FDA approved) 

Nasolabial folds (*off label-not FDA approved) 

Off-label is a term that describes use of Botox in a non-FDA approved area.  

If you are getting Botox in an area that is not FDA approved, then the safety has not been proven and the protocol for treatment has not been established.  This is experimental and considered risky. 

Off label use is legally performed by physicians only and the physician must be performing the off label treatment within the scope of their specialty. Off label use of Botox is not legally performed by RN or nurses, PA’s or physician assistants or NP’s nurse practitioners as their licenses do not support “off-label” use for any reason. 

There are many low level/mid level providers crossing the legal lines by performing off-label treatments even though their medical license does not support this.  Patient must be informed and remain cautious as safety and standardized protocols do not exist for off label use. 

FOREHEAD:  Standard treatments for forehead range from 12 units to 35 units of Botox, depending on strength of muscles, age of the patient and how long the patient has been using Botox. 

EYES: Standard treatments around the eyes vary from 10 to 20 total units of Botox. 

NECK CORDS OR BANDS:  Standard treatments vary greatly because of length and number of platysmal bands vary.  Each band inserts under the jaw at the top and into the clavicular area at the bottom.  The area treated is treated according to where the visible tension is found.  Neck bands can range from 15 to 65 units. 

Like any medical procedure, getting a Botox injection starts with a conversation between doctor and patient. The doctor will discuss the desired objectives from the treatment, potential risks and side effects, and medical history. 

Each injection site is carefully cleaned and the Botox is injected from individual customized tiny syringes into the muscle groups that are causing wrinkles in the forehead and around the eyes. 

The types of needles used by doctors during Botox injections are extraordinarily thin, and cause as little discomfort as possible. The low level of pain, coupled with the fact that the procedure itself can take less than fifteen minutes in the hands of an experienced professional, makes this a very common outpatient procedure.