What is Botox®?

Botox® is a neurotoxin that, simply put, stops muscles from moving. Muscles underneath the skin are what cause wrinkle formation. When a muscle contracts, for instance, it causes the overlying skin to bunch up – which visibly creates a wrinkle. So if you can stop the muscle from contracting, you will also stop wrinkle formation – leaving the skin with a smoother appearance.

Botox® is used most commonly along the lower aspect of the forehead for those dreaded ’11s’ or vertical frown lines. Other very popular areas for Botox® include around the eyes (crow’s feet) and within the mid to upper forehead for horizontal skin creases. During your treatment session, a series of tiny injections will be strategically placed into the selected muscles where the unwanted wrinkles are present. The Botox® treatment itself takes just five to ten minutes to be completed in the office.

Once Botox® is injected into the muscle, it takes about a day or so before the muscle becomes inactivated. So most patients will see a visible, clinical change in the wrinkle formation within 24-48 hours after Botox® treatment.

Botox® Results

Most patients getting Botox® treatment will see results that last upwards of 2-3 months on average. Repeat injection is recommended before the Botox® wears off completely.

Finding a Botox® Provider

Although there is no shortage of Botox® injectors in San Diego, it is imperative that you choose an office that has providers who have true, dedicated experience with Botox® treatment. Even though so many patients consider Botox® injections to be very simplistic compared to surgical procedures, there are risks associated with Botox® that occur more commonly in the hands of inexperienced injectors. If you choose someone who is considered an expert Botox® injector, it is much more likely that your cosmetic results will be natural looking – providing you with a rejuvenated and rested look. Our Botox® injectors are highly educated, experienced and trained specifically in the use Botox®, which will give you the highest chance of attaining a beautiful, cosmetic result from the treatment. 

Plan Your Botox® Treatment

Average Cost: $250 – $300 for the most common area (the lower forehead region)

Average Procedure Time: 15 mins

Average Recovery Time: None

Follow-up: Every 3 months 

Cosmetic Botox® Basics

So how does Botox® work when it comes to the face and forehead, in particular? First, you have to understand that the forehead is basically divided into an lower half and upper half.

The muscles of the lower half of the forehead help to depress the brow, or pull it downward. If you try and frown, it is this collection of lower forehead muscles that works to pull the brow down toward the nose, which creates the vertically oriented wrinkles that are easily seen (the dreaded 11s or frown lines).

The muscles of the upper half of the forehead help to lift the brow upward. You can test this for yourself by raising your brow while staring into a mirror. As you can readily see, the mid to upper forehead will show very obvious horizontal wrinkles because the underlying frontalis muscle is contracting.

Knowing forehead anatomy helps with Botox® injections and face rejuvenation

Knowing forehead anatomy really matters with Botox® treatment because of the different muscle groups just noted. For example, we commonly see patients coming to our medical spa looking to get Botox® after having it done by another office and noting their brow feels ‘heavy’ afterwards. This is readily explained by going back to simple anatomy. If Botox® is injected only in the mid to upper forehead region, as is shown in the adjacent diagram, the brow will drop down or descend – making the brow look and feel very heavy. The arrows indicate the direction of brow movement based on the shaded area of Botox® injection. This happens because, as was mentioned above, the mid to upper forehead musculature is what keeps the brow elevated.

If we negate the effects of these muscles by injecting Botox® into this zone and paralyzing the muscles that help to lift the brow, there is no surprise the brow will then drop down, or descend over the upper eyelids. When the brow drops down and sits lower along the forehead, the brow feels and looks much ‘heavier’ than it should. Plus, the brow encroaches on the upper eyelids, which further exacerbates the cosmetic concerns.

There are a lot of Botox® patients who want to treat their pesky, horizontal forehead wrinkles, which are caused by the mid to upper forehead muscles. But if someone injects these muscles with too much Botox® – especially without treating other muscles in the face – the forehead will become ‘too stiff’ looking because it lacks the ability to animate, or move. And, although the forehead wrinkles have stopped, it is still not an esthetically pleasing appearance. Therefore, any mid to upper forehead Botox® treatment must be carefully done in combination with other maneuvers that will help reduce wrinkle formation without dropping the brow down.

The ideal way to inject Botox® in the forehead

The ideal way to treat the forehead using Botox® typically requires injections strategically placed along the lower forehead – just above the eyebrows. This area is commonly referred to as the glabella region of the face. This is shown more visually in the adjacent diagram. If you only inject the area shaded in green, you will effectively paralyze those muscles that pull the brow down. There are actually three different muscles in this zone that are primarily responsible for lowering the brow. This includes the single muscle in the middle of the brow, called the procerus. To the side of the procerus muscle is a pair of muscles, called the corrugators, that sit immediately above the eyebrow. 

