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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: 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.

Q: Would Botox help relax frown lines? Is 30 too young?

A: The frown lines you are developing are quite deep, so no, you are not too young for Botox. We always determine dermatologic treatments based on presentation, not chronological age. Neuromodulators such as Botox or Dysport will relax the glabellar muscles, which are causing the furrows. When the muscle relaxes, the skin smoothes out. You may also need some hyaluronic-acid based filler such as Juvederm, Restylane or Belatero to even out the grooves. Botox and Dysport need to be re-administered every three to four months. A filler will usually last at least up to a year or more. Over time, as your muscles lose strength from disuse caused by the neuromodulator, the skin may smooth out even more and you will not need as much or even any fillers. You may also need less Botox or Dysport as you continue to get treatments over time. Please consult a board-certified dermatologist who is an expert Botox injector to get help with your frown lines.

Q: Sad mouth - is Botox effective?

A: Without a photo or an in-person consultation, I can't say for sure what treatment would be best for you. However, Botox can very effectively relax mouth corners that are overly active and pull downwards. If this is causing the sad look to your mouth, then Botox could work well for you. You might also have creases that need to be smoothed out with hyaluronic-acid based fillers such as Juvederm, Vobella, Belotero, or Restylane. Botox needs to be repeated every three to four months. Dermal fillers can last from 6 months to up to 2 years. Please consult a board-certified dermatologist who can give you more specific answers to your questions by evaluating what is causing the sad look that concerns you.

Q: Should i get Botox or fillers for the upper side of my lip that is smaller/thinner?

A: Botox would not be the right solution for your lip asymmetry. Your lips can be evened out with subtle injections of a hyaluronic-acid based filler such as Volbella, Juvederm, Belotero or Restylane Silk. Lip augmentation takes a great deal of expertise, as it is easy to overdo. Please consult a board-certified dermatologist who can show you beautiful and natural results for lip augmentation.

Q: Frown lines. Should I get a higher dose?

A: I'm not sure why you were satisfied with your first round of Botox but have been disappointed by subsequent rounds. It may be that, as you guessed, you need a higher dose and perhaps you were given less on follow-ups than you were on your initial treatment. Your question implies distrust in the information that you're being given. You may disagree with your practitioner's assessment that you need a dermal filler such as Juvederm, Belotero or Restylane. You may even believe you were given a lower dose of Botox to encourage the add-on of a filler. In the first case, If your furrow is deep, a filler may be necessary. In the second case, please find out the number of units injected and then consult with a board-certified dermatologist who is an expert Botox injector to find the right practitioner for you. Botox is a long-term treatment. Investing time now in finding a dermatologist who inspires confidence will save you frustration later.

Q: Can You Get a Professional Facial As Well As Botox Done on the Same Day?

A: It is quite common to receive a number of cosmetic dermatologic treatments on the same day when you are being injected with Botox. It's important to remember, however, that Botox takes a few hours to settle into the muscle it is meant to affect. Therefore, you cannot manipulate your skin for several hours after injection (or to be safer, 24 hours). That means that Botox is injected a day or more before all massages, facials, laser treatments, microdermabrasian, chemical peels, etc. Please consult a board-certified dermatologist who has many years' experience with injecting Botox as an anti-aging treatment to get the best results.

Q: Any suggestions to make my chin appear smaller and more feminine? I think my appearance could be improved by possibly some jaw surgery or botox to make my jaw appear smaller.

A: A small amount of a neuromodulator, such as Botox or Dysport, will slightly relax the bulking around your jaw. The Botox will be injected directly into the masseter muscle, which opens and closes the jaw. This will allow it to relax and create a slenderizing effect on your lower face. You will need to maintain your results with re-treatments a few times a year. Please consult a board-certified dermatologist who has expert injection technique because it is essential to create a more flattering and feminine jawline without impairing the masseter muscle's function.

Q: I have this box face shape. Without using botox can my jaw muscle slim down if I no longer chew gum?

A: Chewing gum will not significantly build up the masseter muscles (the ones on the jawline) nor will ceasing gum chewing allow them to slim down. If you have a bulky jawline that is making your face look too square and boxy, Botox would be a great solution for you. This neuromodulator works by relaxing the jaw muscles, which eliminates the bulked-up look and gives a more slender appearance to your face. Yes, you will have to continue with Botox injections once or twice a year, just as you need to cut your hair every so often. Keeping up appearances takes some maintenance. Please consult a board-certified dermatologist who is an expert Botox injector, as slimming the masseters with a neuromodulator takes a great deal of skill.

