On July 29, 2016, Food and Drug Administration (FDA), of the United States of America approved abobotulinumtoxinA for injection for the treatment of lower limb spasticity in pediatric patients two years of age and older.[20] AbobotulinumtoxinA is the first and only FDA-approved botulinum toxin for the treatment of pediatric lower limb spasticity. In the United States of America, the FDA approves the text of the labels of prescription medicines. The FDA approves which medical conditions the drug manufacturer may sell the drug for. However, those approved by the FDA to prescribe these drugs may freely prescribe them for any condition they wish, called off-label use. Botulinum toxins have been used off-label for several pediatric conditions, including infantile esotropia.[21]
Lastly, a Botox treatment does not offer permanent results. Botox is most effective when treatments are carried out at regular intervals before the results fully wear off. On average, the results last for three to four months,  although Botox metabolizes at different rates in different individuals. The first ever Botox treatment you receive may not last as long as subsequent treatments, plus you may require touch-ups two weeks after the procedure as your injector determines the right dosage for you. Over time, however, many patients notice that they can wait longer intervals between treatments as their treated facial muscles weaken.
The cost of a Botox treatment is usually communicated as a flat cost, but can also be measured in individual injectable units. Each unit usually costs somewhere in the neighborhood of $15, but prices vary between geographic areas and between individual clinics. How many units are needed per treatment will depend on which areas of your face are being treated, and on your individual facial anatomy.
Botox has also been shown to prevent chronic migraines, but there, it's unclear exactly why Botox works. (For doctors, reaching a firm understanding of how Botox prevents migraines will be tricky, since they don't know for certain what causes the severe headaches in the first place.) "There were multiple clinical trials for migraines, and most of them failed," says Dr. Mitchell Brin, senior vice president of drug development at Allergan and chief scientific officer for Botox. "It took a long time to figure out where to inject and how much." Today people who receive Botox for migraine prevention get 31 injections in different spots on their head and neck. The effects of Botox can last about three to six months depending on the condition.

The potency Units of BOTOX (onabotulinumtoxinA) for injection are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, units of biological activity of BOTOX cannot be compared to nor converted into units of any other botulinum toxin products assessed with any other specific assay method [see WARNINGS AND PRECAUTIONS and DESCRIPTION] .
Postmarketing reports indicate that the effects of BOTOX® and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These may include asthenia, generalized muscle weakness, diplopia, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence, and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening, and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity, but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have an underlying condition that would predispose them to these symptoms. In unapproved uses, including spasticity in children, and in approved indications, cases of spread of effect have been reported at doses comparable to those used to treat Cervical Dystonia and spasticity and at lower doses.

In fertility studies of BOTOX (4, 8, or 16 Units/kg) in which either male or female rats were injected intramuscularly prior to mating and on the day of mating (3 doses, 2 weeks apart for males, 2 doses, 2 weeks apart for females) to untreated animals, reduced fertility was observed in males at the intermediate and high doses and in females at the high dose. The no -effect doses for reproductive toxicity (4 Units/kg in males, 8 Units/kg in females) are approximately equal to the maximum recommended human dose of 400 Units on a body weight basis (Units/kg).

The average price for Botox in the Houston area is $14-15/unit. Most providers nowadays will offer specials. In addition, Botox has a "rewards" program that gives you $25 off each treatment done within 3-6 mos of the last treatment, as long as it's done at the same office. Treatment of the glabella, crow's feet and forehead require 25-50 units, depending on the severity of the lines.

In a long term, open-label study evaluating 326 cervical dystonia patients treated for an average of 9 treatment sessions with the current formulation of BOTOX, 4 (1.2%) patients had positive antibody tests. All 4 of these patients responded to BOTOX therapy at the time of the positive antibody test. However, 3 of these patients developed clinical resistance after subsequent treatment , while the fourth patient continued to respond to BOTOX therapy for the remainder of the study.


