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Botox FAQs
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Botox is one of the most popular cosmetic procedures, and we understand that you have questions. We’ve compiled some Botox frequently asked questions for your benefit here.

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Q: Had Botox on forehead frown, now having surgery in 11 days under general anaesthetic. Will it affect the Botox from working?

A: Botox is injected directly into your muscles and so is not a systemic treatment. Its efficacy won’t be affected by your undergoing general anesthesia for your procedure. Now, if it’s your face that’s being operated on, and your Botox-treated muscles are affected, then that could interfere with your results. Please tell your surgeon about your Botox treatment, regardless; physicians should always have a complete and accurate profile of your medications, including cosmetic treatments.

Q: Is Botox injection the right treatment for me?

A: From your photographs, it does look like it’s the masseter muscle that’s causing your bulky jawline, rather than fat or bone. Botox, Dysport, or Xeomin would do a beautiful job of relaxing your jaw, allowing your face to slim down into a more feminine and softer heart shape. Absolutely do not even consider a facelift at your age! Please consult a board-certified dermatologist who is an expert at changing face shape with Botox.

Q: I have been considering using Botox for jaw slimming (masserter muscle reduction) but since I am 49 and have A very strong jaw with very little Joweling i’m wondering since Botox will atrophy the muscle from nonuse if this could cause skin sagging when the muscle shrinks? Also, how many units is generally used for this treatment thank you in advance

A: Botox in the jaw only affects the masseter muscles, which will then atrophy. If your skin is good quality, you should get a slimmer face shape without jowls. However, the definitive answer depends on your unique bone, muscle, skin, and fat structure and quality. If you’re at risk for jowling, Ultherapy, Thermage or ThermiTight could help. About 40 to 50 units of Botox  in total are usually needed for creating a heart-shaped face. Please consult a board-certified dermatologist who can determine if you’re a good candidate for Botox jaw slimming.

Q: Does the Botox lip flip weaken the muscle and make the lip and philtrum longer over time?

A: When you use Botox over the long term, the treated muscle does tend to lose some strength. This translates into needing less product to create the same result. As for Botox lengthening the philtrum in a lip flip, again, this would take some time. Simultaneously, your face will be aging and your philtrum (and everything else) naturally extending/sagging. However, that effect can be remedied with fillers and staved off with treatments that make your skin stronger and firmer, such as lasers.  Please consult a board-certified dermatologist who can help you get a beautiful lip flip while preserving you current philtrum length over the long term.

Q: My eyes and eyebrows are asymmetrical, can my brows be made more even with Botox?

A: If you find an expert dermatologist, he or  she can use Botox to either raise your low eyebrow or depress the high one. Your choice. Your eyebrows will be more symmetrical, which will improve the appearance of your eyes, too. Please consult a board-certified dermatologist who is an expert with Botox eyebrow correction. My office is in San Diego and I’d be happy to either meet with you in person or over Skype.

Q: I am interested in getting lip fillers and botox injections around my eyes and forehead. Are these procedures dangerous for your overall health long-term? If you started, would it be something that would become noticeable if you ceased treatment? Would look different if you got it a few times then decided you didn't like it and stopped?

A: Both Botox and dermal fillers are safe procedures with no adverse long-term consequences. Botox and fillers have been used cosmetically since the late 1980s. The main adverse effects with the neuromodulators Botox, Xeomin, and Dysport and fillers Juvederm, Restylane, Sculptra, and Belotero come from the injections themselves. As with any injection, you can feel a little sore or bruised for a couple of days. Other than that, a poor outcome is almost always due to an inexpert injector. One of the great things about neuromodulators and fillers is that they’re temporary, so whenever you wish, you can go back to baseline (your starting point). That allows you to experiment with a refreshed, new look without having to commit to it long-term. One caveat: After getting a beautiful improvement with Botox and fillers, if you do stop them, your normal appearance might bother you more than it did before you got used to seeing a more refreshed look. However, you can always start your treatments again! Please consult a board-certified dermatologist who is an expert using Botox and fillers to create a beautiful liquid facelift.

Q: Semi-permanent eyelashes 7 days after Botox? Or will this affect the eye muscles or interfere with anything?

A: Botox is injected into the forehead or into the sides of the orbicularis oculi muscles that create crow’s feet. Botox should not affect the function of your eyelids. Getting semi-permanent eyelashes after Botox is fine. Consulting a board-certified dermatologist will get you the most beautiful Botox results.

Q: Is there an alternative to Botox without spending a lot more? I have been receiving treatments for several months and even though my skin looks a lot better I feel like I’m not getting the exact results I want and still have a good bit of movement in my forehead, between the brows and my under my eyes.

A: If you’re not getting the results you want from Botox, you may not be getting a strong enough dose. You can try other neuromodulators, such as Dysport and Xeomin, but they’re about as effective as Botox and about the same price. You may need to improve the overall quality of your skin with laser resurfacing or chemical peels.  Consulting a board-certified dermatologist who has many effective therapies will get you the rejuvenation you want.  

Q: Im 26 tears old. My skin looks fine not amazing. Do you recommend to do Micro current facial? Thank you

A: You’re at a perfect age to start getting help with prejuvenation from a dermatologist. Based on your needs, we might recommend a medical-grade skincare with retinol and anti-oxidants, regular facials and chemical peels, and Botox. It all depends on your individual needs. Be sure to consult a board-certified dermatologist who is willing to work with you over the long-term so your skin starts to look, and continues to look, amazing.

Q: My regular Botox injector is telling me she can inject for migraines. My neurologist is trying to get me approved for Botox for migraines. Is this just an insurance/money issue?

A: Botox to treat migraine is usually a reimbursable expense. It’s important to note this therapy must  be administered by a medical professional, usually a neurologist, both for safety and for reimbursement. Please consult a board-certified dermatologist or neurologist who has experience relieving migraine pain with Botox.

Q: How can I get smooth skin on my cheeks and eliminate cheek wrinkles from smiling? (Photo) I’m 49 years old. I have fairly good laxity in my facial skin but I get deep crows feet and cheek wrinkles when I smile.

A: You have a lot of options for solving your problems, but Botox or another neuromodulator such as Dysport or Xeomin is still your best bet for controlling the crow’s feet. As for laxity, I’d recommend facial rejuvenation with an ablative laser like Deep or Active FX or a Sciton Er:YAG laser which stimulates your skin to produce rejuvenating collagen. The most dramatic lifting options are Thermage FLX and Ulthera, which creates a nonsurgical facelift and are also collagen stimulators. Finally, while there is no “magic in a bottle” there are a variety of topical creams like Calecim, SkinMedica TNS and Sente Eye Brightener which complement other treatment options.  Please consult a board-certified dermatologist who can take time to analyze your issues and come up with a comprehensive treatment plan.

Q: I got my Botox At 11:15 and had my eyebrows done at 1:00pm my concer is she would press her finger in my forehead couple of times and rub it and I didn’t know I wasn’t supposed to do that will it affect me ?

A: Botox actually settles into your muscles within minutes, so it’s unlikely it could be spread or be dislodged by someone lightly touching your forehead. However, you don’t really want to press on or manipulate your forehead after Botox or any other kinds of injections, because you don’t want to irritate the injected area and cause extra swelling. You should see the full effects of your treatment in about two weeks. That said, next time, do your brows before Botox so you can relax about your treatment. Please consult a board-certified dermatologist who gives you post-treatment care instructions so that you don’t upset yourself unnecessarily.

Q: I have an old lady neck, I am only 25 anyway of Botox helping me? When I recline or lay down they look even worse.

A: Your neck rings are inherited, as well as due to age and especially photodamage. You can smooth them out by using Botox, Dysport or Xeomin to create what’s called a Nefertiti neck lift. It will last about three to four months. Please consult a board-certified dermatologist who is an expert at creating a smoother, more uplifted neck by using Botox in the platysmal bands.

Q: Can you use less Botox to just weaken muscle instead of completely paralyzing it?

A: You don’t ever want to completely paralyze the muscles with Botox. They should be allowed to move enough to create natural expressions, but not enough to create wrinkles and creases. Think of Botox as more of a muscle relaxant rather than a paralyzer. As for changing the balance of muscles permanently, that doesn’t really happen. When one set of muscles is relaxed, the other doesn’t go into overtime trying to make up for the lack of resistance, unless — perhaps — you’re doing intensive facial exercises. Please consult a board-certified dermatologist who can explain the process in more depth to you so you can decide if Botox is the right treatment to get smoother, younger-looking skin.

Q: Can I get Botox for my nasal tip and flared nostrils? really like my nose at my resting state and when I have a soft smile BUT when I smile fully or with my teeth I look like I have a freakin arrow!! I dont want to have to consider a rhinoplasty because I do like my nose at its resting state, my only issue is when i fully smile. I put those boxes so i could remain private.

A: Any of the neuromodulators — Botox, Xeomin, or Dysport — can improve the look of your nose when you smile by relaxing the flare of your nostrils and lifting the tip. It should not look different at rest than it does now. The nice thing about Botox, Dysport or Xeomin is that they will wear off in 3 to 4 months. You can experiment with your looks and can always return to baseline after the neuromodulator stops working. You may find you prefer the new look, or you may end up appreciating your old smile.  Please consult a board-certified dermatologist who is an expert at reshaping the nose using Botox so you can get the changes you’re hoping for.

Q: Would botox lift my right eyebrow to even out my eyes? Or would a different procedure be preferred?

A: Yes! A little Botox in the depressor muscle that controls your right brow will keep it from pulling downward too strongly. The brow will then lift to be more even with your left brow. You’ll need touch ups every three to four months. Consulting a board-certified dermatologist will help you schedule a maintenance routine so you can keep your brows looking symmetrical over the long term.

Q: I just had Botox in my forehead area, is it okay to proceed with dental work?

A: Botox is a local therapy. When it’s injected into the forehead, it settles into those muscles within minutes. It does not migrate or get into the bloodstream. You can have dental work the same day, if you wish. Please consult a board-certified dermatologist who is an expert with Botox to get your treatments, as this not only gets you the best results but also helps you understand how Botox works.

Q: Can I get dermaplaning 3 days after Botox?

A: Dermaplaning after Botox is safe. Generally, I only advise a 24-hour waiting period between Botox and other procedures or vigorous activities. Please consult a board-certified dermatologist who is an expert at dermaplaning, as it takes a light touch and skilled hand.

Q: I need to know, when is the SAFE time I can exercise strenuously after Botox treatment?

A: Botox settles within the muscle just a few minutes after its injected. Therefore, I usually advise my patients to avoid strenuous exercise for a hour or so. Please consult a board-certified dermatologist who is an expert at using Botox to relieve your wrinkles.

Q: Would Botox improve my crow's feet? I've heard droopy eyes can be a side effect.

A: Botox is absolutely the best treatment to resolve crow’s feet. It works by relaxing the muscles that cause them, allowing the skin to smooth out. After two weeks or so, your wrinkles are gone. You’ll need a touch-up in three to four months. As for Botox making your eyes droop, Botox is injected near the side of your eye and won’t affect the upper lid. If you have droopy lids you can have them improved non-invasively with either Thermage or Ulthera or with a Botox brow lift. Surgical correction is best for severe skin laxity. Please consult a board-certified dermatologist who is an expert at facial rejuvenation using injectables so you get the beautiful improvement you’re seeking.

Q: This is my first time doing any cosmetic procedure. I'm scheduled for Xeomin injections for the 11's and forehead wrinkles. The assistants in the office mentioned that I should not lean forward afterwards. I have two dogs. It is difficult to manage them if I do not bend forward.

A: You should be OK bending down to tend your dogs about 3 to 4 hours after your Xeomin treatment. We recommend against reclining or bending down directly afterward mostly as a precaution. The Xeomin works quickly and should already be in your muscles, calming them down. However, the injections traumatize your skin a bit so dangling your head or reclining can worsen the swelling. Consulting your board-certified dermatologist for detailed after-care instructions will help you feel more comfortable with this wonderful new self-care treatment you’re giving yourself.

Q: Is Botox a good solution for my gummy smile?

A: Botox isn’t just a good remedy for a gummy smile, it’s a great one. After your treatment, your upper lip is slightly more relaxed so that it doesn’t pull so far upward and backward when you smile. Your smile will be filled with your beautiful teeth, not gums. You’ll need a touch up every three to four months. Please consult a board-certified dermatologist who is an expert at using Botox on the lips for consistent and beautiful results.

Q: I have bells palsy since October 10th of 2016. Will Botox help fix my face?

A: While Botox cannot treat Bell’s Palsy, it can correct the facial asymmetry of Bell’s palsy and other facial palsies. Botox works by relaxing the muscles that have become spastic or frozen. It should make your face look more at ease and symmetrical. Please consult a board-certified dermatologist who is an expert at alleviating asymmetry due to facial palsy with Botox, because few doctors can do this well.

Q: Can masseter Botox be prescribed for patients who experience pain due to clenching their jaw?

A: I frequently use Botox to help relax overly clenched masseter muscles. The Botox relaxes your jaw muscle so that it releases tension, alleviating your pain. Botox is also a great remedy for teeth grinding (bruxism), which can also cause pain and jaw dysfunction.  Please consult a board-certified dermatologist who is an expert at using Botox in the masseters.

