The lines that appear between your brows, forehead & crow's feet actually result from muscle movement and the passage of time. When those muscles contract they crease the overlying skin. As the skin becomes less elastic over time, repeated frowning can result in those moderate to severe lines that remain even at rest. image012

BOTOX®  & Dysport work by blocking nerve impulses, which reduces the movement of those muscles. With less movement, the skin surface gradually smoothes out the moderate to severe frown lines of the brows, crow's feet & forehead.

This is a quick and minimally invasive treatment. Your doctor makes a few tiny injections into the muscles that cause moderate to severe frown lines between your brows.

Botox was the first neuromodulator of this class to be approved by the FDA.  It has been used worldwide for over 25 years.  It was initially approved for used in neuromuscular disorders.  Dr Chu initially performed injections in patients with facial assymetry due to Bell's palsy, nerve injury, migraines and spasmodic torticollis.  He has been using it for cosmetic correction of  brow creases, crow's feet and forehead lines since it was approved for these purposes by the FDA.  


How is the procedure performed? 

The treatment consists of several injections of a solution into the targeted muscle groups.  It is relatively painless but a topical anesthetic may be used before injection if the patient desires.  The complete treatment only requires 15-20 minutes. After treatment the patient should refrain from strenuous activity or lying down for 4 hours.  This is to prevent migration of the solution and accidental inactivation of other muscles(e.g. migration of the solution from the brow into the upper eyelid causing "drooping" of the affected eyelid).     

How soon after treatment will I see the results?  

Usually the effects of treatment take 1-2 days to begin and continue to improve for 7 days  

How long will the improvement last?

Visible results intially last up to 4 months.  Dr Chu has noticed that patients who maintain the treatments for 18-24 months without allowing the muscles to regain their pre-treatment activity, do not require retreatment for 6 months or longer.  This is most likely due to a combination of muscle atrophy and loss of muscle memory in certain facial expressions using the targeted muscle groups. If a patient decides to discontinue treatments, the muscles will eventually return to their pre-treatment strength and the creases and lines they cause will return.

What are the possible complications associated with Botox or Dysport treatment?

Treatment with the small doses required for cosmetic use rarely caused problems.  Common problems after injection of Botox or Dysport include redness at the site of injections and mild bruising.  After the initial treatment a mild headache is not uncommon and is thought to be due to the inablility to use muscles of expression of the brow and forehead formerly relied on. These headaches resolve spontaneously in several days.  

Most visible complications result from injector error such as injecting the wrong muscle groups or injecting at the improper depth. It is not uncommon for a patient to remark that Botox or Dysport "does not work"  on them after unsuccessful treatment at another office.  Dr Chu tells these patients that these products are essentially infallible and treatment failure is due to improper injection technique or injecting insufficient amounts of the product.    

Unnatural results following Botox or Dysport treatment

Much more common than complications due to errors in judgement committed by the person performing the injection.  These errors are due to a lack of knowledge of human facial anatomy and the goal or these neuromodulators in restoring balance to the aging face.  Botox and Dysport treatents were designed to be injected by physicians.  However, in most spas, salons, and doctor's offices is now left to nonprofessionals or physician extenders.  Dr Chu has seen a concomitant increase in problems with this occurrence.

The facial musculature is a system of opposing pulleys.  When one set of pulleys is inactivated the opposing set becomes dominant.  This effect is responsible for unnaturally arched brows in many patients after Botox/Dysport treatment.  Other unnatural results include the completely motionless forehead which often leads to "hooding" of the eyes by very low lying paralyzed eyebrows. 

Dr Chu uses Botox and Dysport to restore symmetry, proportion and harmony to a patient's face.  He feels that a "frozen" forehead & expression-less brows should not be the goal of treatment in all patients, especially men.  Too many injectors of Botox & Dysport follow a "cookbook" pattern of injection that result in a patient who cannot express emotion due to the complete paralysis of the upper face.  Dr Chu feels the goal of Botox or Dysport treatment should make a patient look like younger, more healthy, more rested...and not look like a mannequin.