Q: Botox causes muscle atrophy over long term use, is this true?

A: Botox is a neuromodulator that relaxes dynamic muscles so that they stop pressing the skin into wrinkles and creases. The operative word here is “relaxes.” We give just enough Botox to let the skin smooth out, but not enough to paralyze the muscle to the point where it would atrophy from lack of use. While over the long term, you may need less Botox because the muscle no longer can contract as strongly as it did, this is a good thing. And while the contractions aren't strong enough to reinforce a wrinkle, they are strong enough to keep the muscle agile. While it may be slightly smaller over the long term, it will not droop or cause an aging look. Please consult a board-certified dermatologist who is an expert in using Botox over the long term to manage aging.

Q: My derm told me that in order to do the 11 lines in between my eyebrows I'd have to do my entire forehead. Is that true?

A: I am not sure why your dermatologist said it was necessary to treat the entire forehead to resolve your glabellar folds (11s) – it is a question that is especially difficult to address because you did not provide any photos. Botox is a targeted therapy that is only injected into the dynamic muscles that are causing the troubling wrinkle or fold. Perhaps you are using both your corrugators and your frontalis muscles when you're frowning. Or perhaps there are other lines or creases that need addressing. Whenever you are dissatisfied or confused by advice you receive from a medical professional, it is your right to ask follow-up questions and/or seek another adviser. Please consult with a couple of board-certified dermatologists to find out how to use Botox to treat your frown lines.

Q: I got Botox for migraines 2 months ago - it didn't seem to work - in fact they got worse. Now, this last week I've had NO Headaches. Could it take 2 months to kick in?

A: Generally, we would expect to see an improvement in your migraines within a few days after you received treatment with Botox. The effects of the neuromodulator should then last about 3 to 4 months before you need re-treatment. However, these figures are arrived at by averaging patient experiences. There are always individual variations and outliers. If you are now experiencing relief from your migraines two months post-injection, it could indeed be related to the Botox. The only answer you will have to your question is waiting and seeing. You may want to keep a diary to track your new headache pattern after Botox and stay in touch with your board-certified dermatologist who is handling the injections so you can work out a treatment schedule that is appropriate to your individual case.

Q: Delicate brow lift: Botox, dermal fillers, or maybe something else? I'm only 25 years old.

A: At your age, I would not recommend surgery. Botox can indeed be used to relax the muscles that draw the brows down. Which ones would need to be injected will be determined in your consultation according to your anatomy and your desired results.

Q: What if Botox is injected the sides of the nose to make nose lift, does it freeze the face too?

A: Your question highlights the need to find an expert injector when considering Botox for cosmetic improvements. Botox should never “freeze” the face, no matter where it is used. The goal with Botox is always to improve the patient's appearance while still allowing them a full range of facial expressiveness. Please find a board-certified dermatologist for your Botox rhinoplasty who has proven expertise in using Botox to lift the nose.

Q: How often can you do a Botox jaw reduction?

A: It's fine to have another Botox injection after three months to relax your masseter muscles and slim your jaw. Botox normally needs to be touched up around that time. Usually it will not last for more than four to six months. Please consult a board-certified dermatologist for your Botox injections.

Q: Can I have Botox injections for TMJ but just for clenching only, as it's disrupting my sleep?

A: We have had great success controlling the pain, stress and irritation of temporomandibular joint disorders (TMJ) with Botox. By injecting hyperactive masseter muscles with a neurmodulator, we block signals that cause the muscles to contract, allowing them to relax and work without stress or clenching. Treating TMJ with Botox takes a great deal of skill on the part of the injector, because it is imperative not to interfere with the jaw's function. Please consult a board-certified dermatologist to have your TMJ alleviated with Botox.

Q: Massage Damage Botox?

A: Botox, Dysport or Xeomen is injected into muscle, where it is taken up into the nerve endings and tissue, relaxing the muscle within minutes. Within hours, the Botox, Dysport or Xeomen should have settled and/or been eliminated through the blood stream. I would suggest waiting at least 12 hours before a massage, just to be safe. Please see a board-certified dermatologist for your maintenance treatment in three to four months.

Q: How to Prevent Wrinkles on Forehead and Between Eyebrow?