Q: How many days before a wedding can I do Botox? I am afraid of a reaction.
 Face has not much wrinkle, eye had puffy, and side line little, and neck has wrinkle. how many day before i can do Botox ? i

A: Botox is not used to treat the kinds of wrinkles you mention. Those would be best smoothed out with hyaluronic-acid based fillers. You can use Botox to treat forehead wrinkles and crow’s feet, as well as a number of other cosmetic issues. It may take up to two weeks for Botox’s full effects to be realized. You might also be very slightly puffy and have a slight bruise from the injections of Botox or fillers for a few days after your treatment. I’d suggest leaving two weeks between injectables and an event like a wedding party. Please consult a board-certified dermatologist who is an expert at rejuvenating the face with Botox and fillers.


Q: I’ve heard that scalp Botox may have some minor benefits for stopping hair loss. Since this is an expensive treatment, would like to know from dermatologists if they’ve performed this or heard of it?

A: In patients who received Botox in the scalp to control hyperhydrosis (excess sweating), it was noted that some of them experienced slight hair regrowth. The result was minor and there have been no formal clinical studies on this effect so it may not be as good as suggested.  Please consult a board-certified dermatologist who can examine your hair loss and determine the most appropriate treatment.


Q: My smile has changed being more gummy and asymmetrical. One side seems to be caving inwards pushing my front teeth out. Would botox help or do I need a lot of work done to my teeth and if so do I need braces or veneers.


A: Botox in your upper lip will keep it from drawing so high and revealing excessive gums. The effect is very flattering and lasts about three to four months. As for your teeth themselves, you can consult with a dentist about orthodontics and/or veneers. Please consult a board-certified dermatologist who understands facial anatomy when relaxing your upper lip to fix a gummy smile.


Q: I’m a kidney donor will Botox effect my one kidney?


A: Thank you for being so generous as to donate a kidney to someone in need. Luckily, having only one kidney does not preclude you from the benefits of Botox or Dysport or Xeomin. These neuromodulators are injected intramuscularly and do not enter the bloodstream. It’s a perfectly safe treatment for you.  Please consult a board-certified dermatologist who is an expert at Botox injection to get the most beautiful results.


Q: Can Botox or lip fillers help hide the after effects of Bell’s palsy on my top lip?

A: Botox is an excellent remedy to relax your face more after Bell’s palsy so that you feel that your smile doesn’t look so forced. It lasts about three to four months. After that, if you’re lucky, your condition will have finished clearing on its own. If not, you can always touch up the Botox. Please consult a board-certified dermatologist who is expert in treating facial palsies with relaxing Botox.

Q: Does Botox injected in the face travel to a breastfed baby?

A: Botox is an intramuscular treatment that doesn’t travel through your bloodstream. That said, I never advise patients to get unnecessary cosmetic treatments while pregnant or breastfeeding. You just don’t want to take the risk. Plus, doing so creates the kind of worry that you’re now undergoing. Take your baby to the pediatrician to find out what’s wrong. Don’t get a touch-up to your Botox if you’re still breastfeeding at that time (also, don’t worry anymore about the Botox you already have). And please consult a board-certified dermatologist who is an expert in Botox injections for your next treatment; I always ask my female patients if they are pregnant or breastfeeding before administering injectables.

Q: Where are the best places to inject botox prophylactically (and how many units) for a 30 year old with no major concerns?

A: Prejuvenation is a growing trend and one which I believe will pay big dividends. Starting with regular Botox at 30 before your wrinkles have taken hold will keep your skin looking fresh and smooth for years. Areas to consider would be crow’s feet, glabellar lines (11s), and forehead furrows. Please consult a board-certified dermatologist who is an expert at Botox and who can also recommend other prophylactic skincare steps, such as sun avoidance, sun protection, medical-grade skin care, and other non-invasive laser and light technologies like Intense Pulsed Light.

Q: Premature ageing and Botox: I’m 18 and my forehead wrinkles are insane.

A: If you don’t smoke and you’re diligent with sunscreen, it’s possible that you just have extra fine and thin skin owing to your genetics. In some ways, the wrinkles you’re seeing now are a good thing: They’re showing you quite clearly that you’re really going to have to step up your skincare program to prevent early jowling, turkey neck, and other unpleasant issues that tend to come with thin skin. In the meantime, it sounds like Botox would be a good solution for your forehead wrinkles. Please consult a board-certified dermatologist who can evaluate your skin to determine if this is the right treatment for you, and to make other prophylactic suggestions to stave off early aging.

Q: I am suffering from clenching and grinding.Treatment options?

A: Botox in the masseter muscles is an ideal treatment to stop you from grinding your teeth at night (bruxism). Your jaw will unclench and relax. The grinding will stop, and so will the pain You’ll also get a softer, jawline. Please consult a board-certified dermatologist who is an expert at using Botox to treat bruxism.

Q: Will Botox work to relax the line by the jowls area?

A: Based on your description, Botox would not be the right choice for you. If anything, it could worsen the jowling. Botox works on wrinkles caused by dynamic muscles, but won’t stop marionette lines, which is what it sounds like you have. Probably your best bet is a Silhouette Thread lift, Thermage, or Ulthera. Sculptra or a filler like Restylane or Juvederm in the midface can add more volume and lift to your face. These procedures can pull up your jowls slightly. If you have deep creases, those should be filled in with hyaluronic acid-based fillers, such as Restylane Defyne or Refyne, or Juvederm. Please consult a board-certified dermatologist who is an expert with liquid facelifts to get a beautiful rejuvenation.

Q: I have learned that there are some doctors who will only provide Botox in the glabella area and not other areas of the forehead. I’m reading about different opinions. Can anyone clarify?

A: All dermatologists have their own unique skill sets and procedures with which they feel most comfortable. If someone is new to Botox, they may want to limit themselves to injecting only the areas they’ve been trained in. They also might choose to use Botox solely on-label, which greatly curtails its utility. Botox is safe and effective when treating forehead lines, crows feet, neck lines and much more, if administered by an expert injector. Please consult a board-certified dermatologist who has demonstrable expertise and experience using Botox in the forehead and other areas of the face.

Q: Is there a minimally invasive surgical procedure (local anesthetic) to tighten lower jaw area and upper eyelids?

A: It sounds like you are referring to “skin-only facelifts.” I have not heard anything good about these procedures. They may give you a nice lift initially, but they cannot last long, as the skin stretches easily and will quickly succumb to gravity without a strong support system underneath it (the muscle is moved upward and sutured in a traditional facelift, which is why it can last for many years). I’d suggest you look into the Silhouette InstaLift thread lift. This is an amazing technology that not only lifts the skin but stimulates it to produce more collagen, which forms a strong, supportive matrix for the skin. Therefore, the lifting effect comes not just from the pull of the threads (which dissolve over time), but from the new and stronger strands of collagen protein. Silhouette cones are made of the same material as Sculptra filler — another collagen promoter. Results can last several years or more. A brow lift can be accomplished with just a little Botox, Dysport or Xeomin. This will need to be re-administered every 3 to 4 months and becomes part of your regular beauty regimen. Ultherapy is also a nonsurgical device approved for a nonsurgical brow lift. Consulting a board-certified dermatologist will determine if you are a good candidate for a nonsurgical face and eye lift.

Q: Is it safe to inject the glabella to lift the brows with Botox after rhinoplasty?

A: Injecting Botox into the glabella after rhinoplasty is perfectly safe as long as there is no longer any swelling from the surgery. However, you should ask your plastic surgeon for advise because he or she should be aware of any procedures you are considering (you didn’t mention how long ago you had the rhinoplasty). Please note, injecting the glabellar muscles will not lift your brows. Please consult a board-certified dermatologist who is an expert at using Botox to get the results you want.

Q: Can Botox masseter wear off in two weeks?

A: Our masseter muscles are much stronger than most of the muscles that Botox treats and therefore require larger doses. If you don’t think the Botox is working for you, go back to your injector for another dose. Most dermatologists would rather err on the side of caution than give too much of any product. It’s always easier to add more than to wait for effects to diminish. If this is your first time being treated, then your effective dose is just being established.

Q: Can I get a brow lift by Botox or will I need to have an actual eyebrow lift surgery?

A: The look you want can be achieved with Botox underneath the lateral brow, which will allow it to rise higher. The lifted brow will also raise the hoods on your eye a bit. You need to re-administer Botox every three to four months. Please consult a board-certified dermatologist who is an expert at using Botox for brow lifts; it takes a lot of skill to do well.

Q: What are the alternatives to Botox with similar effects and results? Botox does not seem to work on me. I received Botox twice in my frown/between eyebows area with no result. It seems that I am immune to it(is that even possible?) What are my other best options as far as alternatives similar to Botox with the same effect ? The frown lines have to go and I do not yet need a filler in that area.

A: he alternatives to Botox that have the same effects, such as Dysport and Xeomin, also have the same mechanism of action: They rely on a purified version of botulinum toxin to partially paralyze a muscle. If Botox didn’t work on you, Dysport and Xeomin might not, either. However, you haven’t provided much information about your treatment. How long ago did you have Botox? How many units? Did you receive Botox from a board-certified dermatologist? It’s possible that you were given too low a dose. It’s possible that you haven’t waited long enough to evaluate your results (it takes up to 2 weeks for the treated muscle to stop moving). If you don’t want fillers, you can improve the look of your 11s with other therapies, such as laser resurfacing and radiofrequency microneedling, but your muscles will continue to press the skin and crease it. Please consult a board-certified dermatologist who is an expert at getting great results with Botox before giving up on this highly effective neuromodulator.

Q: Do I need Botox or fillers for my 11's, or do I need fillers?

A: Your wrinkles are not deeply etched so I believe a good Botox treatment should take care of them. If you’re not happy with the results after two weeks, then you might consider filling in with a small amount of dermal filler or getting a laser resurfacing. Please consult a board-certified dermatologist who can take a closer look at your skin in person and come up with the best solution for you.

Q: What is the ideal time to have chin and jowl liposuction after having Nefertiti lift and Botox in the masseter muscle?

A: My preference would be to do the liposuction first, but since you went for the Nefertiti lift, I’d say wait a couple of days before your next procedure. In addition to liposuction under the chin, I’d recommend ThermiTight to further remove fat and tighten the skin. This combination should help you achieve your ideal. Please consult a board-certified dermatologist who is an expert at chin and jawline contouring.

Q: What is the ideal time to have chin and jowl liposuction after having Nefertiti lift and Botox in the masseter muscle?

A: My preference would be to do the liposuction first, but since you went for the Nefertiti lift, I’d say wait a couple of days before your next procedure. In addition to liposuction under the chin, I’d recommend ThermiTight to further remove fat and tighten the skin. This combination should help you achieve your ideal. Please consult a board-certified dermatologist who is an expert at chin and jawline contouring.

Q: Can Botox cause the brain to stop using a muscle, resulting in a permanent effect?

A: The neuromodulators Botox, Dysport, and Xeomin are injected directly into targeted muscles, where they block nerve signals that prompt the muscle to contract. This only affects the receptors in the muscles themselves. None of the neuromodulators get into the bloodstream or affect the brain’s signals. The brain’s signals are still sent; the message is just blocked in the muscle. With time, however, the brain may no longer send the signals, as it has been “taught” that they do not have an effect. That may be why we see effects from continued treatment last longer and longer with repeated treatments over years. Botox’s (Xeomin, Dysport) effects are not permanent. In the masseter, they stop blocking nerve signals after about 6 months. Over time the treated muscles become a little weaker because they’re not contracting as much. Similarly, if you stop flexing your biceps and training them with weights, they’ll weaken too. A weakened muscle doesn’t do as much damage to the skin, so your Botox may last a little longer. Please consult a board-certified dermatologist who is an expert with Botox, Xeomin, and Dysport to have your masseters treated

Q: Can Botox for craniofacial hyperhidrosis give cosmetic benefits to the face?

A: The injection points for using Botox to control craniofacial hyperhydrosis are different than those used to smooth out wrinkles. While you could get some cosmetic benefits from your hyperhydrosis injections, they could also cause some drooping if not administered properly. If you want to control your wrinkles as well as excess sweating, you need to find a board-certified dermatologist who is expert in both procedures.

Q: Is preventive Botox at 18 too young?

A: You are young for Botox, but if you’re already developing wrinkles that are related to excessive muscle movement, that might be the best solution for you. However, that has to be decided in person. It’s possible you’re not hydrating your skin properly and that’s why it’s wrinkling. Non-ablative fractionated lasers and/or medical-grade skin care might take care of your concerns. Please consult a board-certified dermatologist who can find the right treatments for you now and help you keep your skin youthful as you age.

Q: What can I do about my eyebrow lifting higher than the other?

A: It’s normal to have asymmetry in your face, but if it bothers you it can be corrected with Botox, Dysport, or Xeomin. These neuromodulators can either raise the lower brow or depress the higher brow. Other treatments include skin tightening with Thermage FLX. At times, expert use of an HA filler like Restylane or Juvederm may also help. For best results, more than one type of treatment may be necessary. Please consult a board-certified dermatologist who is an expert in using a variety of techniques to correct brow asymmetry.

Q: got Botox done between directly between my brows and above them. About and hour after Botox I got new sunglasses in the mail. I tried them on and was messing around with them to get them to get them to fit better. I pressed down on the glasses and moved them around.

A: You shouldn’t worry about your Botox treatment. Botox actually settles into your muscles quite quickly, within a few minutes. Wearing sunglasses, and even pressing on them shouldn’t affect your results. Please consult a board-certified dermatologist for your Botox treatments to get the best results.

Q: Is it too soon to get Botox on forehead? It has been 8 months since my first treatment.

A: If you’re 8 months out since your first Botox treatment and still seeing good results, you are lucky. Most of the time, Botox in the forehead wears off after 3 to 4 months. Being re-treated now won’t “freeze” your forehead if you work with an expert injector. You probably only need a touch-up every 6 to 7 months, since you seem to metabolize Botox slowly. Please consult a board-certified dermatologist for your Botox treatments to get the most natural-looking results.