Around The Eyes – It is common to see wrinkles and creases around your eyes, as the muscles around your eyes are constantly contracting when you talk or smile. The crow’s feet that have formed on the corner of your eyes can be effectively reduced with the help of Botox.  Moreover, a Botox can help diminish the fine creases that have formed under your eyes.
Still, there have been enough concerns that the FDA instituted a REMS (Risk Evaluation and Mitigation Strategy) requirement for all botulinum toxin preparations that specifically addresses the issues of distant spread of the toxin and the risk of problems, leading to death, from swallowing or breathing issues in certain patients who may be susceptible after botulinum toxin treatment. All products, including Dysport, Myobloc, Xeomin, and Botox, are monitored via this strategy. This is specifically aimed at a certain population of patients receiving more than the usual doses of botulinum toxin and not aimed at the casual user of Botox, per se.
Since then, several randomized control trials have shown botulinum toxin type A to improve headache symptoms and quality of life when used prophylactically for patients with chronic migraine[88] who exhibit headache characteristics consistent with: pressure perceived from outside source, shorter total duration of chronic migraines (<30 years), "detoxification" of patients with coexisting chronic daily headache due to medication overuse, and no current history of other preventive headache medications.[89]
The trapezius muscle is a large, triangular, superficial muscle. It attaches proximally in the medial third of the superior nuchal line, external occipital protuberance, nuchal ligament, and spinous processes of the C7-T12 vertebrae. Distal attachment of the trapezius occurs at the lateral third of the clavicle and acromion and spine of the scapula. The action of the muscle includes neck extension and stabilization of the scapula and support for the arm. The muscle fibers proximal to the inflection point of the neck (ie, necklace line) run vertically and are involved with neck extension. According to the PREEMPT injection paradigm, one injection of 5 units of onabotulinumtoxinA to each of three sites on either side of the trapezius, for a total of 30 units divided across six sites, is given. The first injection site can be identified by visually dividing the upper portion of the trapezius muscle in half, from the inflection point of the neck (ie the necklace line) to the acromion (acromio-clavicular joint); the midpoint of this location is where the injection should be administered. The second injection is located at the midpoint of the first injection site and the acromion. The third injection should be administered at the midpoint between the first injection site and the necklace line. Injections should occur in the supraclavicular portion of the muscle, lateral to the neckline, and medial to the deltoid and the acromio-clavicular joint. The injections into the trapezius should be administered horizontally and superficially to avoid injecting too deep.
As with the injection of any medication, your body's immune system can develop antibodies to the medication, which render the drug less effective or possibly cause development of an allergy to the drug. The more frequently the drug is injected or the more quantity that is injected, the higher the risk for these antibodies to be formed against the drug.
There have been spontaneous reports of death, sometimes associated with dysphagia, pneumonia, and/or other significant debility or anaphylaxis, after treatment with botulinum toxin. There have also been reports of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal outcomes. Some of these patients had risk factors including cardiovascular disease. The exact relationship of these events to the botulinum toxin injection has not been established.
Lalvani previously worked in organizations dedicated to diabetes, breast cancer and kidney disease, but strongly identifies with our community because she is living with migraine. She recalls first getting what she thought were terribly debilitating headaches when she was 18. “I had no idea what a migraine was,” she said, “and I never saw anyone around me have a migraine, so I had no idea what I was dealing with, and no one else around me knew what I was dealing with.” Lalvani is excited to see the progress that’s been made recently in migraine care and the tremendous effort that AMF has put forth in helping advance research to produce therapies at a faster rate. As you know, the mission for AMF is to drive and support impactful research that translates into treatment advances as well as mobilize the community for patient support and advocacy.
Botulism is an illness caused by a neurotoxin produced by the bacterium Clostridium botulinum. There are three types of botulism: food-borne, wound, and infant. Symptoms include muscle paralysis, dry mouth, constipation, slurred speech, and blurred vision. If food-borne and wound botulism are detected early enough, they may be treated with an antitoxin. Infant botulism is treated intravenously with BabyBIG (Botulism Immune Globulin).

In a recent Facebook Live, our new director Nim Lalvani introduced herself to the migraine community. If you missed our Facebook Live, watch the recording below or read on to learn more about Lalvani’s personal connection to migraine and her plans for the Foundation. [embed]https://www.facebook.com/americanmigrainefoundation/videos/290329171553466/[/embed] In the short time that Lalvani has worked at AMF, she’s been impressed by the strong and vibrant community of doctors, patients and advocates. Lalvani’s background is in public health, and she has dedicated her career to patient engagement. She has worked in the nonprofit and patient advocacy spaces for more than 12 years, helping patients at both the national and international level. “I've specifically focused my career on designing and providing the rights tools and resources for patients at the times that they need it most,” she shared, adding that her goal is to amplify patients’ voices in research and therapeutic development.
Just because not every cosmetic Botox procedure is FDA-approved doesn't mean it's not safe and effective, if done properly. Off-label procedures are still within the standard of care, and there are tons of them. “There are so many non-FDA-approved applications for Botox,” says dermatologist Dendy Engelman, MD. “It can be used to decrease scalp-sweating (which helps prolong blowouts), correct a droopy nasal tip (called nasal-tip ptosis), fix brow asymmetry, minimize bunny lines from wrinkling your nose, decrease skin oiliness, minimize the appearance of pores...” The list goes on and on.