A: Many people in their 20s are now using Botox, Dysport or Xeomen and other rejuvenation techniques for prevention. Because you don't need to smooth out wrinkles, you might not need as much Botox, Dysport or Xeomen as an older person. However, this will depend partly on your skin quality. The minimum amount needed to relax the procerus, corrugator and frontalis muscles would be about 12 to 20 units. More can be added if necessary. Please consult a board-certified dermatologist to have your skin and muscle tone evaluated.

Q: Risk of Drooping Eyelid for Crow's Feet Botox Injection?

A: An expert injector with many years' experience treating crow's feet with Botox should be able to give you an excellent result with no eyelid or forehead droop. Drooping is caused by overinjection or by injecting the wrong muscles. In either case, it's a mistake that a professional should be able to easily avoid. Please consult a board-certified dermatologist with expertise in Botox injection.

Q: At the very top of my nose, between my eyes is a crease that appears as if my forehead is slipping down, which it probably is because when I put on a tight headband it lifts and softens. Would botox help with this?

A: Botox should be able to quiet the muscle that is causing the horizontal crease between your brows. If the crease is very deep, you may need a hyaluronic-acid based filler, such as Restylane or Juvederm, to smooth it out. It is also possible that you might benefit from a slight browlift with Botox. Consulting a board-certified dermatologist who has expertise in Botox injection will allow your wrinkle to be evaluated and the best treatment plan chosen.

Q: Is their any contraindication for accutane patients and botox?

A: There are no contraindications to using these two products at the same time. Accutane treats the oil glands and follicles in the skin while Botox reaches the muscle. Please consult a board-certified dermatologist to find out how to manage wrinkles and acne simultaneously.

Q: The corners of my mouth droop. People often ask me what's wrong. Can Botox be used to help this and where would they inject it?

A: Using Botox in the depressor anguli oris muscle can prevent it from pulling the corners of your mouth down. That will allow your lips to remain upturned. Injjections have to be very carefully placed as too much Botox or improperly placed Botox can give you a “stoke-like” appearance and/or make an unusual smile. Depending on how severe the mouth droop is, you might also need hyaluronic-acid based fillers such as Juvederm, Vobella or Restylane to fill in the grooves. Please see a board-certified dermatologist to find out how to give yourself a more relaxed demeanor.

Q: Are there any side effects to having Botox and is it safe?

A: Botox has had an excellent safety profile for 30 years. Other than possible temporary soreness, bruising or swelling at the injection sites that should resolve within days, there should be no side effects with Botox. The only bad results I am aware of have been from unskilled practitioner error. Administered incorrectly, Botox can give you a “frozen” look, droopy eyes, or distorted smile. More egregious errors could lead to blurred vision and nerve damage. Please do not trust your Botox injections to someone without expertise; consult a board-certified dermatologist with years of experience and knowledge of facial anatomy to help rejuvenate your face.

Q: If Botox is administered incorrectly, like Juvederm, is there something you can inject to counteract the effects and dissolve the Botox?

A: Botox is not a filler, like Juvederm, and cannot be dissolved. Once it has been injected into the muscle, the muscle will relax and continue in a quiescent state until the neuromodulator wears out in about three to four months. This is why it is so important to find an expert injector with many years' experience with Botox: You don't want to risk a mistake that will take months to resolve. Please consult a board-certified dermatologist with expertise in Botox injection.

Q: Just wondering what happens when a woman aged 65 stops her routine botox and restylane injections?

A: Both Botox and Restylane require regular touch-ups to maintain their good results. If you stop Botox, after three to four months you may begin to see your wrinkles reappearing, as the dynamic muscles that form them go back to their normal activity. However, if you have been receiving Botox for many years, the muscles may be weaker than they were initially and you may have broken the ability for the brain to always activate the muscles. If you stop getting Restylane, after a year, the wrinkles will come back but they may never be as bad as they were before you started treatment since all fillers also cause your body to make new collagen. As with all regimens – whether for weight loss, hair care, or skin-care – anti-aging routines must be maintained to continue their benefits. Please consult with a board-certified dermatologist to keep your face looking its best.

Q: I'm young and am very concerned about aging. I've read that Botox can be used as a preventive measure, but couldn't find a lot of information about it. Can botox really prevent wrinkles? If it can, when is a good time to start? Would I need as much of it as someone who has already developed wrinkles? I want to prevent aging as much as I can (I'm already using sunscreen) but I dont want to be throwing away thousands of dollars by starting too early.