Q: Is it too soon to get Botox on forehead? It has been 8 months since my first treatment.

A: If you’re 8 months out since your first Botox treatment and still seeing good results, you are lucky. Most of the time, Botox in the forehead wears off after 3 to 4 months. Being re-treated now won’t “freeze” your forehead if you work with an expert injector. You probably only need a touch-up every 6 to 7 months, since you seem to metabolize Botox slowly. Please consult a board-certified dermatologist for your Botox treatments to get the most natural-looking results.

Q: Is Botox safe? Would it be a good filler for pock mark scars?

A: Botox is absolutely safe and has a 20-year record of cosmetic use to prove it. However, Botox is not a filler and can’t address your chicken pox scars. Botox is used to relax the muscles that cause wrinkles on the forehead and around the eyes. If you want to address your scars, I’d suggest laser treatments to resurface and improve the quality of your skin, a surgical procedure called subcision and/or then filling deeper scars with Bellafill or another dermal filler. Please consult a board-certified dermatologist who can offer you a variety of effective solutions.

Q: Do you still retain full movement of eyebrows after a non surgical (Botox) brow lift?

A: Botox works by relaxing muscles so they don’t move as much. For the Botox brow lift, the muscles that are quieted are the ones that pull the brows down, not the ones that lift them. An expert injector can give you the brows you want. Over-treating this area can drop the brows or make them totally immobile. You can discuss your concerns with your board-certified dermatologist before your treatment.

Q: Botox for masseters - injection techniques and dose?

A: Since this is your first time, I’d suggest starting on the conservative side with Botox. About 20 units on each side can relax the bulky muscles. Your board-certified dermatologist will be able to pick the best injection sites to give you the jawline you want.

Q: What's the best way to treat fine lines for women in their 20s?

A: The best way to sort through all of the amazingly effective assortment of anti-aging treatments that are now available is to consult with a board-certified dermatologist. If you have forehead wrinkles, then the first thing you should do is get Botox, Dysport or Xeomin to stop them from being reinforced. You’ll need touch-ups every three to four months. Your dermatologist can also recommend a medical-grade skincare and sun-protection regimen to keep your skin in optimum condition. Regular treatments with a variety of non-ablative fractionated lasers or fractionated radiofrequency or ultrasound can also help. Please consult a board-certified dermatologist who can work with you over the years to keep you looking as young as possible for as long as possible.

Q: Botox alternative for sensitive patient?

A: I’m not sure what you were using Botox for. In the past 20 years that I have been using Botox I have never had nor heard of anyone having “hives” at the injection site. You could try Xeomin and Dysport. They are also botulinum-toxin based, but their formulations are slightly different and you may tolerate them better. If you’re using Botox for forehead wrinkles, lasers or radiofrequency therapy such as Lutronic Infiny improve the quality of your skin so that it’s not as prone to wrinkling, but it won’t stop the wrinkles altogether. Only the neuromodulators can do that because they actually stop the cause of the wrinkles: dynamic muscles pressing the skin over and over. Please consult a board-certified dermatologist who can take time to evaluate your skin quality and learn more about your needs so the best and best tolerated solution can be found for you.

Q: Would Botox help with my uneven eyes?

A: ou could get a more open look on your right eye by relaxing the lower lid with just a touch of Botox. This is a delicate procedure, so you will need to shop around for an expert. Please consult a board-certified dermatologist who can demonstrate his or her expertise in changing eye shape with Botox, Dysport, or Xeomin.

Q: Can Botox and filler help with the horizontal line between my eyes?

A: Any of the neuromodulators — Botox, Dysport or Xeomin — can smooth out horizontal wrinkles on the nose, commonly referred to as bunny lines. This may be the only treatment you need, although you might also benefit from a laser procedure and/or dermal fillers. I’d suggest going slowly, starting with bunny-line treatment, and see how you like the results. Please consult a board-certified dermatologist who is an expert with neuromodulators.

Q: What can I do to get that chiseled sharp jaw line? Make my eyes bigger? What can I do Botox? Fillers?

A: If your masseter muscles are bulky, Botox, Dysport, or Xeomin may be a great solution to help you achieve a more heart-shaped face. However, if you don’t have bulky masseters, Botox in your jawline would make it softer, not tighter. I’d suggest Kybella or liposuction under the chin, and Voluma and/or Sculptra in the midface and cheeks to create lift and tighten the jaw. Please consult a board-certified dermatologist who is an expert at reshaping the face with dermal fillers to get the beautiful results you want.

Q: Botox a week ago tomorrow. Should I feel results yet?

A: Neuromodulators such as Botox can take up to two weeks to have full effects. Botox may be quite effective at minimizing TMJ and jaw pain. If you don’t feel a difference at the two-week mark, go back to your injector. You may need a higher dose or an injection in a slightly different location. When working with the jaw, it’s best to start on the conservative side, so that may be the path your professional chose. Please consult a board-certified dermatologist who understands anatomy whenever you choose facial injections.

Q: Can a cold decrease Botox lateral brow lift effects because of irritation?

A: Having a cold or other slight malady should not alter Botox’s effects. When you create a brow lift using Botox, Dysport, or Xeomin, just a touch of neuromodulator is used — a different set of injection locations is needed to quiet down forehead wrinkles. Therefore, you might actually be seeing the beginnings of efficacy but they’re so subtle you don’t notice. It takes Botox about two weeks to be fully active. You should notice your brow lift by the end of that time. Please consult a board-certified dermatologist who is an expert injector if you’re not happy with your Botox brow lift two weeks from now.

Q: Can Botox fix my asymmetrical eyebrows? My one eyebrow is obviously lower than the other.

A: Any of the neuromodulators — Botox, Dysport and Xeomin — can be used to create a nonsurgical brow lift and correct your asymmetry. The neuromodulators can last anywhere from three to six months, depending on which you choose. Please consult a board-certified dermatologist who is an expert at correcting brow asymmetry with Botox because it is an advanced procedure that requires a lot of experience to accomplish beautifully.

Q: Injector told me that my Botox treatments are only lasting 1.5 months (approx) because I workout a lot. Is this true?

A: Most of my patients who get Botox also work out to one degree or another. I have not noticed a pattern of the more active patients having less longevity with Botox. Nor have I encountered studies to that effect. Some people just naturally metabolize neuromodulators more quickly than others do. Perhaps you are one of those people. More likely, either your injector is inexpert in his or her technique and/or is not giving you full strength Botox, or is not giving you enough. Ask your injector for more information and then also please consult a few board-certified dermatologists who have proven expertise in administering Botox; you may notice a difference in expertise.

Q: Do you do Botox for the under eye area?

A: The neuromodulators Botox, Xeomin, and Dysport relax dynamic muscles that cause wrinkles — such as those at the corners of the eyes (crow’s feet), between the brows (frown lines aka 11s), and forehead wrinkles. They are not usually appropriate underneath the eyes. Those tiny wrinkles can be smoothed out with lasers, chemical peels, or hyaluronic-acid based fillers. Please consult a board-certified dermatologist who can determine which therapies would make your eyes look healthy, youthful, and bright again by removing under-eye bags, discoloration, and wrinkles.

Q: Not so sure I want to try Botox. Are there good alternatives that will help me get rid of wrinkles on my forehead the same way Botox does?

A: The best treatment for dynamic wrinkles on the forehead are the neuromodulators made with Botulinum toxin, which includes Botox, Xeomin and Dysport. If you don’t want to use them, you can concentrate on improving the texture of your skin with lasers, and filling in frown lines with dermal fillers. However, the only thing that stops the wrinkles at the source is a neuromodulator. Please consult a board-certified dermatologist who can walk you through all of the possible treatments so you can find the ones that make the most sense for you.

Q: Where would Botox be best suited/safe/effective for a person who has wrinkles all over their face?

A: Botox can be used in various areas of the face for different reasons. Usually, we use it for wrinkle control on the forehead, between the brows (the 11s), and at the corners of the eyes (crow’s feet). Botox works by relaxing the dynamic muscles that cause some wrinkles. If you have wrinkles all over your face, however, that suggests you may have a significant amount of sun damage. That can’t be remedied by Botox. You may need lasers, microneedling, chemical peels, and fillers to get a beautiful rejuvenation. Please consult a board-certified dermatologist who can evaluate your skin and recommend the best procedures for you to get healthy, smooth, and glowing skin again.

Q: How long after receiving Botox do you see the full benefit? Also, how many times can one receive this? I know it is every 4 months, but is there a limit to how long one can keep getting botox?

A: You may notice the beginning effects of Botox just a day or two after your treatment. For most people, it takes about two weeks for the full effect to manifest. Botox is an extremely safe treatment and can be used throughout the rest of your life to keep your wrinkles at bay. With continued use, you will probably need less to get the same effects. Please consult a board-certified dermatologist who is an expert at using Botox so you can start controlling your wrinkles today.

Q: My right brow/eyelid is droopy to the point where my eyes look like different shapes entirely. Are there injection options that could help? I’ve read about Botox above the brow as a “Botox brow lift” but I’m not sure. I really don’t want surgery yet, so I’d love to know if other options could at least help.

A: Injecting a neuromodulator such as Botox, Dysport, or Xeomin into the depressor muscles on the forehead relaxes them so they don’t pull downward on your eyebrow. This allows the brow to lift to a certain degree. How much depends on your anatomy and your skin quality. The effect can be made more dramatic with a dermal filler to create support for the brow so that it stays lifted for a longer period of time. Please consult a board-certified dermatologist who can evaluate your skin and muscles to determine if you’re a good candidate for a Botox brow lift.

Q: I have plantar hyperhidrosis, currently taking robinul 5mg BID. I'm looking for a Botox treatment available in the area. If it is available, how much would it cost me?

A: Botox is a very effective way to quiet down the sweat glands in the feet, under the arms, on the face, and elsewhere. The cost varies by your geographic region and the amount of Botox used. Please note that it takes significantly more Botox to stop excessive sweating than it does to treat cosmetic issues. Please take your time to find a board-certified dermatologist who has expertise in treating plantar hyperhydrosis; it’s an advanced procedure.

Q: Can Speed of Botox Results Vary? Botox Takes Several Days to Work

A: A new administration of Botox, Dysport, or Xeomin can take between 24 hours and up to 7 days to work. If you didn’t keep up with your maintenance, your muscles are now back to baseline strength, so it will take longer for them to calm down. In addition, the injector may have switched from one neuromodulator like Botox to another like Xeomin which has different onsets of action. If you don’t see results within a week, please go back to the injector. Always consult a board-certified dermatologist to get the best results.

Q: Can Botox help my wonky face and eyebrows?

A: First, your face doesn’t look “wonky”; you are attractive and your eyebrow asymmetry is within normal ranges. However, if you’d like a more symmetrical look, then yes, neuromodulators such as Botox, Dysport, and Xeomin can bring your eyebrows to nearly the same level and can help minimize the difference in your eyelids, if you find an expert. Please consult a board-certified dermatologist who has experience with this procedure, as it is quite advanced.

Q: How does masseter atrophy enhance your jawline exactly? I'm picturing excess skin in that area?

A: Botox, Xeomin, and Dysport are used to relax overdeveloped masseter muscles. These neuromodulators cause the muscle to temporarily atrophy and also decreases clenching and bulking. When the muscle is relaxed and elongated, it makes your face look slimmer. The skin travels with the muscle and does not droop. You’re not actually changing the volume of the lower face, just the position. Please consult a board-certified dermatologist who is an expert at slimming the face with Botox to find out if you are a good candidate.

Q: What can I do to show more upper teeth when I smile?

A: It looks like your upper lip may be a little tense and that could be why so little of your teeth is revealed during a smile. If that’s the case, Botox, Dysport, or Xeomin could relax the muscles that pull your lip downward, letting it rise a little more during a smile. Consulting with a board-certified dermatologist will allow your smile to be evaluated in person, and the proper recommendations made.

Q: What can be done to get my face back to feminine shape? I'm 40 now and my face has changed .my masseter muscles enlarged it looks like. I lost volume under my eyes fat Pads dropped it looks like .I look tired and face shape is no longer feminine .

A: Botox, Dysport or Xeomin in your masseter muscles will calm them down so that your face slenderizes and looks more heart-shaped and feminine. Hyaluronic-acid based fillers, such as Volbella, Belatero and Restylane Silk, work wonderfully to restore your under-eye area to bring back a more youthful and rested look. Please consult a board-certified dermatologist who is an expert in using neuromodulators and dermal fillers to rejuvenate your face.

Q: Is dermawand ok to use right after Botox?

A: There has been no experience using the Dermawand at the same time as Botox. Radiofrequency treatments are limited to the skin and won’t affect the muscles, into which the Botox, Dysport, or Xeomin are injected. However, I recommend refraining from handling your skin roughly, massaging, or doing any kinds of treatment for about a day after Botox — just to be sure the product doesn’t migrate. Please consult a board-certified dermatologist who can administer your Botox expertly, answer any questions you have, and administer high-powered RF treatments, if needed.

Q: Options for downturned mouth would Botox work? Are there any other treatments?

A: Your depressor muscles may be overactive, which is why your mouth corners turn downward. A little Botox, Dysport, or Xeomin in those muscles should allow your lips to turn up a bit. You can also use dermal fillers to reveal a little more vermillion at the corners, giving you more of an upturned, smiling look. Please consult a board-certified dermatologist who is an expert at reshaping lips with Botox and fillers.

