Botox® for facial spasmsBotox® and other varieties of dermal fillers are types of injectables. Injectables are products that can be injected into the face to address a variety of cosmetic concerns, such as wrinkles or a sagging face.

Your treatment will be personalized based on your specific concerns and facial anatomy.

Getting started with a cosmetic consultation

Before starting any injection treatment, you’ll be scheduled for a 30-minute consultation with one of our providers. During this consultation, you’ll be given a mirror and asked to describe what bothers you about your facial appearance and what you’d like to address.

Depending on your specific concerns, Botox® or fillers may not be able to address what you want, and you may be referred for a surgical procedure.

Our team always strives to make a healthy and reasonable recommendation based on your desired result and need.

Botox® and other fillers may help “turn back the clock” on natural aging, but they can’t stop time.

Skin texture or sun damage can’t be fixed by Botox® or fillers. Having unreasonable expectations may cause you to be dissatisfied with the results.

How Botox® works to address facial areas

Botox®, which is a medical-grade purified form of botulinum toxin, works by paralyzing the injected muscles. When paralyzed, the muscles cannot contract, which prevents the formation of skin wrinkles.

Botox® wears off over time, so regular injections are necessary to maintain results. Injection touch-ups are typically done every three to six months, depending on your preference.

Botox® has been FDA-approved for cosmetic treatment for more than 20 years.

Treatment areas:

  • Lines around and between the eyes and on the forehead, ex. frown lines or crow’s feet
  • Upper lip, ex. “lip flip”
  • Lines and folds around the neck, ex. “tech neck”
  • Botox® brow lift: purified botulinum toxin injected into the eyelid muscles allows the eyebrow to subtly lift

Botox® can migrate to unwanted areas, so it’s recommended to not lie down, to not rub the treated areas and to not exercise for four to six hours after treatment.

How much Botox® do you get and how often?

Botox® is measured in units. How much you receive is based on consultation with your physician and how much movement you want to preserve. An average of 20 units to 40 units may be used for the forehead. For crow’s feet, between 5 units and 12.5 units (per side of the face) may be used, depending on your smile pattern.

Botox® treatment risks

We use a topical numbing cream and ice, so injections typically are not painful. There are some risks, including:

  • Small bumps may form where the toxin is injected, but will go away within 30 minutes
  • Allergies to Botox® can happen, but are extremely rare
  • Physicians who inject more often than every three to six months put patients at risk for muscle atrophy, or the weakening of facial muscles. Always be honest with your physician about previous treatments and procedures.

Some patients can develop antibodies, reducing the effectiveness of Botox®. This is rare but may require physicians to switch to an alternate botulinum toxin solution.

How fillers can address your facial concerns

Injectable dermal fillers are made of hyaluronic acid, a substance naturally produced in the body but that decreases in volume with age. Fillers are injected underneath the dermis (an inner layer of the skin) to fill space and soften the appearance of age-related facial hollows.

Filler treatment areas include:

  • Lip filler to add volume in the lips
  • Filler for nasolabial folds (creases on either side of the nose)
  • Filler for the tear trough (creases between the eyelids and the cheeks)
  • Filler for marionette lines (creases on either side of the mouth)

There are a variety of fillers, which may feel firm, soft or silky. Only certain fillers are recommended for certain facial areas. Based on the preferred injection location, your physician may recommend a combination of fillers to achieve the desired effect.

How much fillers do you get and how often?

Fillers are measured in cubic centimeters (cc). The amount used will vary by treatment and how deep the existing wrinkles are. For example, lip fillers commonly need less than 0.5cc to provide a full yet natural look. On the other hand, deep nasolabial folds may require as much as 1cc per side.

Filler injections are an interactive process. Typically, the physician will stop several times throughout an injection to show you your progress and to discuss whether additional filler is needed, since the effects of filler are obvious right away.

Fillers aren’t permanent. They will dissolve over time, usually depending on how much movement is happening in the tissue. For example, upper lip filler dissolves more quickly and may need to be refreshed between six months to a year, while treatment on the forehead or temple may last up to two years.

What to expect after getting fillers

After injection, you may experience a small amount of swelling as the filler settles in. This should resolve within the first week after treatment. During this time, any bumps can be massaged into the surrounding tissue.

Hyaluronic acid fillers can also be dissolved if you don't like the appearance after treatment. This is done with the injection of hyaluronidase (an enzyme that finds the acid and dissolves the filler). As swelling goes down, your appearance should return to normal within a week.

Risks of filler injections

Lumps, bumps and granulomas (bumps that form after irritation) can be a side effect of dermal fillers but may be treated or dissolved. Other risks include:

  • Skin necrosis – This occurs when filler is accidentally injected into a blood vessel, clots and causes skin to die in that area.
  • Blindness – Incorrect injection around the eye area may block blood flow to the eyes, causing blindness.

To minimize these risks, our oculofacial physicians have a two-year fellowship in eye plastics. We are experts in eye anatomy and appropriate injections to avoid blood vessels around the eye area.

Will insurance cover this treatment?

Because this is generally considered a cosmetic procedure, this is typically not covered by insurance. Be sure to check with your physicians or insurance provider to understand the cost associated with this treatment.

Why choose the Ohio State oculoplastic team

Our oculoplastic physicians are the only specialized experts in the care, diagnosis, treatment and surgery for facial eye plastics at The Ohio State University Wexner Medical Center. Every member of our oculoplastic team is board certified and has completed a two-year fellowship in eye plastics from the American Society of Ophthalmic Plastic and Reconstructive Surgery. As of January 2023, there are only 750 physicians globally with this comprehensive training.

Our products include Botox®, Dysport® and Restylane®.

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