A: Botox can prevent wrinkles by relaxing the dynamic muscles that cause them. Even in your early 20s, getting periodic treatments with botulinum toxin can quiet the muscles sufficiently that they may not produce as many or as deep wrinkles later in life. Also, repeated use of Botox may prevent your mind from always squeezing these muscles which will minimize their use so they no longer crease the skin. If you are using Botox as prevention, you may need fewer treatments than if you were using it to smooth wrinkles that are already present. Please consult with a board-certified dermatologist to find out if you are a candidate for wrinkle prevention with Botox and to discuss a realistic maintenance schedule.

Q: I am 55 years old. I have never had any cosmetic procedures. I would like to remove the frown lines between my eyes as well as wrinkles under the eyes and also would like to know if Botox is effective on frown lines?

A: There is no upper-age limit for using Botox to rejuvenate your face. The only considerations are health and skin tone. As long as your skin is still reasonably elastic, it should respond well to muscle relaxation with Botox. By relaxing the glabellar muscles that cause the “frown” lines that are bothering you, Botox allows the overlying skin to smooth out. Botox can also minimize or stop crow's feet wrinkles around the eyes. However, if you have deep creases or wrinkles underneath your eyes, you may need some resurfacing techniques first. If the wrinkles are deep, hyaluronic-acid based fillers are a possible solution, too. Please see a board-certified dermatologist.

Q: I’m interested in knowing more about the true risk of Botox parties. Are the risks all that significant that you need a doctor on-hand? Afterall, Botox does wear off.

A: Many women enjoy getting cosmetic procedures at the same time as their friends, to make the experience more communal. However, these procedures should always be performed by a qualified and well-trained professional with years of expertise, ideally in a medical office setting. Botox is a neuromodulator that relaxes muscles. If injected incorrectly, it may create nerve damage and/or unwanted paralysis that can disfigure facial expresses and cause a drooping or closed eyelid. Botox takes three to four months to wear off, so if a mistake is made, you will have to live with the consequences for quite some time. If you and your friends wish to do Botox together, be sure to choose a board-certified dermatologist to help you get the results you want. We have performed Botox and other procedures with groups of friends in our medical office during the weekend or on evenings by special request.

Q: I have deep eye wrinkles, Im very worried since Im only 22. Ive tried many creams and serums but with none of them Ive seen improvement. They show up more when I smile. So, Ive tried to avoid smiling. I also use sun blocker and moisturizer everyday, but since I have polycystic ovaries and I have acne I use gel products, the makeup I use is very expensive of known brands as well. Please help!! Should I start with botox from now?

A: First, you aren't doing anything “wrong” and should not restrict yourself from smiling. Everybody's skin is different and some people develop wrinkles caused by dynamic muscles – such as those at the corners of the eyes – at a quite young age. Botox can be a good choice to relax the muscles that are causing the wrinkles, while still allowing you to smile and laugh normally and unselfconsciously. In addition, there are a variety of FDA approved fillers that can be precisely placed under the skin to increase fullness and smooth out deep wrinkles. Often times, both of these procedures are performed together. Finally, lasers are available to help build collagen which also acts to smooth put both deep and superficial wrinkles. Please schedule a consult with a board-certified dermatologist to learn more.

Q: Forehead massage after Botox? Please I need to know the safe time range I could massage my forehead & borrow area after botox injection.

A: You should avoid massaging the treatment area for 2 hours after receiving an injection of botox although washing your face and resuming your daily activities is fine. Please see a board-certified dermatologist to learn more about how Botox can help rejuvenate your face.

Q: Is Botox ok for lip plumping? I want fuller lips and I've heard the most about Botox.

A: Botox is a neuromodulator that is used to relax a portion of a muscle to prevent it from reinforcing a wrinkle. While it can slightly plump lips by relaxing the edge of the lip muscle, hyaluronic fillers such as Restylane and Juvederm are a much better option. When a dermatologist injects a small amount of filler into specific areas of the lips, they appear fuller and rejuvenated. Effects can last for six months or more, depending on the individual patient's metabolism and the amount and type of filler used. Feel free to reach out to a board-certified dermatologist to learn more about your options for restoring youth to your lips.

Q: Can You Exercise After Botox or Will It Decrease the Results?

