A Brief History of Botox
Botox was first FDA approved for cosmetic use in the “frown area” between the eyebrows in 2002
In the picture above, the standard dosing was listed as 4 units in 5 locations (total of 20 units) marked with an “x” in the photo. In reality we customize the number of units, and point of injection, for each patient based upon their own pattern of muscle movement. If you have heard of “getting Botox for the elevens” this is the area we are talking about. Botox takes 3-7 days to start working, and hits peak benefit after 2 weeks. On average Botox lasts 3-4 months, but will vary between individuals. If you have never had Botox, this is a great place to start!
Before and After Botox to the frown area
Eleven years later. in 2013, Botox was FDA approved for treatment of “crow’s feet” wrinkles around the eye. These wrinkles radiate out from the outer edge of each eye and are made worse when we squint, blink or close our eyelids.
The above photo is the FDA approved injection points, again marked with an “x”. There are two options (Figure 2 and Figure 3) based upon wrinkle location. Again, each “x” is injected using 4 units of Botox for a total of 12 units per side, and 24 units total for both eyes. Although this is a good starting point for beginner injectors, the actual injection points and the amount of Botox used per injection will vary tremendously between patients. The more experience your provider receives from treating patients, the more he/she will develop their own personal injection style. There is a big difference between getting average Botox results and getting outstanding Botox results. The difference is based upon the experience and skills of the injector. At Omaha Med Spa, from 2007-2019 we completed 20,000 patient visits using Botox! That adds up to a lot of experience.
Crow’s feet – before Botox on the left and after Botox on the right
In 2017 Botox received further FDA approval for use in the mid to upper forehead. The muscle injected is called the frontalis. We use this muscle to raise our eyebrows. Botox in this area targets horizontal wrinkles that run from side to side across the forehead.
The above image shows 5 injection points across the upper forehead, 4 units per injection for a total of 20 units. In practice, we often use a much more different approach to treating this muscle with Botox. Again, every face is different. What we want to avoid in this area of the face is a heavy or droopy eyebrow, which can occur if the injector uses too much Botox and/or injects it too close to the eyebrow. The other “rookie error” to make occurs when a new injector is nervous and does not treat over outer edges of the frontalis muscle. The result is that the eyebrow will start to arch in a very unattractive way (people call this spiking of the eyebrow).
The above image shows an arching eyebrow, that does not match the left eyebrow.
Before and after Botox treatment of the upper forehead