Board Certified
Plastic Surgeon
Since 1989

What is Botox and How Does Botox Work?

Botox is a very popular cosmetic procedure and is often mentioned in the media as a quick way to remove the signs of aging. Everyday people, as well as celebrities, have benefited from Botox.  In this interview, Doctor Widder describes what Botox is and how Botox works. Botox safety and its effects are also described in easy to understand terms.

Q: What is Botox?

Botox Virginia

Botox is the commercial name for the Botulinum toxin. It is a medication that basically paralyzes muscle.  We use it in very small amounts and it doesn’t have any systemic side effects.  The most common area of use for Botox are the glabella area, between the eyes (the frown lines), along the lateral canthal area (crow’s feet), and the forehead.  Some people use it to raise the corner of the mouth to improve the smile.  I don’t do this because it’s a little risky.  Around the mouth, it is possible to get asymmetries, so I like to play it safe and use it only around the eyes, the forehead, and sometimes the platysma band of the neck.

It is really a miracle drug because without surgery you get very nice rejuvenation.  The use of Botox involves interactions between muscles.  When you use it around the eyes, for example, you can literally raise the eyebrow.  There are muscles that are depressors that pull down, and there are muscles that are elevators and lift the face up.  So if you want to get a lift, you disable the depressor and the elevator lifts up.  The brows can go up 2 or 3 millimeters, which is significant.

Those are the cosmetic uses but there are others as well.  Some doctors use it to reduce sweat production in the armpit.  Neurologists are using it to relax the muscles for people who have spasms.  It’s being used for some people who have lost their voices – by injecting Botox with a very specialized skill, doctors can reduce the muscle tension that caused the loss of voice and people are able to talk again.

Q: How was Botox discovered?

 For quite a few years before it was used for cosmetic purposes, Botox was used for ophthalmological conditions like lazy eye.  Then there was a married couple from Canada – one was a dermatologist and one was an ophthalmologist.  They discussed the issue and the dermatologist decided to try Botox for facial expression.  They used it around the eye for frown lines.  That was probably some 20 years ago; I don’t remember the exact date.  The success rate was so impressive that they kept finding more uses for it.  Now Botox is probably the most popular nonsurgical procedure used for cosmetic purposes.

Q: How long does Botox last?   

 It really varies between people.  Everyone’s body reacts differently to different drugs.  On average it lasts 3-4 months, but I’ve had patients for whom it lasted 8 months.  It depends on metabolism.  Some people break down the Botox faster, and some slower.  Ideally, one should consider doing it continuously every 3 months so that the muscle doesn’t recover.  If it’s being done in that way for about 2 years, then the muscle will become so weak that the need to inject the Botox goes down to once every 10 months or even once a year.

Q: What causes the “too much Botox” look? 

The smart usage of Botox creates a beneficial interplay between the muscles.  If you use too much, you get an exaggerated result.  When a doctor injects the forehead to eliminate wrinkles and goes too low, all the forehead muscles can become paralyzed and droopiness of the brow is the result. That is what they call the overdone look.  What happens is that gravity can take the Botox down.  When you do the injection, there is a little trauma and a bit of fluid is released from the injury site.  The weight of the fluid with the Botox will carry it down because of gravity.  I don’t want to mention a famous politician, but it happened during one of the debates – his brows were very low.  But it also happens in everyday life.

It happened to me at the beginning of my practice.  I knew I had to stay above a certain level, but didn’t really know by how much.  I started with one inch and it wasn’t quite enough. Now I usually leave about 1 ¼ – 1 ½ inch of muscle and inject the Botox only above that level.  Even if it is pulled down a little, that still leaves enough muscle to elevate the brows so they don’t get that tired look or interfere with vision.  There is another possible complication where the Botox paralyzes the levator of the eyelid so that you get droopiness of the eyelid.  That usually goes away in 2 -3 weeks because the amount of Botox that goes into that area is not significant.  Most of it stays outside the orbit, so the effect is short-lived.

Q: Who can get Botox?

Those with the symptoms like wrinkles, hyperactive muscles, droopy brow, or crow’s feet are clear candidates for Botox.  You can also use it as a preventative treatment.  This is because as the facial muscles contract, it is like bending an iron wire – after a while, it breaks.  It’s the same with the collagen fiber in our skin.  It is hard to imagine how many times we use our facial expressions each day, but after 20-30 years, it is probably in the millions.  Those contractions will eventually break the collagen fibers and you’ll get wrinkles.  So if you use Botox at a young age, you’ll prevent the contractions and you’ll prevent wrinkles.  That’s one of the things I talk to my patients about.  Whatever they have now are conditions they’ll continue to have, but if they use Botox continuously, they’ll prevent it from deteriorating.  That is useful, not much talked about, but there is room for this use in young people.

People who want to make good first impressions may consider eliminating frown lines.  Frown lines reflect unpleasantness like anger and stress, so if one wants to avoid that, Botox can help. It is of social benefit to present a pleasant facial expression rather than an unpleasant one.

Q: How safe are these procedures?

The lethal amount of Botox is 5000 units.  The average cosmetic procedure uses no more than 100 units.  So, the safety margin is very, very high.  People shouldn’t worry at all about that.

If have any questions about Botox procedures or costs contact Widder Cosmetic and Plastic Surgery located in the Vienna, VA area for a free consultation: Or call: (703) 506-0300

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*Individual results are not guaranteed and may vary from person to person. Images may contain models.