A: One of the advantages of Botox treatments is that there is no significant downtime. You can immediately go back to your normal daily routines, including wearing makeup and exercising – even on the same day. Just to be on the safe side, allow a few hours to pass before doing heavy exercise, though. Make an appointment with a board-certified dermatologist to find out how Botox can help rejuvenate your skin.

Q: How long does Botox last? What determines how long it will work for each person?

A: There are a number of factors that determine how long a Botox treatment will last: 1. The patient's individual metabolism 2. Where the Botox is injected 3. How much is initially administered. For new patients, we tend to be conservative when using the neurotoxin, as we want to see how that particular patient responds. Our goal is to smooth the wrinkle while allowing the patient to have a naturally expressive face. When Botox is injected in a dynamic muscle that the patient uses frequently, the Botox will wear off more quickly. Finally, each patient will process the neuromodulator differently. Those with faster metabolisms may find out that it wears out sooner than average. However, most people find that a Botox treatment can last anywhere from three to six months. Please consult a board-certified dermatologist to learn more about the results you can expect with Botox.

Q: I'm thinking about getting Botox injections in my forehead but I don't know what qualifications/education practitioners need to do Botox injections.

A: The laws regarding the administration of the neurotoxin Botox vary from state to state. However, injecting this substance with expertise requires intense training, experience and finesse. We've all seen photos of celebrities whose faces look “frozen” because they received too much Botox, or heard oif “painful” procedures because botox or dysport were injected with larger than necessary needles, or had Botox that was placed sloppily, immobilizing too much of the muscle. Certainly there are registered nurses and other medical professionals who have gained the knowledge and know-how to administer Botox correctly; however in my opinion they should always been overseen by a board-certified dermatologist. You can arrange a consult to determine if Botox is the right treatment for you.

Q: How can I avoid Botox Side Effects? I read that Botox has some side effects like droopy eyelids. Is Botox safe? Any tips for making sure my Botox (first time!) has no bad side effects?

A: When receiving Botox from a board-certified dermatologist who has expertise in fine-needle injections, you may experience either no or minimal side effects. A droopy eyelid after Botox indicates that the practitioner was not expert enough to deliver the correct amount of neuromodulator and/or didn't evaluate the patient's face thoroughly. That's why choosing an experienced board-certified dermatologist possible will minimize any possibility of a less than perfect result.

Q: What Areas of the Face Can Botox Be Injected? Where would Botox be best suited/safe/effective for a person who has wrinkles all over their face?

A: In the hands of a board-certified dermatologist with injection expertise, Botox can be used to treat everything from forehead creases to neck bands. Using a very fine needle and precise delivery of the neuromodulator, I can also smooth out crow's feet, the “11” lines in the glabellar complex between the eyes, and “bunny lines” (the lines that wrinkles at the top of the nose). Botox can even be used to create a nonsurgical brow lift, which can give you a more bright-eyed, youthful look. We can also treat full cheeks making them more oval and a gummy smile as well as marionette lines. Schedule an appointment with a board-certified dermatologist to find out how Botox can help give you a smoother face and restore your natural beauty.

Q: I had Botox in my 11s and forehead today, and after the treatment I ran errands for about 2 hours then fell asleep for about 15 minutes while lying back with the pillows propped up to read. Is this okay? I read that you shouldn’t lie down for at least 4 hours after injections

A: You should be fine. While some doctors recommend not lying down for a few hours after Botox injections, it’s more of a precautionary measure and lying down on some pillows and falling asleep for 15 minutes should not affect your results.

Q: Is it possible to smooth forehead lines and also lift the brows with Botox? I often look angry or tired due to my droopy brows and forehead lines.

A: It is possible to smooth wrinkles as well as subtly lift the brows with Botox. Be sure to visit an experienced, board-certified dermatologist with an excellent knowledge of facial anatomy to ensure the best results.

Q: I’m thinking about Botox for my gummy smile, but I’m worried that once I treat it I won’t be able to make any “big” smiles. Will my facial expressions be affected?

A: Botox can be a good treatment to reduce a gummy smile, but it should only be done by a highly experienced, board-certified dermatologist as it is a a delicate area to treat. When done correctly, your facial expressions should not be significantly affected. Your smile will be slightly affected, as the Botox limits the ability of the upper lip to lift as high. I would recommend visiting a board-certified dermatologist for a consultation, and remember that Botox is temporary so if you for some reason don’t like the result, it will wear off in 3 to 4 months.