Q: I’m pregnant and the smile lines around my eyes really look bad without Botox. Are there any safe alternative procedures?

A: Don’t use Botox, Dysport, or Xeomin or dermal fillers while you are pregnant. You can improve the look under your eyes with chemical peels, lasers, and fillers. Avoid retinoids and retinol. Please consult a board-certified dermatologist who can help you find noninvasive ways of helping you feel better about your skin while you enjoy this amazing time in your life.

Q: Feminizing square bony female face: I'm concerned with my large masseter muscles and long rectangular face. feel it makes me look old and masculine (I’m 20) what procedures could make my face shorter, rounder, and more femenine? Would masseter Botox help me?

A: Botox, Dysport, or Xeomin in your masseter muscle can help you get a more heart-shaped face. You can also soften the lines of your jaw with dermal fillers. Consulting with a board-certified dermatologist will give you a better idea of the possibilities that are open to you.

Q: Botox results after 3 days, will the lines continue to fade?

A: You are already looking better, just 3 days after your Botox. Most neuromodulators, such as Botox, Dysport, and Xeomin, take at least a few days to a week for maximal effect. Once your muscles are fully relaxed, the skin smooths out little by little. Depending on how deep your wrinkles were, it may be a couple of weeks before your forehead looks less furrowed. Sometimes, we also inject a hyaluronic acid filler to smooth the deep wrinkles as well. Please consult a board-certified dermatologist who is an expert injector whenever you get Botox.

Q: Can You Use Gua Sha After Botox? 24 Hours Post Botox, Anything Goes

A: The neuromodulators Botox, Dysport, and Xeomin all settle into the muscles shortly after injection. After an hour, as long as you’re not swollen or sore from the injections, you can treat your forehead normally. Massage is OK, exercise is OK, and so is gua sha. Please consult a board-certified dermatologist who is an expert injector whenever you receive neuromodulators.

Q: How can I get rid of a horizontal crease between my eyes? It is as my forehead skin is slipping down on my nose.

A: Photos would be helpful, but it sounds like a neuromodulator, such as Botox, Dysport or Xeomin, could give you some relief. A little Botox in the muscles that pull downward on your forehead would relax them and lift your brow. That should also decrease the crease that bothers you. Sometimes, we also recommend injection of a hyaluronic acid filler into the crease to fill it up. If a filler is used, results can last over a year. Please consult a board-certified dermatologist who is an expert at using fillers and neuromodulators to treat the forehead.

Q: Is there a non-surgical way to fix a nose-covered smile? 


A: Small amounts of well-placed neuromodulators — such as Botox, Xeomin, and Dysport — can rectify both of your problems. Your nose can be lifted by relaxing the muscle that’s currently dragging it downward. Your lip can be lifted in a similar fashion. In addition, sometimes a small amount of filler can be used to raise the nasal tip and evert and raise the lip for more effect. Please find a board-certified dermatologist who is an expert at using Botox around the mouth, because you wouldn’t want a poorly placed injection to interfere with the function of your lips or impede your speech. You need a real expert to help you with this. The Botox should last about 4 to 6 months. Fillers usually last at least 6 months.


Q: I'm 33 and have never had any cosmetic procedures. However I would like to get Botox to dynamic forehead lines (faint lines visible when I raise my eyebrows) and fillers to naso labial folds. As I haven't had anything before I would prefer to get one area treated at a time.

A: Botox is a great first-line treatment for the early signs of aging. By smoothing out the forehead, you attain a younger look overall. That said, if the nasolabial folds bother you more, then do them first, especially since you can’t see the forehead lines unless you raise your brows. It all comes down to your preference, not someone else’s judgment of you. The new skincare routine you have plus sun avoidance will keep you looking young for quite some time. I’d suggest adding in a laser treatment to help your skin stay thick and healthy. Please consult a board-certified dermatologist who is an expert in anti-aging techniques.

Q: My right eyebrow is slightly droopy when my face is relaxed, but much more noticeable when I smile. I was wondering if I could achieve the look I want with Botox rather than with a facelift.

A: You don’t need a facelift or even a brow lift to raise a slightly droopy eyebrow. Botox does a great job of relaxing the muscles that pull the brow downward, allowing it to rise 1 to 2 mm naturally. The Botox, Dysport or Xeomin will last between 3-4 months. It takes an expert injector to lift the brows nonsurgically, so please take your time finding a board-certified dermatologist who can show you good results for Botox eyebrow lifts.

Q: Is there swelling when getting Botox injections?

A: Botox is injected through the skin, so depending on how sensitive you are, you may have a small amount of swelling afterwards. However, most patients only get a tiny bump or two at the injection site that disappears within an hour. If you do have a little redness and swelling, you can control it with ice. If you get more severe redness or swelling, then you need to find a new injector for your next treatment. Please consult a board-certified dermatologist who has verifiable expertise with Botox to get the best results with the fewest (or zero) side effects.

Q: Are there any doctors who have performed Botox on patients with Tourettes?

A: In certain cases, Botox can be a highly effective remedy for quieting down grimacing and spasticity in patients who have Tourettes Syndrome, and can also alleviate other spastic conditions, including Bell’s palsy. I have multiple patients with these conditions that respond really well (see our website). You could ask your neurologist for some recommendations for dermatologists who perform this procedure (if he or she doesn’t already do it), or simply do the research yourself to find an expert. Please only work with a board-certified dermatologist who has successfully treated Tourettes with Botox in the past.

Q: How much Botox would be needed for major forehead wrinkles due to extended tanning for 10 years?

A: Don’t even think about getting Fraxel, Botox, or any other cosmetic treatment until you’ve stopped using a tanning bed and tanning on the beach. You are damaging your skin and dangerously increasing your risk for skin cancer. The exact number of units you’d need to relax your forehead wrinkles and glabellar lines could vary depending on their depth, but around 20 to 40 units would probably work. The choice of filler would also depend on the depth of your wrinkles; the Botox might be sufficient. Please consult a board-certified dermatologist who can help you break your tanning addiction and undo the damage that the UVA and UVB rays have caused.

Q: I got Botox injected under my eyes for subtle eye wrinkles. I saw many people say you shouldn't get it under your eyes because it can cause swelling and bags... it has been 2 1/2 days since I got injected. When would the swelling show up? Should I reverse it before it's too late?

A: If you haven’t experienced any swelling 2.5 days after your Botox injections, you are probably OK. For future reference, though, Botox is a muscle relaxant that removes wrinkles indirectly by relaxing muscles. It should not be injected underneath the eyes, as it can cause swelling. If you want to fill in under-eye wrinkles, your injector should use a hyaluronic-acid filler such as Belotero Volbella or Restylane Silk or use a laser to treat the skin. Please consult a board-certified dermatologist when getting cosmetic injections; it is a medical procedure.

Q: Can Botox help with hooded eyes by subtly raising the arch on your eyebrows?

A: You can improve the arch on your right eyebrow with a neuromodulator. such as Botox, Xeomin, or Dysport. This will indeed raise your eyelid skin slightly so that it doesn’t look so droopy. Reshaping the brows with neuromodulators is an advanced procedure that requires expertise, so please consult a board-certified dermatologist who can demonstrate good results on previous patients.

Q: What would be my best option for asymmetry correction: Botox? Restalyne, or surgical procedure?

A: You have very minor asymmetry and I’m sorry that you are being chided for it. Those frown lines can be nicely smoothed out with Botox, Dysport or Xeomin, which will prevent your forehead muscles from pressing the skin into creases. If neuromodulators aren’t enough to completely smooth out the skin, then a little Restylane Defyne or Refyne would work. As for your nose asymmetry, if it’s due to a crooked nasal bone, dermal fillers can create a straighter line. If it’s caused by an overactive muscle on one nostril, a neuromodulator will relax it. A light filler, such as Volbella or Restylane Silk, could even out your lips. Neuromodulators can last from 4 months to over a year. Dermal fillers can last from 6 months to almost 2 years. Please consult a board-certified dermatologist who can help you resolve these issues and feel better about your appearance overall.

Q: What is the best treatment for forehead wrinkles? Age 33.

A: If you have light forehead wrinkles without significant sun damage, then Botox, Dysport, or Xeomin would be your first best step. These neuromodulators relax the muscles that press your skin into wrinkles. Without the constant creasing, the skin smooths out and the wrinkles disappear. To verify that this is the best choice for you, please consult a board-certified dermatologist who can evaluate the tone and quality of your skin.

Q: I am breastfeeding my daughter twice a day. But want to resume my botox due to constant migraines. I also have found that my right brow sits higher than my left and this is most likely because of the effects of my botox (pre-baby) wearing off. Do I have to wait until my child is completely weaned to get botox again?

A: The chance that Botox or any other neuromodulator — such as Dysport or Xeomin — could affect your breast milk is pretty low. These are local treatments that do not enter the bloodstream. However, when it comes to babies, we don’t like to take any kind of risk if a procedure isn’t absolutely necessary. If your migraines are debilitating, you may need to make the choice of getting Botox to control them; there are no studies that have linked any kind of risk to Botox and breastfeeding. I would not do it for the eyebrow asymmetry. Please consult a board-certified dermatologist or neurologist if you decide to move forward with Botox for migraines.

Q: Can I get a hair botox treatment before a breast reduction surgery?

A: Botox, Xeomin, and Dysport are neuromodulators that express only local effects. They do not migrate more than a few centimeters from the injection site, nor do they enter the bloodstream. It is perfectly safe to have surgery elsewhere on the body if you’ve just had Botox. Please consult a board-certified dermatologist who is an expert injector to get the best results from Botox.

Q: How Safe Are Botox and Filler Parties? Don’t Allow Nonprofessionals to Inject Fillers and Botox at Parties

A: Botox, Xeomin, Dysport, and dermal fillers are all administered by injection — a medical procedure. This should always be done by a medical professional in a medical setting and with proper precautions. If you and your friends want to arrange a “party” at the dermatologist’s office — meaning that you all book appointments at around the same time slot — that would be a safe alternative. Then afterward, you could go celebrate your rejuvenated looks elsewhere. But please don’t ever get Botox or fillers at someone’s home or in an atmosphere that isn’t professional and safe. You get what you pay for and I would hope that you value your face enough to make sure it is treated in the most professional and safe manner possible. Please consult a board-certified dermatologist who is an expert injector for your Botox and fillers.

Q: Does exercising regularly shorten duration of Botox?

A: Many of my Botox, Dysport and Xeomin patients are quite athletic. I haven’t noticed any difference in the duration of their treatments, when compared with the standard duration of 3 to 6 months. Feel free to exercise as usual. Please consult a board-certified dermatologist who is an expert injector to get the best, most natural-looking results.

Q: I am searching for a botox alternative that is natural and does not require animal testing. Are there any alternatives out there?

A: Botox should always look natural. If it doesn’t look natural, then it was inexpertly administered. If you’d like an alternative to Botox, both Xeomin and Dysport are just as effective in quieting down the dynamic muscles that cause wrinkles. I am not sure what their animal-testing policies are. If you decide not to use a neuromodulator, you might benefit from laser treatment and/or microneedling. Please consult a board-certified dermatologist to find out about all of the wide variety of effective options that are available to you.

Q: Hello doctors I’m 18 and having dynamic wrinkles on forehead very fine (dynamic) Can Botox from young age can slow down again process

A: I noticed that you live in California, which may be why you are seeing forehead wrinkles even at the young age of 18. First, before even thinking about Botox, I’d recommend you get to the dermatologist so you can be prescribed a medical-grade skincare regimen plus get a high-quality sunscreen that you will wear every day. As you know, the sun shines all year round in California, and even on the few days when it doesn’t, the clouds reflect the UVA and UVB rays that will damage your skin. You must minimize your sun exposure if you want to have healthy skin. Wearing ultraviolet blocking sunglasses will also help minimize the squinting from the sun. And yes, Botox in your forehead and between your eyes will quiet down the muscles that’s causing your wrinkles. It will last about 3-4 months. Please consult a board-certified dermatologist who can help you prevent more wrinkles in addition to fading the ones that you have.

Q: When I pay for Botox units, am I paying for pure Botox or Botox that has been mixed in a solution?

A: All Botox must be reconstituted with a normal saline solution before it can be injected. If you are being treated by a reputable, board-certified dermatologist, you are paying for the Units of active Botox needed to relax your muscles — not for the saline. While there is a standard dilution recommendation, there is some individual variation based on practitioner preference. Be sure you are working with a board-certified dermatologist who treats you with the correct amount of Botox.

Q: Hi, I have a asymmetrical jaw that I guess comes from grinding my teeth and chewing mainly on one side (my crooked teeth are beeing treated and should be aligned in ca. 10months). I wonder if the asymetrical look can be corrected with botox. What results can I expect? How many ml I would need on each side?

A: You are already getting treatments that may alleviate your asymmetrical look. If you don’t want to wait 10 months to see how that affects your jaw asymmetry, then a little bit of Botox in the overdeveloped masseter muscle will slim it down. If you just want to do the one side, then 10-20 Units may be sufficient. Please consult a board-certified dermatologist who is an expert at treating the jaw with Botox, as this is a very advanced procedure.

Q: Would these deep lines on my forehead disappear with Botox or do I need a brow lift?

A: Any of the neuromodulators — Botox, Dysport, or Xeomin — could do a terrific job in smoothing out those forehead furrows by not allowing the muscles to contract and reinforce them. Resurfacing your skin with a laser could also help your skin become stronger, more resilient, and less prone to wrinkling. Please consult a board-certified dermatologist who is an expert at relaxing the forehead with Botox.