Unremarkable. I mean, that’s a good thing in the MRI-reading world, but I’d like to say my brain is freakin’ remarkable sometimes. Maybe I’m biased. Anyways. Shortly after those tests, the Botox arrived at the office and I was scheduled for my injections. To say I was scared is putting it lightly. Like I mentioned before, I have a complete irrational fear of new medication. Also, I didn’t want my face to look different! So I documented my wrinkles just to see how many would last (if you want, be my guest to check out my embarrassing video). I didn’t have to wait long and before I knew it, I was in a room with my mom, my boyfriend, a neurologist and three needles.

Tell your doctor about all your medical conditions, including if you: have or have had bleeding problems; have plans to have surgery; had surgery on your face; weakness of forehead muscles; trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; are pregnant or plan to become pregnant (it is not known if BOTOX® can harm your unborn baby); are breastfeeding or plan to (it is not known if BOTOX® passes into breast milk).
Children do very well after having this procedure in our clinic and are not upset when they leave. We rarely use sedation. We use distraction and a quick injection method instead. In rare cases, localization of a muscle may be needed using an electromyograph (EMG) machine or electric stimulator. If this is needed we will discuss this before scheduling the injections.
But it could be something else altogether. In 2008, Matteo Caleo, a researcher at the Italian National Research Council's Institute of Neuroscience in Pisa, published a controversial study showing that when he injected the muscles of rats with Botox, he found evidence of the drug in the brain stem. He also injected Botox into one side of the brain in mice and found that it spread to the opposite side. That suggested the toxin could access the nervous system and the brain.
There are no limits on therapy or activity after the session. For patients that don’t normally use a device to help them walk, at first it may seem like their walking has gotten worse. They need some time to get used to the feeling of the sudden change in the way their muscle contracts when they walk. This most often improves quickly over one to two weeks. Some very young children may have discomfort in their heel cord from rapid stretching. The child may limp or refuse to put weight on it. Again, this most often resolves quickly in the first week.