Q: Are there any negative long term effects of having the masseter muscles reduced with Botox over a long period of time?

A: There are no negative long term side effects associated with Botox to the masseter muscles. Botox is a great treatment to reduce the size of the masseter muscles, but it is temporary and if you stop using Botox the muscles will eventually return to their old size. See the photo in the link below to see results that I’ve achieved at my practice with Botox to the masseter muscles.

Q: Are Botox injections to the masseter to relieve TMJ pain covered by insurance?

A: You would need to talk with your insurance provider to see if they would be willing to cover Botox for TMJ. Botox injections are very rarely covered by insurance, and never covered for cosmetic reasons, but there is a chance that you could get it covered for a medical reason.

Q: Will fat transfer under the eyes help with crow’s feet or would I need Botox?

A: Botox is the gold standard for treating crow’s feet, frown lines, and forehead lines. Fat transfer is usually not recommended for under the eyes due to the delicate nature of the skin there. If you have dark circles or eye bags in addition to your crow’s feet, an HA filler such as Restylane might help. I suggest seeing a board-certified dermatologist for a consultation to come up with a custom treatment plan.

Q: I’m planning to have Botox injected in the left masseter muscle which is more developed than the right, causing asymmetry and difficulty opening my mouth wide, and I’m curious if the muscle is reduced if I would be able to open my mouth wider?

A: Botox is a great choice to reduce the size of an overdeveloped masseter muscle in the right candidate. If the tightness of the muscle is what is causing your difficulty in opening your mouth, then relaxing the muscle should help with this problem. Discuss your concerns with your doctor to see if Botox for the masseter is the most appropriate treatment for this problem

Q: Can Botox lift an eyebrow?

A: Botox can be used to subtly lift the eyebrows by a few millimeters in the right candidate. Often, patients who have a “Botox brow lift” done are very satisfied with the results that brighten the eye area while still looking natural. Please see a board-certified dermatologist with experience in this procedure to see if you are a good candidate.

Q: What’s the difference between Botulax and Botox? Besides the brand name, are they pretty much the same thing? Botox seems to be twice as expensive so I’d rather go for Botulax if it’s the same thing.

A: Botulax is not FDA approved for use in the United States, and I would advise strongly against having it injected. No reputable dermatologist or plastic surgeon will offer a product that is not FDA approved for use in the USA, and on top of that, there are no quality control regulations on products imported from overseas. You only have one face, so it is better to pay more and know that you are having quality injections with a legal product rather than risk terrible side effects from an unethical provider and non-FDA approved product. Here in the United States, the three FDA approved neuromodulators are Botox, Dysport, and Xeomin.

Q: How effective is jaw reduction treatment using Botox?

A: Botox can be very effective in reducing the size of the jaw in the right candidate. I perform this treatment often at my practice, and have seen great results. The best candidates have an overly square facial shape caused by an excessively large masseter muscle. If you bite down on your back teeth you can feel this muscle. Many people have a large masseter, especially if they grind their teeth at night. When we treat this muscle, it reduces in size and the facial shape will be a prettier, more feminine heart or tapered shape. One caveat in older patients who have jowls, treating the masseter will cause more sagging and the jowl will look worse. If your jaw shape is not due to overactive masseter muscles, but to bone shape or fat, then Botox will not be the appropriate treatment. I suggest visiting a board-certified dermatologist for a consultation to see if you are a good candidate for this treatment.

Q: My daughter had Botox in her hands two weeks ago, and now she’s experiencing weakness in her hands. She’s a softball player and is having trouble gripping the ball. How long will this weakness last, and is there anything she can do to speed up the recovery?

A: Botox for hyperhidrosis in the palms should not have the side effect of weakening the muscles, as it is injected very superficially. Most likely, your daughter’s Botox injections were placed too deep or the dose was too high. Unfortunately, there is no way to speed up the process of Botox wearing off; your daughter will simply have to wait it out. It may take a week, but could take 3-4 months for the weakness to wear off completely.

Q: Is there any evidence that MS patients have antibodies that reject Botox and other cosmetic treatments?

A: While there is no evidence of MS patients having antibodies that reject Botox, MS is a disease that affects the nerves and muscles, so it is best to have any Botox treatment cleared with your neurologist before having it as a cosmetic treatment. Botox affects the muscles in the face so it’s better to be safe. Other types of cosmetic procedures such as dermal fillers or laser resurfacing should be fine, as these treatments do not affect the nerves or muscles.