When Botox® is injected into this zone, patients lose the ability to frown, which also eliminates the vertical 11s, or wrinkles, that commonly form in this area. By knocking out the muscles that pull the brow down, the mid to upper forehead muscles are left without any ‘competition’ or opposing force. Therefore, these muscles that help to lift the brow can function in an uninhibited manner. This means that the brow will rise up and sit in a more youthful, rested position – which is precisely what most cosmetic Botox® patients desire!

It is this precise pattern of Botox® injection to the lower forehead that should be included in any patient’s wrinkle-reduction treatment plan. That is because these injections are the ones that will create a more esthetically desirable cosmetic brow. If your Botox® provider then elects to inject the mid to upper forehead in an attempt to reduce the horizontal wrinkles, that is fine to do – as long as the lower forehead is treated at the same time. When this combination Botox® injection pattern is used, the usual net result is that the brow will raise up slightly – giving a chemical Botox® brow lift. In some cases, the net movement of the brow is not as pronounced. But at least the brow is much less likely to drop down when you perform Botox® injections along the lower forehead. 

Crow’s Feet Botox®

After forehead treatment, the crow’s feet are considered the most popular area for Botox® injection. The crow’s feet are the radial wrinkles, or deep lines, that form around the side of the eye – usually seen more so when people smile. This is shown in the adjacent photo diagram. There is a muscle, called the orbicularis oculi, that surrounds the eye, which is responsible for the wrinkle formation seen when you smile. As the muscle contracts, or shortens, along the side of the eye, the wrinkles become visible. These are called crow’s feet because they resemble the radial outline of the bird’s foot. 

When Botox® is injected into the crow’s feet on each side of the face, that portion of the orbicularis oculi muscle stops moving. If that portion of muscle cannot move, you cannot create the overlying wrinkles. The end result is that the eyes look much smoother and more youthful when you smile. 

Botox® for Bunny Lines

Were you aware that Botox® is also commonly used to treat unwanted bunny line formation? Well, it is!

Bunny lines are those wrinkles that are formed when someone scrunches their nose and eyes together. These can readily be seen in the adjacent patient photograph. The wrinkles that are seen along the side and bridge of the nose are the result of the underlying nasalis muscle contracting, or squeezing together, during animation. Just like wrinkles in other areas of the face, these ones are quite bothersome to many patients considering Botox® treatment.

Fortunately, Botox® injections can effectively and predictably erase those bunny line wrinkles. The nasalis muscle is injected on both sides of the nose with a relatively small amount of Botox®. The muscle then stops moving and you are no longer capable of wrinkling the nose even if you wanted to do so!

Many Botox® patients combine bunny line injection with lower forehead Botox® treatment to help rejuvenate the entire midface region all at once. 

Face Slimming with Botox®

Botox® is also commonly used in our medical spa as a non-surgical facial slimming treatment. This is more frequently done in female patients who wish to have their face narrowed in the region of the jaw muscles. These muscles, called the masseter muscles, are located along the back end of the jaw and can be rather easily felt when you bite down, or clench the jaw. In many patients, the masseter muscle can become more prominent than desired, which leads to added width when looking at the face from the front view. In a female patient, this is undesirable since it can make the face look more masculine. Fortunately, Botox® injections can help with this by reducing the strength of the muscle. This, in turn, makes the muscle smaller and results in a slimmer, more feminine facial contour. Just like Botox® injected elsewhere in the face, masseter muscle treatments can be completed during a quick 15-minute office-based procedure. Results for this type of facial slimming are typically seen within a few weeks of the treatment.

Treatment for Sweaty Armpits

Botox® is also used quite regularly for patients who have sweaty armpits. This condition, which can be very anxiety-provoking for many patients who suffer from it, is called axillary hyperhidrosis. Essentially, in this condition the body creates an unusual amount of sweat from hyperactivity of the sweat glands. These patients have typically tried all sorts of other measures to help control the excess armpit sweat, but to no avail. In these instances, Botox® can work very effectively to help control the sweat glands and significantly reduce production of the armpit sweat. 

Botox® for Migraines

Did you know that many patients get Botox® treatment for their migraine headaches? Well, it has become an increasingly popular choice for many patients suffering from chronic migraines. When used in combination with traditional migraine treatment protocols, regular use of Botox® has been shown to decrease the frequency and severity of migraine headaches. 

Dirty Little Secrets About Diluting Botox®

One of the dirty little secrets about Botox® treatment is the method of dilution, which ties into how some medical spas in San Diego charge for their Botox® injections. To help patients understand this in more detail and to demystify Botox® dilution, we have put together some helpful information to consider.

Proper Botox® Dilution

Allergan is the only maker and distributor of Botox® cosmetic. So any medical spa that is offering you Botox® has to get their product from Allergan. When Allergan sends Botox® to a medical spa, it comes as a frozen, dried powder at the bottom of a vial. The dried powder contains 100 units of Botox®. In order for the Botox® to be injected, it has to first be reconstituted into a solution – meaning, it has to be converted into a liquid form in order for it to be injected into the body. This is where the issue of dilution comes into play with Botox®.  