Lalvani previously worked in organizations dedicated to diabetes, breast cancer and kidney disease, but strongly identifies with our community because she is living with migraine. She recalls first getting what she thought were terribly debilitating headaches when she was 18. “I had no idea what a migraine was,” she said, “and I never saw anyone around me have a migraine, so I had no idea what I was dealing with, and no one else around me knew what I was dealing with.” Lalvani is excited to see the progress that’s been made recently in migraine care and the tremendous effort that AMF has put forth in helping advance research to produce therapies at a faster rate. As you know, the mission for AMF is to drive and support impactful research that translates into treatment advances as well as mobilize the community for patient support and advocacy.
Even if Botox's mechanism isn't always well understood and some of its off-label uses are still unproven, interest in the drug isn't likely to wane. "Botox is a big cash cow for the physicians' practices," says Ronny Gal, an investment analyst at Sanford C. Bernstein who has watched the drug closely for more than a decade. "When I talk to physicians, they say, 'Botox is not a problem. It works and gives you the result you want.' If it works for depression and atrial fibrillation, it could be massive."
The number of headache days determines whether the patient has episodic migraine (EM) (14 or fewer headache days a month) or CM (more than 15 days of headache a month). The best method of determining the actual number of headache days is to subtract this from the number of completely headache-free days in a month. If headache is present on more than half the days in the month, and there are migraine features on at least 8 days a month, the condition is termed CM. The migraine features only have to be present on 8 days out of the month and not on every headache day. The other headache days in this condition are considered to be milder forms of migraine, and they do not have all the typical migraine features. If headache is present on fewer than 15 days a month, this is referred to as EM. EM can transform to CM over time. If analgesics are used on 10 or more days per month, this can lead to a transformation to CM. The patient’s headache pattern over a 12-month period should be determined, and during this time, there should be at least 3 months with 15 headache days; 8 of these days should meet migraine criteria.1-3
A migraine requires only two of the following headache features: a unilateral distribution (one-sided), pulsatile quality (throbbing), moderate or severe pain (more than 5 out of 10), and aggravation by physical activity (such as bending over). In addition, to diagnose migraine, only one of the following is required: nausea or vomiting or sensitivity to light and noise.
In clinical trials, 30.6% of patients (33/108) who were not using clean intermittent catheterization (CIC) prior to injection, required catheterization for urinary retention following treatment with BOTOX® 200 Units as compared to 6.7% of patients (7/104) treated with placebo. The median duration of postinjection catheterization for these patients treated with BOTOX® 200 Units (n = 33) was 289 days (minimum 1 day to maximum 530 days) as compared to a median duration of 358 days (minimum 2 days to maximum 379 days) for patients receiving placebo (n = 7).
With the outbreak of World War II, weaponization of botulinum toxin was investigated at Fort Detrick in Maryland. Carl Lamanna and James Duff[42] developed the concentration and crystallization techniques that Edward J. Schantz used to create the first clinical product. When the Army’s Chemical Corps was disbanded, Schantz moved to the Food Research Institute in Wisconsin, where he manufactured toxin for experimental use and generously provided it to the academic community.
“Your doctor still has to be willing to do the work of filing a waiver and they don’t get reimbursed for that work, so they don’t like to do it,” Hoffman says. Plus, there’s a federal law called ERISA that exempts certain types of employer-provided health plans, called self-funded plans, from the requirements of state laws. So, for roughly a quarter of Americans who have these health plans, the state limitations to step therapy don’t apply.
Botulinum toxin exerts its effect by cleaving key proteins required for nerve activation. First, the toxin binds specifically to nerves which use the neurotransmitter acetylcholine. Once bound to the nerve terminal, the neuron takes up the toxin into a vesicle. As the vesicle moves farther into the cell, it acidifies, activating a portion of the toxin which triggers it to push across the vesicle membrane and into the cell cytoplasm.[1] Once inside the cytoplasm, the toxin cleaves SNARE proteins preventing the cell from releasing vesicles of neurotransmitter. This stops nerve signaling, leading to paralysis.[1]
Once the protein stops functioning at the neuromuscular junction, it is broken down into its harmless components (amino acids) and either recycled for use in other proteins or excreted by the kidneys. "The bigger the muscle, the quicker you'll see motion return," says Rowe. "Likewise, the smaller the muscle, the longer the effect of botox lasts." It doesn't have a tolerance effect, either—your body never gets used to Botox.
BOTOX injections for migraines is a preventative treatment, rather than treating the condition with pain medication. It was FDA-approved in 2010 and is considered an appropriate treatment for adults who experience migraine headaches more than 15 days per month, for more than three months. The product blocks the release of certain brain chemicals, and it is believed that blocking these chemicals limits the nerve signals causing pain.
The safety and effectiveness for the treatment of anatomic regions other than the mid-face with JUVÉDERM VOLUMA® XC; facial wrinkles and folds with JUVÉDERM® Ultra XC, JUVÉDERM® Ultra Plus XC, and JUVÉDERM VOLLURE™ XC; and the lips and perioral area with JUVÉDERM® Ultra XC and JUVÉDERM VOLBELLA® XC have not been established in controlled clinical studies
Some critics say Botox makes you lose all the personality from your face, leaving you with a significantly less range of motion when you laugh, or get angry or upset. While it’s true that your movement will be restricted, a moderate amount of Botox will still allow you to react and communicate in a lively way. “Botox relaxes the wrinkle-forming facial muscles at the sight of injection, such as crow’s feet, glabella (the ‘furrows’ in between the brows), and frontalis (forehead lines),” Dr. Waibel says. “Botox does not affect other facial muscles that are used for overall facial expressions.”
On July 7, 2015, the company acquired the rights to the late stage CGRP migraine portfolio of Merck & Co, as well as two experimental drugs (MK-1602 and MK-8031) for an upfront payment of $250 million.[12] On August 10, the company acquired Oculeve for $125 million.[13] On August 31, the company acquired Naurex for an upfront payment of $560 million.[14] On October 19, the company acquired AqueSys, developer of ocular implants that reduce intraocular pressure associated with glaucoma, for an initial payment of $300 million.[15] On October 1, the company acquired Kythera Biopharmaceuticals, a company focused on the medical aesthetics market, for $2.1 billion.[16] On November 4 the company announced the acquisition of Northwood Medical Innovation, developer of earFold, a medical device to correct protruding ears.[17] On November 25, 2015, the company announced it would partner with Rugen Therapeutic to develop new therapies for autism spectrum disorder, rabies and obsessive compulsive disorder.[18]
Botulism is an illness caused by a neurotoxin produced by the bacterium Clostridium botulinum. There are three types of botulism: food-borne, wound, and infant. Symptoms include muscle paralysis, dry mouth, constipation, slurred speech, and blurred vision. If food-borne and wound botulism are detected early enough, they may be treated with an antitoxin. Infant botulism is treated intravenously with BabyBIG (Botulism Immune Globulin).