Q: I was diagnosed with Hashimoto’s disease last July, and since then I’ve been on Plaquenil with good results. It is safe to get Botox for crow’s feet?

A: Autoimmune diseases such as Hashimoto’s are generally not a contraindication to having Botox done. You should be fine, just make sure to tell your provider about your medical history and medications and be sure to visit a board-certified dermatologist for your treatment.

Q: Will a lift using Botox on a 32 A cup actually work? How long would it last and how much would it cost?

A: Botox cannot be used for a breast lift. It works by relaxing muscles and would have no effect in lifting the breasts. Please visit a plastic surgeon to learn about your options for a breast lift.

Q: Should I use Botox or Juvederm for my deep marionette lines?

A: For marionette lines, filler is generally a better choice than Botox. Botox works by relaxing muscles that cause wrinkles, while fillers add volume. Marionette lines are caused by volume loss and skin laxity, so fillers usually work well in this area. You may need a combination of fillers to the midface, such as Voluma, and collagen building fillers such as Radiesse for a more comprehensive result. I suggest visiting a board-certified dermatologist for a consultation to come up with a custom treatment plan.

Q: How much longer than Botox does a Dysport procedure for crow’s feet last?

A: There is not a significant difference in how long Dysport and Botox last. Both will last for approximately 3-4 months when injected for crow’s feet. You may begin to see results slightly more quickly with Dysport than Botox, but this varies from patient to patient.

Q: Can Dysport injections be reversed quickly? It changed the shape of my face and I’m not happy with it. A doctor said steaming my face might help it to disappear. What can I do?

A: Unfortunately, Dysport injections cannot be reversed. Luckily though, the effects are not permanent. It will wear off on its own within 3-4 months. Steaming your face is not likely to help it to wear off any faster.

Q: What’s the best treatment for deep wrinkles? Is plastic surgery the only option?

A: Depending on the location of the wrinkles and their severity, there are a number of non-surgical options that can be used. Botox is good for smoothing wrinkles on the forehead, frown lines, and crow’s feet, while fillers are best for wrinkles around the mouth such as nasolabial folds and marionette lines. Laser resurfacing can also be used if wrinkles are especially deep. I’ve had great success at my practice treating patients with extensive deep wrinkles with laser resurfacing. In the right hands, it can take 20 years off a person’s face. See the link below for before and after photos.

Q: Which wrinkle treatments get rid of forehead lines?

A: Botox is usually considered the treatment of choice for reducing forehead lines. It is safe and highly effective, and the treatment takes only around 10 minutes with no downtime required. Botox works by relaxing the muscles that cause forehead wrinkles, allowing the skin to smooth out. If you have deeply etched forehead lines, you may need laser resurfacing or filler as well to smooth your lines out effectively. Visit a board-certified dermatologist for a consultation to see what treatment is best for you.

Q: What are the side effects of prolonged, repeated Botox injections? If I get injections every 4 months, will I develop a permanent dazed expression due to not being able to control my facial expressions?

A: There are no real side effects to having Botox done every four months. Many people get Botox done repeatedly for years and have no complaints. In a recent study looking at patients who had Botox for an average of 9 years regularly, over 90percent were happy with how they looked and reported looking up to 7 years younger than their age.A “dazed” look should never occur with properly done Botox injections. If you find that your expression looks unnatural, it is due to poor injection technique or over-injection and you should find a new injector with more experience achieving a natural look. I recommend visiting a board-certified dermatologist for Botox injections.

Q: It’s been a month since I had Botox and I’m not happy with the results, it looks like nothing was done. How soon can I get more?

A: Final Botox results usually appear by week 2, so at a month after you should be fine to get more units placed as how much you see is dose dependent, and you may just need more. Make sure to see a board-certified dermatologist.

Q: How long does it take to see results from Botox and Juvederm?

A: Botox takes 3-7 days to begin to see results, with full results appearing after two weeks. Juvederm results are immediate, although there may be swelling that obscures them for up to a week, especially if done in the lips. Always be sure to see a board-certified dermatologist to ensure that you get the best results.

Q: I had filler and Botox done for frown lines and lines around my mouth, but I don’t see much difference. I only had one syringe of Juvederm, my doctor said to come back in two weeks if I want more.

A: Botox does not work immediately. It can take 5-7 days to begin to see results, with full results being seen at two weeks. If you are unhappy with the amount of filler you received, go back in two weeks as suggested to have more put in. Good luck.