It is recommended by Allergan that 4 milliliters be added into the vial of Botox®. Based on this amount of solution being added, the concentration of Botox® in the vial becomes 100 units per 4 milliliters – or 25 units per 1 milliliter. Keep in mind that most medical spas will inject Botox® using a 1 milliliter syringe. So within each full syringe, there should be 25 units of Botox® if that medical spa is using proper dilution methods

Deceptive Botox® Dilution

Now, let’s look at a different scenario where a medical spa may dilute the Botox® more than they should. What if, for example, the spa staff dilutes their Botox® by putting 8 milliliters of solution into the vial during their reconstituting process – or twice as much as is recommended. That means the Botox® vial will now have a concentration of 100 units per 8 milliliters – or 12.5 units per milliliter. That means each of their syringes has half of the amount of Botox® (half the number of units). Since a unit of Botox® in one office is the same as one unit in another, that means their Botox® syringes are half as strong as they should be! When a patient looks at a syringe of Botox®, they will all look the same to the naked eye since the solution is clear regardless of the number of units inside of it. So the syringes will look the same in both offices. But that is how some medical spas will get away with diluting their Botox® down – because patients can’t tell the difference by simply looking at the syringe. 

If a certain medical spa charges you ‘by the syringe’ and doesn’t disclose how many units are in each syringe, you might think you are getting the same amount of Botox® as another office, but, in reality, you are being scammed. By charging per syringe, that office can get away with using less units of Botox® per patient.

An extension of this deception is seen when some medical spas charge for Botox® ‘by the area’ as they say. For instance, you may want your glabella treated with Botox® to stop the 11 lines from wrinkling up. Some medical spas will charge you a certain amount of money to inject just this area – but they don’t tell you how many units of Botox® you are getting. If they pull out one of those overly diluted syringes of Botox® – which looks identical to a properly diluted syringe – and use the ‘whole thing’ to treat one area, you might think you are getting a full treatment. Unfortunately, you just got half of the amount of Botox® that a patient would get at our office for the same treatment.

A Unit of Botox®

This is precisely why, as a patient, you need to know the number of units of Botox® you are getting – and paying for after the treatment. Since a unit of Botox® is the only consistent factor between different medical spas in San Diego, it is imperative that you only pay for the exact number of units you received. Don’t fall for the deceptive pricing schemes seen out there where medical spas are charging by the syringe or by the area of Botox® injection. 

Botox® Pricing

Knowing this, pricing for Botox® distills down to the amount per unit. Here in San Diego, it is not uncommon to see a range of prices from $9 per unit up to $15 per unit in places like La Jolla.

Is the Botox® in La Jolla better? Absolutely not. It was purchased from the same distributor – Allergan – as every other office providing Botox® in San Diego. So why is Botox® more expensive in La Jolla versus other areas of San Diego? This is mostly because medical spas in neighborhoods like that have much higher overhead costs to run their offices. Therefore, they need to charge more for the same product or service.

So what about those medical spas that charge on the lower end of the scale? Is it an issue of having lower overhead, therefore, they can charge less per unit of Botox®? In some cases, this factor is relevant. And in many of these instances where the Botox® is so cheap, it is related to the fact that their providers are not as experienced or well-trained as in other medical spas.

At the end of the day, you need to look at Botox® just like any other luxury item. There are those that are outrageously priced and not worth it for what you are getting. And then there is the other end of the spectrum where it is inexpensive for a reason – because you are simply not getting something of quality. In the middle of these two extremes is a range of medical spas where Botox® is fairly priced and you are getting a very good cosmetic service backed by reputable, well-trained providers.

Botox® Brilliant Distinctions

Brilliant Distinctions is patient-oriented service program offered by the makers of Botox® (Allergan) that helps drive loyalty to their brand. In addition to getting discounts and rebates on Botox® treatment by Dr. Hilinski and his medical spa staff, the program assists patients in staying up-to-date on exclusive events and specials related to their line of products. To learn more, use this link to Allergan’s Brilliant Distinctions program.

Botox® Frequently Asked Questions (FAQ)

Does Botox® Hurt? Every individual has a different threshold, but, for the most part, Botox® treatment is minimally painful. Some patients will note a brief, sharp stinging sensation as the injection takes place. A cold compress at the time of the treatment may reduce any discomfort as will use of vibratory device during the actual injection.

How Long Are the Effects of Botox®? In most patients, Botox® will last about 2-3 months before the effects begin to wear off. In cases where too few units of Botox® are used, the treatment effects will be more short-lived. 

Is Botox® Only for Women? The answer is absolutely not! In the last 10 years our medical spa has seen increasing numbers of men coming in for Botox® treatment every year. The pattern of injection is a bit different for men versus women – which is not surprising given the esthetic goals of Botox®. But men are great candidates for Botox® treatment.