Q: Can you develop an allergy to Botox even if you never had one before?

A: I think you already answered your question, just by asking it. The injection process felt — and sounded — different to you. Between your description and your photos, this looks like an operator error, NOT A REACTION. Take some time before your next touch-up to find a board-certified dermatologist who is an expert with Botox, Xeomin and Dysport to treat you. You should not have any of the symptoms you described.

Q: I had Sculptra injected into my nasolabial and melolabial folds. However, it did not seem to make a difference in the downturn of my mouth. Is there another injectable to fix this? Do I need Dysport or Botox for that area? Is surgery my only option?

A: Your downturned mouth can be corrected with a neuromodulator that will relax the muscles that are dragging it downward. Botox, Dysport or Xeomin could all improve your expression, if administered by an expert. In addition, strategically placed filler, like Restylane or Juvederm can also lift and fill in this depressed area with results that last over a year. Often we use both of these techniques together for an amazing result. Please be sure to consult a board-certified dermatologist who has many years of experience using neuromodulators around the mouth; you want to get a beautiful result without impeding expression or motion.

Q: I'd like to remove my under eye wrinkles, any suggestions?

A: You’re at a good age to start regular Botox to prevent crow’s feet. This neuromodulator will relax your eye muscles so the wrinkles smooth out. Dysport and Xeomin would also work. In addition, your dermatologist should make a recommendation for a skin-care regimen with retinoids to keep your skin healthy and strong. Be sure to consult a board-certified dermatologist who can work with you over the long term.

Q: Is it safe to inject Botox into filler that was previously placed between my eyebrows? Will the needle push the filler into a vein or artery.

A: Not only is it safe to use Botox, Dysport or Xeomin and hyaluronic-acid based dermal fillers together, it’s preferable — particularly in the forehead. Botox is used to quiet down the dynamic muscles that create wrinkles. The decrease in motion also keeps the HA fillers from being metabolized too quickly. The fillers can’t be pushed into an artery or a vein. Please consult a board-certified dermatologist who is an expert at using neuromodulators and dermal fillers to rejuvenate the face.

Q: My forehead is very bumpy and gross looking, and it isn’t smooth. I was wondering if botox would be able to smooth it out and make it look more normal

A: It looks like you may have an overly active frontalis muscle, which is causing the bulging that distresses you so much. If this is the case, Botox or any of the neuromodulators like Dysport and Xeomin could be the ideal treatment for you. However, you will need to meet in person with an expert. Please consult a board-certified dermatologist who has experience using Botox on male faces.

Q: Will 10+ sessions of Botox to the masseter muscles eventually cause them to stay down permanently?

A: It’s true that, over time, repeated sessions of Botox may weaken your muscles sufficiently that you need a lower dose, with the results lasting longer and longer. However, it’s unlikely that you would ever be able to forego the treatment entirely, as “permanent” really means forever. In general, you need to re-administer Botox in the masseters every 6 months to keep the face-slimming effect. This will just be part of your normal self-care routine. There is no guarantee, either, that your muscle will be weak enough after 10 treatments to need a lower dose; everyone is different. Please consult a board-certified dermatologist who has experience in slimming faces with Botox to get the most flattering face slimming.

Q: I had Juvederm filler for my forehead lines as well, i had one long horizontal line, not too deep. My question is "if I decide to do a bit of botox for forehead area to smooth the lines, will my eyebrow lift like Dr. Spock - noting that I will not have botox between eyebrow (frown lines).

A: Using Botox, Dysport or Xeomin and hyaluronic-acid fillers together is a great combination because the Botox minimizes muscle movement, thereby prolonging the action of fillers. A result such as “Dr. Spock” brows is always caused by inexpertise on the part of the injector and is from the Botox, or the filler. That’s why it’s so important to take your time and find a great board-certified dermatologist who can give you the look you desire without creating any unwanted effects.

Q: What is the best option for treating my fine lines and wrinkles around my eyes?

A: I wouldn’t use Voluma on the eyes. It is much too thick and will not look natural. You can control your crow’s feet with regular Botox injections every 3 to 4 months. The under-eye wrinkles can be improved with laser therapy and microneedling. Very thin fillers, such as Belotero, can smooth out the lines and tear troughs. Also be sure to avoid the sun and use sunscreen regularly. Consulting a board-certified dermatologist will help you come up with solutions to your immediate problems and minimize the impact of other aging issues in the future.

Q: Will 12 units for both sides with Dysport give a heavy eyebrow a good lift?

A: The amount of Dysport you received seems appropriate for your needs. You can expect to start seeing your results in the next few days. All of the neuromodulators can do an excellent job of slightly raising the brows without surgery. But, proper technique is important. Please consult a board-certified dermatologist when you’re ready for your touch ups in about 4 months.

Q: Are there different types of Botox injection techniques? Last time was extremely painful and left me with puffy eyes.

A: The reaction you had is not what one expects from an expert injection of Botox. There should be virtually no pain — other than the slight pinch of the needle. I have been injecting Botox in tens of thousands of patients over the last 15 years with not one patient having the experience you had.Your practitioner may have injected too deeply, too roughly, or used a painful solution to dilute and reconstitute the product. None of these is acceptable. Please consult a board-certified dermatologist who has years of experience helping patients resolve wrinkles with Botox — virtually pain free.

Q: When I smile, the right side of my face looks completely different and feels forced. It's been like this ever since I was little but becomes more prominent every year.

A: The sides of our face are meant to be sisters, not twins. You are absolutely correct that the asymmetry just becomes more prominent with age, as you lose more bone after the age of 25, and have less bone to support the muscles that contract and lift your lip when you smile. A little Botox, Dysport or Xeomin will relax that muscle so that your smile evens out. But if it is not enough you can inject a bit of filler along the maxilla to support the muscle.Consulting a board-certified dermatologist will help you feel better about your lovely smile.

Q: Is my masseter Botox working? I can still clench my teeth.

A: You should still be able to clench your teeth after Botox, Dysport or Xeomin in the masseter muscles. The fact that you can’t clench as much is a good sign. You need the muscle to be relaxed, but still functional so you can chew. It generally takes a few weeks before you’ll notice jaw slimming after Botox. If, after 2 months, you don’t notice a change, please consult your board-certified dermatologist to get a higher dose.

Q: I have an orange peel chin. What can be done to fix this? I know Botox can be used, but is this something I’d have to keep getting done every couple of months?

A: Botox can do a great job of smoothing out your chin and removing the orange-peel look. It only takes a small amount of Botox to make a big difference in this area. Over time, as your muscle weakens, you may need less Botox. Regardless, it would only have to be re-administered every 4 to 6 months. That’s a much longer maintenance schedule than that for a haircut or a manicure. Looking our best takes constant vigilance! Another option is the use of a very fine hyaluronic acid filler like Restylane Silk or Belatero. Please consult a board-certified dermatologist who can help you feel better about your chin.

Q: I am trying to have a more feminine lower face shape and thinking about getting jaw reduction botox. However, how do I know if my jawline width is due to masseter hypertrophy or if the width is due to bone?

A: It does seem that the wideness of your jaw may be due to bone, not clenched muscles, but this can only be determined by an in-person consultation. Your jawline and lower face look beautiful and feminine to me. However, if you do have an overdeveloped masseter muscle, you can try Botox and see if you prefer a more heart-shaped face. If so, you’ll have to have Botox re-administered every 6 months or so. If not, your jaw will return to baseline after the Botox wears off. Please consult a board-certified dermatologist who is an expert at reshaping the face with Botox.

Q: Do I need to get Botox in my forehead, a brow lift or both?

A: You already have a high hairline, so a brow lift would probably not be flattering. I’d recommend finding an expert Botox injector and get a dose that would be strong enough to quiet down your forehead muscles and allow the wrinkles to smooth out, but not strong enough to affect your eyebrow position. The wrinkles can also be improved with laser resurfacing and/or hyaluronic-acid based dermal fillers. Please consult a board-certified dermatologist who can show you great results with Botox.

Q: Does Botox cause loss of hair?

A: I know of no association between Botox and hair loss — or hair growth, for that matter. In my 30+ years of practice, I’ve never heard of any patient complaining about hair loss after Botox. Probably the association you noticed was coincidental. If you are bothered by the hair loss and the hair does not grow back on its own, please consult a board-certified dermatologist who can examine your hair and recommend remedies to help you regrow it.

Q: How many units of Botox for a slight tip of nose lift?

A: You would only need a small amount of Botox to accomplish a slight nose lift. The actual amount would be determined by your dermatologist, but it would probably be between 2 and 4 Units. Please consult a board-certified dermatologist who has expertise in creating nose lifts with Botox.

Q: I had botox injections yesterday to improve wrinkles in my forehead. Today, I took two activated charcoal tablets for an unrelated issue, but now I am concerned this will effect the botox or draw it out of my system?

A: Botox is injected into the muscle that is being treated, and stays there. It does not enter the bloodstream and therefore will not be affected by an oral remedy, such as activated charcoal. Your Botox should last about 3 to 4 months. Please consult a board-certified dermatologist who can help you set up a maintenance schedule for your Botox.

Q: Botox for facial slimming on the east coast, how long does it last?

A: While results will vary by patient, Botox in the masseters to slim the face tends to be very successful. Usually, Botox lasts about 6 months in that area. How much is needed will vary by your anatomy, which is why it is important to consult a board-certified dermatologist who can examine your musculature and discuss your desired results. Cost also varies and can be discussed in your consult.

Q: Can Botox be giving in the temple to stop temple twitching? I've been having these temple twitching for quite some time now and it's very annoying my nose also twitches I heard Botox can stop the twitching.

A: Botox works by blocking the signals that nerves send to the muscles. Because twitches are generally caused by overactive muscles, Botox can be a good remedy. It will last about 3 to 4 months. Your nose twitching can probably be helped with Botox. Often times muscule twitcing of the temples is related to stress, but even in that case, injections of botox are safe and effective in this area. Please consult a board-certified dermatologist who can help you determine if your twitches can be controlled with Botox, or if you should consult with a neurologist or other medical professional.

Q: For years now my eyebrow has raised itself when talking to people or when I get nervous. Any solutions to this?

A: A little Botox in your overactive brow will calm it down so that it doesn’t move without your willing it. Botox lasts about 3 to 4 months. Consulting with a board-certified dermatologist for your Botox will help you regain control over your expressions.

Q: Is my activated charcoal face cream causing my botox injections to wear off quicker? Every time I get another injection it is wearing off after two months.

A: Botox is injected into the muscle and so will not be affected by any kind of face cream. If it is wearing off after just 2 months, you may be one of those people who metabolize it quickly. Or, perhaps, you did not receive a high enough dose or proper placement of the Botox. Please consult the board-certified dermatologist who administered your Botox to get some insights into why this is happening. You also may need to find a more expert injector.

Q: Hello, I have a pretty short beard, like 3 milimeters in length. I never shave it completely so I was wondering if I should shave it before getting this kind of botox (masseter).

A: Your beard is short enough that it wouldn’t interfere with being able to palpate the muscle in order to locate the proper place for a Botox injection. Longer beards might need to be trimmed or shaven. Please consult a board-certified dermatologist who is an expert in slimming down the masseters with Botox.

Q: I am 22 years old and I have a lot of wrinkles in my forehead. I have been thinking about getting botox but I was wondering if there are more permanent treatments for these types of wrinkles.

A: The best remedy for forehead wrinkles is Botox, Dysport or Xeomin. These neuromodulators will stop your forehead muscles from pushing your skin into furrows, which is what causes those wrinkles across your brow. Botox, Dysport or Xeomin needs to be re-administered every three to four months. Over time, you may need it less often, as the muscle begins to weaken with repeated use. You can also improve the quality of your skin with laser therapy, which will stimulate it to produce more collagen. If you have really deep wrinkles, HA fillers may need to be used. The forehead is a tricky area to inject fillers and every patient is unique. So, be sure to go to an experienced dermatologist.

Q: The grinding and accompanied headaches and jaw aches have been getting worse. I was hoping botox would help reduce the pain and tension while also making my jawline less square. How many units are suggested for someone with a prominent jawline and masseter muscles as large as mine?

A: A highly skilled dermatologist who has expertise in treating the masseters with Botox should be able to help you. Botox is very effective in relaxing the jaw muscles so that they stop clenching and grinding your teeth. The nice side effect is that the bulkiness of your jaws will also relax, making your lower face look slimmer, softer and more feminine. The exact dosage would be determined during your consultation. Please consult a board-certified dermatologist who can work with you to help your jaw relax; the effects of Botox in the masseter should last about six months.

Q: How long should I wait to shower after Botox?

A: Botox is a well tolerated procedure that is administered directly to the muscle and so does not curtail most normal activities. A shower the same night after Botox is fine. Alcohol, in moderation, is also fine. Please consult a board-certified dermatologist who can work with you, helping you to understand your treatments and how to get the most out of them in the long term.

Q: I had Botox injected on my glabella lines on Friday and I am now in Spain in 25-30 degrees Celsius heat. I've been wearing SPF 50 along with a cap when I can. Is that ok or should I not be in the sun at all?

A: Botox isn’t affected by sunlight, because it is injected into the muscle. Your skin will thank you for the SPF 50 and the hat in years to come. Please be sure to reapply sunscreen every couple of hours if you are outdoors, in a car, or near sunny windows. Limiting sun exposure is one of the best beauty secrets around. Please consult a board-certified dermatologist who can maintain your Botox and help you keep your skin looking beautiful for years to come.

Q: Light Botox has left some faint lines in my '11s' - would simply upping the dose in the area knock these lines out completely?