The 5-unit dose that is injected at each site is a very low dose. Earlier studies with total dosing below 155 units failed to show separation from placebo. As a result, I encourage all patients to get a minimum of 155 units, even if they have a small frame. The optional component of the injection paradigm is the 40 units that are used for following the pain sites. The pain sites are the temporalis, occipitalis, and trapezius. These can be held if the injector is concerned. I do not reduce the dose below 155 units as lower doses have not separated from placebo, and thus I may not achieve an adequate headache effect with a lower dose. In fact, most of the time I increase the dose to at least 165 units, as this was the mean dose in the PREEMPT trials. I inject 5 units behind each ear for a bilateral headache and 5 units in two sites behind one ear in a side-locked headache.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.
Most insurance providers now cover the expense of Botox injections when they’re used to treat chronic migraines. If you don’t have insurance, or your insurance won’t cover the cost of the procedure, it may cost you several thousand dollars. Before you begin receiving injections, talk to your insurance company. In some cases, they may require you to undergo other procedures or tests before they will cover the costs of Botox treatments.

The most commonly reported side effects for JUVÉDERM® injectable gels were injection-site redness, swelling, pain, tenderness, firmness, lumps/bumps, bruising, discoloration, and itching. For JUVÉDERM VOLBELLA® XC, dryness was also reported. For JUVÉDERM VOLUMA® XC, side effects were predominantly moderate in severity, with duration of 2 to 4 weeks; for JUVÉDERM® Ultra XC , JUVÉDERM® Ultra Plus XC, or JUVÉDERM VOLLURE™ XC, they were mostly mild or moderate in severity, with duration of 14 days or less; and for JUVÉDERM VOLBELLA® XC, they were predominantly mild or moderate, with duration of 30 days or less.
Currently, there are several anti-CGRP treatments undergoing clinical trials. Some of these treatments involve monoclonal antibodies, which reduce the activity of CGRP, potentially leading to fewer migraine attacks. One of these anti-CGRP monoclonal antibodies, erenumab (Aimovig™), has been approved by the Federal Drug Administration (FDA) and is now available for patients. A second agent, fremanezumab (Ajovy™), was approved in September 2018. A week later, the FDA approved galcanezumab (Emgality™), making it the third anti-CGRP treatment currently on the market. Results from the clinical trials involving anti-CGRP antibodies have shown that about 50 percent of patients will have at least a 50 percent reduction in migraine days. “If you think about someone who has 20 migraine days per month, they have a 50 percent chance of having 10 or less migraine days,” Dr. Starling says. “We think that there are even these super-responders who have a 75 percent response rate, as well as super-super-responders who actually go into remission.” The results from these clinical trials are very promising, Dr. Starling adds. “The adverse events have been very minimal and the efficacy has been very good. It’s all looking up.” Dr. Starling says that although these medications are available, what really needs to be looked at is how to make them truly accessible for patients. Erenumab can cost about $7,000 per year without insurance coverage. “Insurance coverage is very, very key for the majority of our patient population,” she says. “Because the medications just came out on the market, there are still a lot of unknowns about insurance coverage.”
Dermal fillers, as we’ve discussed in our previous post, vary on what you’re looking for and how long you’d like to see those results. According to the Plastic Surgeons Portal, the minimum you’ll pay for dermal fillers, like Juvederm and Restylane, is going to $1500, while the maximum you’re looking at is $2,500. It’s a small price to pay for radiance and confidence!

