Year after year of squinting eyes and frowning can create deep wrinkles between the eyebrows that can even extend to the bridge of the nose. Frown lines and frown lines between the eyebrows can also appear on the forehead and in the corners of the eyes (crow’s feet). Dermatologists can remove these wrinkles that create angry or sad expressions and replace them with pleasant facial expressions with a quick and safe Botox injection in such a short period of time during a patient’s office visit. What is Botox? Botulinum toxin type B and botulinum toxin type B are both purified substances, obtained from bacteria, that block nerve signals to the muscles. This can temporarily reduce muscle contraction to eliminate undesired wrinkles. Botox has been used since 1980 to treat many muscle abnormalities such as weak strabismus and uncontrollable blinking, and in 1987 Botox was tried by some of the pioneers of dermatologic surgery for cosmetic treatments. Once the contraction of the muscle is weakened and relaxed, it cannot be contracted. Because there is no way to make some undesired facial expressions, these fine lines gradually flatten out and prevent new wrinkles from forming. Some other muscles such as those that raise the eyebrows are not affected, so that the natural expression is maintained. For optimal results, Botox treatments can be combined with other cosmetic dermatology procedures such as chemical peels, laser resurfacing, and dermal filler injections. The combination of treatments can also help stop the formation of new wrinkles. Botox is not suitable for treating smile lines around the mouth because the muscles in this area have very important functions such as eating and speaking. Botox treatment: Before treatment, the dermatologist needs to know the patient’s medication history, including any medications taken. The treatment involves injecting a very small amount of Botox directly into the facial muscles that need to be relaxed. A very small needle is used, and the procedure is well tolerated and takes only a few minutes, with no “downtime” or longer recovery periods. Botox begins to work 3-7 days after the injection. The improvement period usually lasts 4-6 months, as the muscles regain contraction and the effects fade. Patients need to be re-injected after various intervals of time. Muscle atrophy may occur after repeated treatments. This usually results in longer lasting effects. Areas treated: Vertical wrinkles between the eyebrows and on the bridge of the nose Oblique lines at the corners of the eyes (crow’s feet) Horizontal lines on the forehead Visible lines on the neck, commonly referred to as “turkey neck” What are the other side effects? Side effects are generally minimal and temporary, and are limited to the injection site. Occasionally, there may be pain and minor bruising around the injection site. Makeup can be applied after treatment, but care should be taken to avoid pressing and rubbing the treatment area for a few hours after treatment. Occasionally, a temporary headache in the forehead area may occur, especially after the first treatment, but is uncommon. In some rare cases temporary drooping of the eyebrows or eyelids may occur, which is caused by a weakening of the muscles near the treated area. All possible conditions are very mild and self-limiting and can be recovered. Other applications of Botox: Hyperhidrosis can be treated with highly diluted Botox injected directly into the skin of the armpit, palm of the hand or plantar area of the foot. This weakens the sweat glands of the skin to inhibit excessive sweating. A single treatment can provide relief for several months, and can be repeated if sweating becomes severe again. Botox can also be injected into the appropriate areas to treat post-herpetic neuralgia. Botox can make a difference in a person’s appearance. It can be used in combination with other treatments to enhance its effectiveness.