A: You can probably add more Botox next time, if you wish to completely smooth out the 11 furrow. However, if you want to keep your movements natural you might consider other methods of removing it. Laser resurfacing can improve the quality of the skin so that it doesn’t wrinkle as easily. A light dermal filler, such as Volbella or Belotero could also fill in the groove. Please consult a board-certified dermatologist who can offer you a number of options to get the smooth and youthful forehead you desire.

Q: I had 8 units botox at 11 weeks pregnant in the corner of my eyes. How harmful is this to my baby?

A: Congratulations on your new baby to be! There is no evidence that Botox can cause any harm to your baby. Botox is a local treatment that affects just the muscle into which it is injected. The amount of active ingredient is very small and it does not circulate in your blood. The use of Botox has never been studied in pregnant women so it is NOT approved for use in pregnant women. But, many women have had Botox while pregnant and have suffered no adverse effects. We recommend to wait until after you’ve finished nursing before getting another treatment — just to be safe. Please consult a board-certified dermatologist when you’re ready for anti-aging treatments again.

Q: My face is too round, I want my face to look longer or slimmer, also I want to add some volume and definition to my chin since I have a weak chin, can this be accomplish with Botox and fillers? Or would a chin implant be a better option?

A: You could create a slimmer, more heart-shaped face by relaxing your jawline with Botox. This would make your face look more feminine. Rather than a chin implant, I’d recommend building up your chin with a dermal filler such as Voluma. This would add length to your face, and further thin it. And it’s not as permanent a commitment as a chin implant. Dermal filler will last up to 2 years. The Botox will need to be redone every 4-6 months. Please consult a board-certified dermatologist who can help you try a new, more feminine look.

Q: How can I control sweat under my arms?

A: If you have excessive armpit sweat, it can be controlled with regular injections of the neuromodulator Botox. Hyperhydrosis is a medical condition and therefore may be covered by your insurance policy, if you have one. If you do not meet the criteria for hyperhydrosis and merely want to stop the normal amount of sweating under your arms, Botox would not be an option. It’s an expensive treatment, must be repeated every 3 to 4 months, and is only worthwhile when it will improve the quality of your life by stopping out-of-control perspiration that causes physical and social discomfort. Consulting with a board-certified dermatologist will allow you to be evaluated for hyperhydrosis to see if you qualify for Botox treatments of this medical condition.

Q: The corners of my lips are uneven when I smile and when I just close my mouth. I want to know does this need to be fixed with lip injections or something or is it a result of my teeth and jaw issues?

A: First, talk to your orthodontist or family physician about your dental and jaw issues. Perhaps there is a physical problem that’s causing your lips to be uneven. However, asymmetry is natural in the face. If you still want to make your lips match each other better, this can probably be achieved with a little bit of Botox to relax your overactive mouth corner and perhaps a dermal filler such as Volbella, which looks very natural, to even out your lips. Consulting with a board-certified dermatologist will help you decide what you want to do; if you are under 18 you will need your parents’ permission.

Q: Upper lip rolls under when I smile - how to help a gummy smile?

A: An expert with lip augmentation and correction can relax your upper lip with Botox so that it doesn’t roll under, revealing your gums when you smile. A touch of Volbella could be used to correct the slight asymmetry in your upper lip, too. You could add volume as well, but that’s up to you. Consulting with a board-certified dermatologist will help you get a more relaxed and flattering smile.

Q: Does Botox work for craniofacial hyperhidrosis?

A: Botox can effectively control excessive sweating (hyperhidrosis) in a number of areas, including the face and head. This is a very advanced procedure in any area of the body, but especially so in the face as there are many important nerves and blood vessels located there. You absolutely must find an expert to help you. Please consult a board-certified dermatologist who has expertise in treating the face and head for hyperhidrosis with Botox.

Q: Is 19 a too young age to get Botox?

A: As long as you are over 18 years of age, you can receive any cosmetic procedure — as long as you are otherwise a good candidate for it. Botox at your age could be used to slim down the jawline, stop muscles from reinforcing wrinkles, resolve a gummy smile, smooth out fine lines around the eyes or forehead, raise or lower the brows, control sweating and/or control migraines. If any of these scenarios reflect your needs, please consult a board-certified dermatologist who has experience with Botox to find out if you are a good candidate for using this highly effective neuromodulator.

Q: Can Botox be used to lower eyebrows?

A: The frontalis muscle is responsible for lifting the brows. A little Botox in that muscle will relax it enough that the brow would drop slightly. It will take an expert hand to do this well. Please consult a board-certified dermatologist who has many years’ experience with Botox to get beautiful and pleasing results.

Q: Other than aesthetics, what are the the benefits of “Scrotox"?

A: The aesthetic benefits that arise from using Botox in the scrotal area are incidental. We began using Botox in that area simply to control sweating. In addition to reducing sweat, however, it was found that Botox smoothed the skin out, the testicles dropped and the testicles looked larger. Please consult a board-certified dermatologist who is an expert injector if you are considering “Scrotox”; this is an advanced use of Botox that must be entrusted only to a highly skilled professional.

Q: I hear that when you use botox at a young age that the face muscles will at a later stage need that botox to function?

A: Actually, the effect is just opposite that which you propose: You need to stop Botox to allow the muscle to contract fully again — no matter what age you started. Botox is a neuromodulator that relaxes the dynamic muscles that cause wrinkles, preventing them from creasing the skin and reinforcing the wrinkles. Usually, the Botox wears off after about 3 to 4 months. Prolonged use may weaken the muscle sufficiently that you don’t need to get Botox as often. However, whenever you stop Botox, the muscle begins to contract again. Please consult a board-certified dermatologist who is an expert in Botox to learn how this neuromodulator can help keep you looking young for years to come.

Q: Based on my profile picture, do you believe I am a good candidate for masseter botox and kybella treatments?

A: I think you would do very well using Kybella to remove your double chin, tighten the skin a bit and create a sleeker jawline. I am not sure that you would benefit from Botox in your masseters; you do not seem to have a heavy lower face. However, the photos make it difficult to visualize your lower face in proportion to your upper face. Consulting a board-certified dermatologist will allow you to be thoroughly evaluated to find the best solutions to get the results you want.

Q: My smile is awkward and my lips pull too tight. What treatments would work best for me?

A: You would probably benefit from a combination of Botox to relax your overactive mouth muscles plus a hyaluronic-acid based filler to even out your lips. However, this can only be determined by an in-person evaluation. You don’t need to figure out which treatment you need before you go to the dermatologist; simply come prepared with your desired outcome — either through description or through photos. An expert will be able to help you choose the best therapy to get the results you want. Please consult a board-certified dermatologist who has used Botox and fillers to correct awkward smiles.

Q: What are the pros and cons to getting Botox in the masseter?

A: The only real side effects to Botox arise from either the injections themselves (slight soreness, swelling, bruising, etc. for a few days at most) or to operator error. You can avoid that last possibility by working with an expert dermatologist. As far as the pros of getting Botox in the masseter, it’s a wonderful remedy to jaw clenching, jaw pain and bruxism. It may even give you a slightly slimmer look to your lower face. Please consult a board-certified dermatologist who has expert injection technique and demonstrated success with relaxing the jaw using Botox.

Q: Belotero filler, does it really work for the face? What does it specifically do?

A: Belotero is one of my favorite hyaluronic-acid based dermal fillers because it has a thin consistency that makes it ideal for creating subtle yet effective facial rejuvenations, such as filling in fine wrinkles and creases and evening out the tear troughs. It easily integrates into the skin itself, which makes the results look natural. I use it to improve signs of aging such as frown lines, crow’s feet, smoker’s lines, nasolabial folds, marionette lines, and horizontal brow lines. It’s also a terrific lip filler and can even reinforce the vermillion border of your lips so that your lipstick doesn’t “bleed.” Please consult a board-certified dermatologist who has experience using Belotero to naturally rejuvenate the face.

Q: I'm 24 years old and I want a slight brow lift. Is Botox or Juvederm good for young adults?

A: Botox would be the right choice to keep your brow muscles from pulling downward. This would create a slight, nonsurgical brow lift. It will also prevent your forehead from creating wrinkles. 24 is not too young for Botox; whether the signs are visible or not yet, you have already begun to age. Regular Botox will keep your forehead looking smooth and wrinkle free for many years. Please consult a board-certified dermatologist who has experience creating brow lifts with Botox, as this is an advanced procedure.

Q: Are there different brands for Botox?

A: Botox is the brand name for botulinum toxin that is used for cosmetic purposes. Two other brands are Xeomin and Dysport. All three brands of botulinum toxin can relax the dynamic muscles that cause wrinkles. In addition, 3 more types of “Botox” will be approved by the FDA in the next few years. All of these formulations differ slightly, so that some patients respond better to one than to the other. However, most will do well on any of them. Please consult with board-certified dermatologists who are experienced with neuromodulators when you are traveling; successful and flattering wrinkle control with botulinum toxin takes a great deal of expertise and skill.

Q: I went in for consult/ botox injections and was told that I was not a good candidate for botox due to my wrinkles starting too low down on the forehead. The doctor explained that if he got too close to my brows they would either droop or point up. He also said that if he were to just inject the upper part of my forehead it wouldn't look good and cause the lower muscles to work harder. Is it possible to be a bad candidate for botox for this reason? Is there a solve?

A: Forehead wrinkles generally respond very well to Botox. Seeing photos would help to understand your particular case. Deep wrinkles may also need to be treated with a dilute filler. In addition, if you have a low forehead and already droopy upper eyelids, Botox may not be helpful. Please consult a board-certified dermatologist who is an expert injector and has many years’ experience fighting the signs of aging with Botox.

Q: What are the expected side effects of Botox on the long run?

A: If you are being treated by a board-certified dermatologist, you should not have many side effects at all after Botox. The most common reactions include slight redness, soreness, swelling or bruising at the injection sites for a couple of days. In the United States, you can find reputable professionals to handle your Botox by searching the American Society for Dermatologic Surgery’s website: ASDS.net to find a qualified Dermatologic Surgeon near you. Other countries have equivalent organizations. Please consult board-certified dermatologists wherever you travel so that you can ensure you are getting high-quality medical treatment with fully potent Botox.

Q: Can I get Botox above my lip for smoking lines?

A: Botox works by relaxing the dynamic muscles that create crow’s feet, glabellar lines (11s) and forehead wrinkles. The lip lines are best treated with skin resurfacing via lasers or chemical peels and by filling them in with hyaluronic acid fillers such as Juvederm, Restylane and Belotero. Please consult a board-certified dermatologist to have your perioral lines removed with HA fillers.

Q: Can I use Retinol serum and Vitamin C serum after Botox and Juvederm?

A: You can absolutely use your retinol and Vitamin C serums after Botox and Juvederm. You need to take excellent care of your skin to reap the full benefits of hyaluronic-acid based fillers and neuromodulators. Please consult a board-certified dermatologist who can help you learn about all the different ways you can improve your skin and slow down your aging process.

Q: I would like to soften the lines in my forehead but I'm concerned that I will not be able to make expressions. I'm an actor and my job depends on it. It also helps to look my best!

A: When Botox is expertly administered, it will quiet the dynamic muscles that cause wrinkles, preventing them from creasing the skin. However, the muscles should still be able to move so that you have natural-looking expressions. Please consult a board-certified dermatologist who has experience creating natural-looking rejuvenations with Botox.

Q: What kind of treatment do I need for wrinkles when smiling?

A: Your skin looks lovely and well cared for. It’s normal to have some “scrunching” under the eyes when we smile. However, the wrinkles under your eyes can be improved with a thin hyaluronic-acid based filler such as Volbella. If you have light crow’s feet or forehead wrinkles (they can’t be seen in your photo), these can be controlled with Botox. You can keep your skin looking and acting young with regular chemical peels, a medical-grade skin care regimen plus sun avoidance. Please consult a board-certified dermatologist who can help you resolve your current problems and avoid future ones so that you will be happy with your face for the long term. You can discuss costs at that time, as they vary by practitioner, skill and region.

Q: I just turned thirty and don't really have wrinkled but kind of expression wrinkled on my forehead that diminish with lots of moisturizer? Do I need Botox?

A: You are young, but at 30 you are already aging. Although you may not have any wrinkles etched into your skin at this point, it sounds like you will soon. Getting Botox now will prevent those “expression lines” from becoming permanent. Now is also the time to get onto a medical-grade skin-care regimen like SkinMedica’s HA5, which contains hyaluronic acid to keep your skin thick and moist and/or SkinCeuticals antioxidant serum. Because you are in California, you absolutely must be diligent with sun avoidance and protection, too. Please consult a board-certified dermatologist who will be able to help you look young for decades to come.

Q: Hello my jaw is a bit more square than what I would like and I feel like it causes it takes away from my face, giving it a bit of a masculine look. I would like my jaw to have more of a V and feminine shape.

A: Botox injected into the masseter muscles at the sides of your face will relax them, giving your face a more heart-shaped look. If you like the look, you will need to get Botox every six months or so to maintain it. If you don't like it, simply discontinue the Botox and your jaw will go back to normal. The Botox cannot affect the structure of your jaw because it only interacts with muscle; not bone. As for your chin, it can be evened out with dermal fillers, such as Voluma. Please consult a board-certified dermatologist who has experience sculpting the face with injectables.

Q: I usually get Botox once every 3 months. But is is it OK to get, for example Botox in upper forehead in Feb, above brow line March, and eyes April, and upper forehead in May?