On February 1, 2017, the company acquired LifeCell, a specialist in regenerative medicine, for $2.9 billion.[32] On April 28, the company acquired Zeltiq Aesthetics, marketer of a cryolipolysis procedure, for $2.4 billion.[33] On June 7, the company announced the acquisition of Keller Medical, a company that manufactures devices for use during breast augmentation surgery.[34] On December 12, the company announced the acquisition of Repros Therapeutics, a developer of drugs for reproductive system diseases.[35]

Botulism toxins are produced by bacteria of the genus Clostridium, namely Clostridium botulinum, C. butyricum, C. baratii and C. argentinense,[70] which are widely distributed, including in soil and dust. As well, the bacteria can be found inside homes on floors, carpet, and countertops even after cleaning.[citation needed] Some food products such as honey can contain amounts of the bacteria.[citation needed]
Migraine is not a synonym for just a really bad headache, Galli says, which is one of the biggest misconceptions of this disease. It’s a full-body experience that affects your daily life. Being able to break that stigma and, instead, making migraine a synonym of the “this huge debilitating monster of a disease” is one way to change that. Knowledge is a powerful tool for migraine management. The American Migraine Foundation maintains a comprehensive resource library full of fact sheets, toolkits and advice sourced directly from the nation’s leading migraine specialists. Visit AMF’s website to learn more and to find a headache doctor near you.
Botulinum toxin injections are one approach to the treatment of muscle spasticity. These injections can be given with ease and have minimal side effects. They can also be used in very focal spasticity problems that involve a few muscle groups. This treatment may not be right for some patients, such as patients with severe, widespread muscle spasticity, and patients with permanent muscle contractures that have become rigid.

In a double-blind study of 123 adults with regular, chronic migraine, the adults receiving botulinum toxin type A experienced fewer migraine attacks each month. In addition, attacks they did experience were less intense, of shorter duration, and required less treatment than adults who did not receive Botox injections for migraine. These injections were also well-tolerated in adults experiencing migraine with and without aura.
BOTOX® can be used on the forehead lines, frown lines, crow’s feet, bunny lines (lines in the nose), chin (for dimpling), skin bands on the neck, and around the mouth (for smoker’s lines and down-turned corners of the mouth). Wrinkles caused by sun damage and gravity often will not respond to BOTOX®. It is important to re-emphasize that BOTOX® is NOT a facial filler (that is, it does not fill existing wrinkles) – it merely relaxes the muscles that are creating those wrinkles.
Think about it this way: people make facial expressions every single day, whether it's expressing an emotion (i.e. smiling) or simply out of habit (i.e. raising your brows). Making facial expressions causes temporary dynamic lines to show up in your face. These lines go away when your face returns to rest. However, as you continue to make facial expressions, day after day and year after year, and as your skin ages, these lines start to get etched in your skin. That's when frown lines get progressively deeper for people who frown all the time. Or when crow's feet stay put even after you stop smiling or squinting. Eventually, what once were dynamic wrinkles become wrinkles that are just there, even when you don't make any facial expressions.
Once the protein stops functioning at the neuromuscular junction, it is broken down into its harmless components (amino acids) and either recycled for use in other proteins or excreted by the kidneys. "The bigger the muscle, the quicker you'll see motion return," says Rowe. "Likewise, the smaller the muscle, the longer the effect of botox lasts." It doesn't have a tolerance effect, either—your body never gets used to Botox.
"As we get older, we lose volume in our face and hyaluronic acid filler can be used as a replacement,” explains Wexler. "For younger women, injections can be used to treat areas with acne scarring or hollowness under the eyes." During your ‘20s, when the face is at its fullest and healthiest, it has been argued that a shadowy gaze can even be quite charming. But in other cases, hereditary dark circles can result in a persistently tired look, which is where a few drops of filler under the eyes may be useful. As top dermatologist David Colbert, M.D. is quick to note, however, too much Botox and filler distorts the face and as a result will make you appear older. “When the line is crossed everyone starts looking like they are related," he also cautions of a uniform cookie-cutter appearance that lacks character or individuality. Or worse. “It’s a snowball effect of people liking something, coming back too soon [for even more], and then it gets too heavy,” adds Wexler.
Tell your doctor about all your medical conditions, including: plans to have surgery; had surgery on your face; have trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; are pregnant or plan to become pregnant (it is not known if BOTOX® Cosmetic can harm your unborn baby); are breast-feeding or plan to (it is not known if BOTOX® Cosmetic passes into breast milk).
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