A: If you need to rotate your Botox injections by area, owing to scheduling or finances, it's perfectly safe to do so. The only reason we recommend treatment every three months is that that is when its effects begin to wear off. Although there is no reason to not time your treatments as you propose, it does mean you will be going back and forth to the dermatologist's office every month. Timing your treatments in this way will also affect your re-treatment schedule. Please consult a board-certified dermatologist who can work with you to create a Botox regimen that will work with your schedule and your finances.

Q: If I get Botox in the crow's feet area will that help with under eye wrinkles?

A: Botox will soften the wrinkles on the sides of your eyes, otherwise known as crow's feet. If the wrinkles under your eyes are extensions of the crow's feet, they may resolve. However, under-eye wrinkles are usually separate and therefore need to be treated differently. Lasers and/or chemical peels can resurface the under-eye area. You can also use fillers such as Belotero, Volbella and Restylane Silk to fill out that area and soften the wrinkles. Stopping Botox and fillers does not have any ill effects; you simply go back to baseline (the way you looked before treatment). Consulting a board-certified dermatologist will allow you to learn about your options and make the right choice to get the effect you want.

Q: My left side of lip raises more than the right while I am speaking. Can you advise me on how to fix this?

A: It's quite normal to have asymmetry in your face and lips. It may be possible to resolve your problem with Botox to relax the muscle that's pulling too hard on one side of your mouth and even up your lips with hyaluronic acid fillers such as Volbella. Consulting with a board-certified dermatologist will let your asymmetry be evaluated and solutions proposed.

Q: Can I get travel vaccination such as diphtheria, polio and tetanus (combined booster) typhoid. hepatitis A – including when combined with typhoid or hepatitis B. cholera. 6 days after having Botox for crows feet?

A: The botunlinum toxin in Botox is both minuscule and highly purified. Botox is also a local treatment, which means it only affects the muscles into which it is injected. It is not absorbed into the bloodstream. Therefore, there will be no interactions between the Botox and the vaccines you need to get for your travels abroad. Please consult a board-certified dermatologist who has expertise with Botox to be sure you get the best results.

Q: I have residual effects from Bell's palsy, tight cheek, smaller eye, uneven smile. Could Botox help with these issues?

A: I have been using Botox injections for many years to help relax the faces of people who have Bell’s palsy. Whether you would benefit from Botox can only be determined in person. From your description, it sounds like the uneven smile and tight cheek would respond well to Botox. The smaller eye may, too, but again you need to be examined in person. Please consult a board-certified dermatologist who has experience with and expertise in treating Bell’s palsy with Botox.

Q: Can Botox injections flip the upper lip?

A: You need to be very careful using Botox around the lips, as if the injections are not performed well or too much Botox is injected, you may have functional issues. As for whether using Botox to “flip your lip” would work depends on the anatomy of your lips, plus the amount of fillers you have. You need to find a board-certified dermatologist who is expert in using Botox to reshape the face and lips. My office is in San Diego. Please feel free to contact me there for a consultation if you are willing to travel. Otherwise, research Los Angeles dermatologists and find one who has expertise in using Botox for the lips.

Q: I need to find a medical doctor, not a dentist, to inject Botox for my TMJ

A: Your best bet for an expert Botox injector is to find a board-certified dermatologist in your area. You can search the American Society for Dermatologic Surgery’s website: ASDS.net to find a qualified Dermatologic Surgeon near you.. There are many dermatologists in Georgia who can help you; dermatologists have medical degrees (not dental degrees) and therefore should be accepted by your insurance. Be sure to ask the board-certified dermatologists you interview if they have experience using Botox to treat TMJ.

Q: Is 20 too young to get Botox?

A: You can begin to have Botox treatments as soon as you think you need them. Everybody's skin ages differently. Environmental causes, such as sun exposure and smoking, can also degrade the quality of the skin, leading to more wrinkles. If you want to smooth out your frown lines and prevent them from being reinforced by the dynamic muscles that cause them, then Botox is the right choice. Each treatment lasts about 3 to 4 months, though you may need re-treatment less often as time goes by. If you stop Botox, it doesn't negatively affect your skin. However, your muscles will then begin pressing your skin into furrows and your wrinkles will eventually reappear. Please consult a board-certified dermatologist who is an expert with Botox so you can begin to schedule regular treatments.

Q: Migration of Botox to other areas, when does the risk stop?

A: In my practice, I haven't seen any migration with Botox. Leaning over should not be a problem if your forehead was treated, because if the Botox did migrate, it would go toward the scalp – lifting more – rather than the eyebrows. We recommend refraining from vigorous exercise and heat exposure for 24 hours post-Botox more as a precaution than because there's a real risk for migration. As for sunbathing, there is never a good or right time to do it, whether you have Botox or not. Exposing your skin to the sun guarantees that it will be damaged. Always use sunscreen and barrier protections, such as hats, when you are outdoors. Consulting with a board-certified dermatologist will help you get the best results from your Botox treatments.

Q: About how much for Botox on smile lines?

A: I'm not sure which lines are troubling you. If they are the small wrinkles that surround the lips and are often called “smoker's lines,” then Juvederm Volbella – a very thin hyaluronic-acid based filler – would probably be the best choice. If you are talking about the nasolabial folds, then a thicker dermal filler such as Restylane, Juvederm or Belotero would work quite nicely to even out the furrows. Botox is used to relax dynamic muscles, such as those that create crow's feet and the “11's” between the eyes. Consulting with a board-certified dermatologist will allow him or her to evaluate your wrinkles and make recommendations to rejuvenate your face with Botox and/or dermal fillers.

Q: I am having botox. However, im scared i will get anaphylactic shock which can kill you. Also im worried that the chemicals will shoot off in different directions in my body?

A: Every elective cosmetic procedure has its risks, as do our daily actions. Driving, for instance, is a very risky endeavor and yet most of us do it every day. Botox has been used as a cosmetic treatment for almost 30 years in hundreds of millions of injected patients without any reports of anaphylactic shock that I know of and has an excellent safety profile. It is much more dangerous driving to your appointment than receiving the Botox injections. The most common side effects with Botox are soreness or swelling in the injection area, which can be controlled with ice and over-the-counter pain medication. Botox doesn't “shoot” into other parts of your body; it stays where it is injected. If you want to manage your aging process with Botox, then begin consulting board-certified dermatologists who have expertise in using this highly effective neuromodulator until you find one who inspires your confidence and trust. You can discuss your concerns and learn more about how Botox works in your consultations so that you can make a confident decision about whether you want to go forward with this procedure.

Q: I have a really square jawline and decide to have botox injection, and have consult several doctorsmall but they give me different dosage from 40 unit each side to 25 each side, can anyone give me some suggestions?

A: It's wonderful that you are consulting multiple board-certified dermatologists who are expert at relaxing the masseters with Botox. You don't have to worry that they have different recommendations as to the number of units of Botox required. Each injector has his or her own technique – some are more conservative and would rather get a great result in one treatment while others would rather take 2 treatments if necessary. The important thing is to find a board-certified dermatologist whom you trust and who can show you the good results he or she has obtained in other patients who have similar issues with their masseters. Good luck!

Q: I had botox and fillers in my lips and cheeks 2 weeks ago. I have just found out I am around 8 weeks pregnant.

A: Congratulations on your pregnancy! You don't need to worry about having been treated with Botox and dermal fillers before you knew you were pregnant. We don't advise their use in pregnancy simply out of caution. No clinical studies have been done about the effects of Botox or fillers in pregnancy, nor could they be ethically performed. Both Botox and fillers such as Restylane, Belotero and Juvederm are, in general, very safe. I don't know of any anecdotal incidences of negative reactions to fillers or Botox that are related to pregnancy. There is no reason to feel stressed out or worried. Please do mention this to your obstetrician, however. And after a healthy birth and nursing, consult a board-certified dermatologist when you are ready for anti-aging procedures again.

Q: How would I know if/when I need more Botox in my masseters?

A: Botox in your masseter muscles should not affect chewing, so don't try to use that as a sign for whether you need another treatment or not. Botox in the jaw can last up to six months or more, so I would use that as a guideline. Every person is different, and so you will have to pay attention to how your face looks. You may find the effects wear off after about 4 months, or they may last til almost a year. A safe bet is to re-treat biannually. You should be able to maintain good results without spending too much time in the dermatologist's office. Consulting your board-certified dermatologist will allow the two of you to develop a schedule for your Botox maintenance.

Q: If Botox, Dysport and Xeomin don't work anymore can I use Restylane on glabellar lines instead?

A: 60 Units of Dysport may not be sufficient to treat the degree of contraction in your glabellar muscles – that's why you are not getting a good result. Before you start considering dermal fillers, go for a higher dose of a neuromodulator. Dermal fillers would only accentuate the bunching of your brow until you can relax the muscles. If you do decide to add in a dermal filler such as Restylane, Juvederm or Beletero please be sure you work with a board-certified dermatologist who has many years' experience treating this area with fillers as you want the most natural results possible.

Q: Botox worked immediately! Is it normal that it works this fast?

A: It is unusual for Botox to work within a few hours, but not unheard of. Everybody reacts differently. As long as you are happy with your results, you shouldn't worry. The effects should last up to 3 to 4 months. Please consult a board-certified dermatologist for your Botox treatments.

Q: One side pulls more than the other. Would botox make my smile even?

A: You don't have much asymmetry in your smile but if it sincerely bothers you, it can be corrected by an expert injector by using a neuromodulator such as Botox, Xeomin or Dysport to relax the muscle that is over-pulling. I caution you, however, to be sure to take the time to find an expert dermatologist who has done this many times before and can show you good results. If you decide on someone based on price rather than expertise, you could be left with even more asymmetry, which could last for up to 4 months. Start meeting with board-certified dermatologists to find one who has verifiably excellent injection technique and who can evaluate your anatomy to determine if you would be a good candidate for smile correction with Botox.

Q: Want that Kylie Jenner look! How?

A: The nice thing about living today, with so many options in dermatology, is that you can make quite dramatic alterations to your appearance without ever having to undergo surgery. And, if you don't like them or grow tired of them, they wear off, leaving you with your “baseline” (original) look. You could make a number of nonsurgical improvements to get a more feminine look, including Botox in the masseters and a chin augmentation with Voluma to also give you a more heart-shaped face, building up the cheekbones with Sculptra and/or Voluma or Restylane, and lip augmentation with Volbella, Belotero or Restylane. You could also get a cleaner jawline and lose the double chin with either liposuction, Kybella or CoolMini. Please consult a board-certified dermatologist who has many options for you to choose from and who can also get you on a high-quality skincare regimen to keep you looking young for as long as possible.

Q: Can you use botox to relax overactive muscle near nose?

A: If one side of your face is lifting higher owing to an overactive muscle, a neuromodulator such as Botox, Dysport or Xeomin can relax it. This will make your face look more symmetrical when you talk, yawn and sing. If that's the muscle responsible for the nasolabial fold, it should smooth out, too. If not, you can even it out with a hyaluronic-acid based filler such as Juvederm, Beletero or Restylane. Please consult a board-certified dermatologist to find out if you are a candidate for Botox and/or filler.

Q: Can I get Botox, Vobella?

A: If you are using a board-certified dermatologist who is an expert injector, not only is there no problem using neuromodulators such as Botox at the same time as a hyaluronic-acid based filler like Volbella, it's common practice. Each has its own mechanism of action and its own set of benefits. Volbella can plump up the lips or smooth out perioral lines. Botox quiet downs overactive dynamic muscles, which allows the skin to relax and wrinkles to fade. In fact, when both are used together, the effect of fillers tend to last longer. Please see a board-certified dermatologist to have your aging treated with Botox and Volbella.

Q: I had Bell's palsy a few years ago. Would lip injections would trigger facial (smile) paralysis again?

A: I have heard no reports about Botox or hyaluronic-acid based dermal fillers causing Bell's Palsy. There is always the risk of some facial paralysis if you are injected by someone who does not have proper training or expertise and accidentally hits a nerve. This should not happen with a properly trained and experienced doctor. In fact, I frequently use Botox to relax the paralysis for patients who are suffering from Bell's Palsy. Please consult a board-certified dermatologist who has many years' experience as a Botox injector to get the best and safest results.

Q: Will getting a brow lift with Botox make my forehead even smaller?

A: The degree of lift you will get from Botox on your eyebrows will not shorten your forehead. A small amount of Botox should be placed on your lateral brows so that the muscle will not pull the tails of your brow downward. Once the muscle is relaxed, the brows will lift about 2mm, giving you a more open expression and attracting attention to your eyes. Please consult a board-certified dermatologist who is an expert at reshaping the eyebrows with Botox, as it takes a great deal of skill to do well.

Q: What are the side effects of CoolSculpting especially in the double chin area?

A: Zeltiq's CoolSculpting is a very effective and permanent means of getting rid of a double chin. It works by lowering the temperature of the fat to the point where it begins to self-destruct. However, the surrounding tissues are not “frozen” or damaged at all. Some patients may have a little bit of redness or swelling, but these generally resolve within hours to days and usually occur when the patient has been treated with the original CoolSculpting applicator, which uses suction. The CoolMini – the smaller applicator designed for under the chin – is easier to tolerate. Be sure to consult a board-certified dermatologist who is a certified Zeltiq practitioner, too.

Q: How can I fix my lip/smile without surgery?

A: It looks like one side of your mouth is overactive and that is what is causing the asymmetry in your smile. A little Botox can help relax that muscle so that your smile will look more flattering. Botox needs to be repeated every three to four months. Consulting with a board-certified dermatologist who has expert Botox injection technique will get you the best results.

Q: I'm getting saddlebags at only one side of thigh. The other side is normal. What to do? What exercises I should do?

A: Diet and exercise reduce overall fat and excess weight. You cannot “spot exercise” to eliminate fat in just one area. If you have developed stubborn, exercise-resistant fat, then the best solution is to remove it permanently. Liposuction works well for this, if you are near your ideal weight or just slightly overweight. You may also want to consider noninvasive fat-elimination techniques, such as Vanquish, CoolSculpting and ThermiTight. Please consult a board-certified dermatologist who can evaluate you in person and recommend the best solutions.

Q: Is liposuction the best way to deal with my inner thigh chub rub?

A: Without photos, I can give you only a general answer, but from your description you would probably do well with liposuction to remove the excess fat from your inner thighs. If you are athletic and your skin quality is good, then your skin will probably accommodate to the reduced volume once the fat has been removed. If your skin is poor quality and is inelastic, you might need ThermiSculpture, which is a combination of liposuction to remove fat and ThermiTight to tighten the skin. You may also want to consider noninvasive fat-elimination techniques, such as Vanquish and CoolSculpting. Please consult a board-certified dermatologist who has successfully contoured the inner thighs with liposuction and noninvasive fat-elimination techniques.

Q: What type of brow lift do I need?

A: I'm not a fan of unnecessary surgery, so I would recommend you try a Botox brow lift to give you a younger and more alert look. Judiciously placed, Botox can lift the brows slightly, which will rejuvenate your eyes. The effect will last three to four months. In addition, Ultherapy or Thermage are two additional non-invasive methods to lift the brows. Please consult a board-certified dermatologist who has expertise in using Botox to create a nonsurgical brow lift.

Q: Accidentally used Clarisonic brush on face after botox?

A: It is perfectly safe to use a Clarisonic cleaner after receiving Botox. Botox is a fast-acting neuromodulator that generally settles into the muscles within a few seconds. You probably have no cause for concern. Please consult a board-certified dermatologist who is an expert in Botox if you fail to see results from your Botox treatment.

Q: Botox for bruxism?

A: Botox can be injected into the masseter muscles, which will relax them and thereby inhibit them from over-clenching or grinding. This will also help to slim your face. Botox's effects will last about three to four months. Please consult a board-certified dermatologist who has expertise in treating the masseters with Botox to alleviate bruxism.

Q: Botox? Botox lip lift? Filler? Or all of the above?

A: It looks like you would be a good candidate for combination treatment with both hyaluronic acid fillers to smooth out wrinkles and add shape to your lips, plus Botox to lift the corners of your mouth. Volbella, Belotero or Restylane are wonderful for lip lines and adding shape to the lips. Other fillers like Vollure, Juvederm and Restylane Defyne can fill in the indentations and folds. Please consult a board-certified dermatologist who has expert injection technique to get results that are natural and flattering.

Q: Botox on thin skin, what are my options?

A: Although Botox may have been sufficient to resolve your wrinkles in the past, as we continue to age, our needs change. Botox works in patients with both thin and thick skin, but aging not only makes the skin thinner, it also atrophies the underlying muscle and bone. You are probably losing collagen and elastin in your skin, which are the building components that keep it looking plump and supported. If you want to avoid fillers, you can improve the texture of your skin with a variety of lasers including both non-invasive and no-downtime treatments with. intense pulsed light or more aggressive ablative lasers with minimal downtime that can stimulate collagen production to minimize wrinkles and enhance Botox's effects. A high-quality skin care routine, including topical antioxidants and SkinMedica’s HA5 hyaluronic acid cream are also helpful. Please consult a board-certified dermatologist who has a number of anti-aging strategies to help you move through each stage of life looking beautiful and youthful.

Q: My question is how I removed my problem of scowling glabella?

A: Botox could do a great job of relaxing your glabellar muscles so that your forehead looks smoother. This will give you a more pleasant demeanor and relaxed expression. Please consult a board-certified dermatologist who is an expert Botox injector to get the most subtle and natural results.

Q: Botox - how long does it last? How safe is it? Will it help reduce all my face wrinkles ?

A: We've been using the neuromodulator Botox for about 20 years in cosmetic dermatology and it has an excellent safety profile. Only a small amount of the purified protein botulinum is needed to achieve results such as relaxing dynamic muscles to allow wrinkles to smooth out. Botox will last about 3 to 4 months in most cases. It only can treat wrinkles that are caused by dynamic muscles, so you may need other therapies to fully resolve your wrinkles, including possible hyaluronic-acid fillers such as Juvederm, Restylane and Belotero; laser resurfacing; and chemical peels. Please consult a board-certified dermatologist who can analyze the different types of wrinkles you have and design an effective treatment plan to rejuvenate your face.

Q: Could Botox be used to lift my eyebrow to make them even?

A: While Botox is not a solution for all eyebrow asymmetry, in your case it would be an excellent remedy. It could relax the muscle on the outer brow that's pulling it downward, so you would get an arch that is similar to the one on your other eye. Please consult a board-certified dermatologist who has expertise in treating the brow with Botox, as this will take a fair amount of finesse to get a beautiful and flattering result.

Q: I have two dimples or indents on my chin when I smile. Would Botox fix this?

A: The mentalis is a dynamic muscle that is probably responsible for the dents in your chin when you smile. If this is the case, Botox would be an appropriate remedy. If it didn't resolve the dimples completely, you could add a hyaluronic-acid filler such as Belotero or Restylane. Please consult a board-certified dermatologist who has expert injection technique to have this problem rectified.

Q: If I get botox under my arms for sweating will I sweat more out of different areas of my body?

A: Botox is a neurmodulator that can be used to block the sweat glands in your arm pits to resolve hyperhydrosis (excessive sweating). Hyperhydrosis is a medical condition that can cause a patient extreme social discomfort. In my experience, Botox works extremely well to control excess sweating in a variety of areas, including the hands, armpits, feet, groin and forehead. It is unusual for another, untreated area to become sweatier when Botox was used. Botox only affects the area into which it is injected. One treatment will usually last 6-12 months. Please consult a board-certified dermatologist who has experience using Botox for hyperhydrosis, as it takes special expertise.

Q: Is it true Botox and fillers should be used together for crows feet?

A: I've had very good success in using Botox alone to resolve crow's feet. Once the periocular muscles have been relaxed, the overlying skin smoothes out and you generally don't see the wrinkles anymore. If the wrinkles are still visible, my next step would be the use of a gentle hyaluronic acid filler or laser resurfacing, as deeply etched wrinkles suggest that the skin has experienced a significant loss of elasticity and collagen. Lasers can stimulate the skin to produce more collagen and elastin, so not only would your skin be resurfaced, thus minimizing the look of the etched wrinkle, your skin quality would also improve over time. The Botox will keep the wrinkle from being created again. Botox should be repeated every three to four months to start. Please consult a board-certified dermatologist to find out which treatment plan is best in your case.

Q: I am 23 years old and was suffering from face paralysis since I was 9. about 60% is recovered. Can botox injection help me out to recover it fully?

A: I have successfully used Botox to treat facial paralysis caused by Bell's Palsy and other conditions. While it will not cure the “paralysis” it will help normalize your appearance. The extent of this improvement can only be determined by an in-person consultation. Using Botox to relax spastic muscles requires specialized expertise. Please consult a board-certified dermatologist who has many years' experience using Botox to resolve facial paralysis to see if this treatment would work for you.

Q: I am developing fine lines in my forehead. Am I too young for Botox? I am 26 years old.

A: If you're developing fine lines in your forehead, then it is time to start Botox. This neuromodulator has been used by dermatologists for more than 30 years to relax dynamic muscles so that they cannot press aging or damaged skin into wrinkles. Please consult a board-certified dermatologist who can not only treat your wrinkles with Botox but also design a skin-care and sun-protection regimen that will slow down your aging process. Cost will vary by practice, but can be discussed in your consultation.

Q: How will I know when Botox for Masseters / Jawline is wearing out?

A: The two best ways to keep track of the results of any dermatologic procedure are to 1) take good before-and-after photos, keeping the lighting and positioning consistent so you can compare results; and 2) maintain a relationship with the same board-certified dermatologist who acted as your injector so you will get reliable results and be able to keep track of your treatments. You shouldn't expect the Botox in your masseter to begin wearing off for at least three to four months. It may take another several months before the muscle again builds up strength and starts to cause bulking. Please consult a board-certified dermatologist who is an expert at treating the masseters with Botox to be sure you are on a treatment schedule that keeps you looking and feeling your best.

Q: I'm only 23 years old and I have long wrinkles under my eyes and crows feet. What treatments can I get to help the wrinkles on my face?

A: Botox is the right choice for the forehead wrinkles and crow's feet, as these are caused by dynamic muscles that press the skin. Botox will relax the muscles, allowing the skin to smooth out. The under-eye wrinkles may be improved with a hyaluronic-acid filler, such as Restylane, Juvederm or Belotero, and this can be used in your nasolabial folds, too. Because you are beginning to show signs of aging young, I highly recommend you begin other anti-aging measures, such as a high-quality skin-care regimen, emphasizing topical antioxidants and creams like SkinMedica’s HA5 that contain hyaluronic acid, and become vigilant with your sun protection. Finally, some mild laser treatments with non-ablative fractionated ResurFX or intense pulsed light may also stimulate collagen production to minimize wrinkles. Please consult a board-certified dermatologist who can help you with your current problems and devise a plan to prevent future ones so you'll look even better in five years than you do today.

Q: Botox allergy - what's my alternative?

A: As has been mentioned, Botox allergy is extremely rare and I have never heard of this ever occuring. I'd recommend that you find out from your dermatologist what kind of topical anesthetic was used, plus what was used to dilute the Botox. Do patch tests with those ingredients – your allergist can help with this – until you've identified the substance that is causing your skin to react. Please consult a board-certified dermatologist who can help you get to the bottom of this mystery and design an anti-aging regimen that will work for your skin.

Q: Undecided if I should get Botox or restylane to help with uneven upper lip and gummy smile.

A: Botox can help relax the side of your mouth that is pulling up slightly more than the other. However, just evening out your upper lift with a natural-looking and feeling hyaluronic-acid based filler such as Belotero, Volbella or Restylane Silk would be my recommended first step. Fillers can last for up to a year or more. Please consult a board-certified dermatologist who is an expert Botox injector and lip augmentor to be evaluated and get the best and most consistent results.

Q: Can I get Botox or fillers done after I tattoo freckles on my face?

A: Botox is a neurmodulator that only affects muscles. It is used to relax the dynamic muscles that fold the skin into expressions and, over time, create wrinkles. It is placed under the surface of the skin and will not affect any cosmetic tattoos you have. As for the cosmetic tattoos being affected, displaced or stretched by a dermal filler such as Belotero, Juvederm, Sculptra or Restylane around your eyes and cheeks, that is highly unlikely. Unless you are planning to create a very dramatic volume change, your skin (and therefore tattooed freckles) will not stretch significantly – if at all. The freckles should be fine. Please consult in person with a board-certified dermatologist who is an expert in sculpting the face with Botox and fillers to get a better idea of what kinds of changes you should expect to see when sculpting your face with fillers and Botox.

Q: As I aged my lower face looks bad and my masseter muscle enlarged. Would I benefit from botox?

A: It does look like your masseter muscle is enlarged. This can be remedied with the neuromodulator Botox, which will allow the muscle to relax and create a more slender look to your lower face. If you have been clenching the jaw from stress, Botox will prevent you from doing that. You will need to be treated every three to four months to keep up the good effects. Over time, you may need less Botox as your muscle begins to lose strength. Please consult a board-certified dermatologist who has expert injection technique to have your problem resolved with Botox.

Q: I have a forehead crease when I don't lift my eyebrows. How do I get rid of this ?

A: The first step I would recommend for you is to have your forehead muscles treated with Botox, so that you will stop reinforcing and deepening the crease. That may be sufficient to resolve the wrinkle because you are young and your skin is probably resilient. However, if the wrinkle doesn't smooth out just from Botox, then I might recommend some skin resurfacing, such as radiofrequency microneedling and/or a hyaluronic-acid based dermal filler such as Juvederm, Belotero or Restylane.

Q: Is Botox the right option for me if I want resting wrinkle lines filled?

A: The wrinkles in your forehead are caused by dynamic muscles that press the skin until it forms a groove. When we relax these muscles with Botox and the skin is no longer compressed, and the wrinkles smooth out. Based on your photos, it seems that the “resting wrinkles” you refer to are relatively shallow. This means they will probably respond very well to Botox. Please consult a board-certified dermatologist who is an expert at smoothing out wrinkles with Botox.

Q: Could Botox make my chin smaller and/or more feminine?

A: Botox in the masseter muscles and chin area will relax any bulking or clenching, which should lead to a slimmer look to your jaw and chin. The aim is to create a softer, more heart-shaped face, which we tend to find pleasing and feminine. Please consult a board-certified dermatologist who is an expert at sculpting the face with Botox and dermal fillers, as it takes a great deal of knowledge and skill to do this well.

Q: Can my inherited glabella lines be treated? I am tired of people saying I look permanently upset, even when I am happy?

A: Botox can be used to relax the glabellar muscles so that they will no longer reinforce your frown lines. Without the pressure from the muscles, the skin gets to relax and smooth out. Because you've had these lines for many decades, they are deeply etched and will probably need to be filled in with Juvederm or another hyaluronic-acid based filler like Restylane or Belatero. The filler will last at least a year or more. The Botox will need to be re-administered every three to four months. These two treatments together will make a big difference in your expression and how you are perceived. Please consult a board-certified dermatologist who is an expert Botox injector to help you get a more relaxed look.
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