Q: I had Botox and three hours later coughed very hard. Could this make my Botox move?

A: No, coughing will not affect the placement of Botox. Enjoy the results of your treatment.

Q: Can a bad Botox effect causing droopy eyelids take more than 6 months to wear off?

A: While Botox effects can last longer than the usual 3-4 months, it is very rare. I would try to compare what you look like now to “before” photos, and if you are still concerned, visit your injector again for a follow-up. Even if it turns out you are still experiencing some lingering Botox effects, they will wear off soon. Botox is a temporary treatment.

Q: Can a 20 year old get Botox for the 11s as a preventative measure even if there are no visible lines yet?

A: Botox does have benefit and is often used as a preventative measure in people who want to slow the development of their dynamic and static wrinkles. I suggest visiting a board-certified dermatologist for a consultation to see if you are an appropriate candidate for preventative Botox at this time.

Q: I got Botox in my forehead a week ago, and now I have a runny nose and cough as well as a heavy, tingling feeling in my forehead. Are these cold symptoms a side effect of Botox? When will the tingling stop?

A: Heaviness/tingling is a common side effect of Botox, and should resolve within two weeks. As far as the cold symptoms, most likely you coincidentally happened to catch a cold right after your Botox injections. Cold symptoms are not a common side effect of Botox. It's always best to let your provider know about the symptoms you may be experiencing as they know exactly where they injected you.

Q: How many days will it take to see my final Botox result for gummy smile?

A: Botox starts to work within 3-7 days of injection, with full results appearing after two weeks. Good luck with your gummy smile reduction.

Q: Is Botox good for fine lines and wrinkles? What are the side effects or risks?

A: Botox is the gold standard for reducing dynamic expression lines such as forehead lines, frown lines, and crow’s feet. For fine lines not caused by movement, laser resurfacing or a lighter hyaluronic acid filler may be a better option. Botox is extremely safe and when injected by a skilled, board-certified dermatologist, the risk of unwanted side effects is very low. Side effects could include temporary eyebrow or eyelid drop, and there is always a risk of bruising, although it is very small since the needle used for Botox is so fine. As long as you visit a good injector, you shouldn’t worry about side effects.

Q: It’s been 5 days since my Botox treatment and while I see improvement in my forehead I don’t see any in my frown lines. My first time having Botox I saw results within 3 days. Will I have to pay for a touch-up if I need one?

A: My advice is to be patient. Botox results generally START to appear within 3-7 days, with full results appearing after two weeks. If after two weeks you still feel that there’s no improvement, visit your injector again for a touch-up. It’s completely up to your injector if you’ll need to pay again for a touch-up.

Q: I’m 55 and my face is starting to sag. I notice it especially on the sides of my mouth. Should I do Botox?

A: Botox is great for smoothing and preventing dynamic wrinkles in the forehead, frown lines, and crow’s feet, and can be used in other areas of the face as well by an experienced dermatologist. It works by relaxing the muscles that cause the wrinkles. What you are describing does not sound like an issue best addressed with Botox, but you may benefit from a skin tightening procedure or from dermal fillers to replace lost volume. I recommend scheduling a consultation with a board-certified dermatologist who can evaluate your concerns and come up with a custom treatment plan for you.

Q: My right eyelid is very puffy from Botox two years ago, can anything be done?

A: Botox effects are temporary, only lasting approximately three months. It is highly unlikely that your eyelid puffiness is related to Botox injections from two years ago. I suggest visiting an ophthalmologist for an evaluation and treatment plan.

Q: How can a person know if they’re allergic to Botox if they’ve never had it done? I’m uncomfortable with getting Botox because I’m afraid of getting an allergic reaction to it. I don’t have any allergies at all, but how can I know if I’m allergic until it’s injected?

A: The possibility of having an allergic reaction to Botox is extremely rare. In all my years of practice, I’ve never seen a patient have an allergic reaction. There is no allergy test for Botox, so if you are still concerned even knowing how rare it is, it may be better just not to do it.

Q: Do you treat TMJ with Botox?

A: TMJ can be treated effectively with Botox in the right candidate. We perform this procedure at my practice with great success.

Q: I’m 13 days post Botox for the first time to my glabella, and I don’t see any results. What’s going on? I’m 29 years old and I got 28 units.

A: It’s possible that you need more units in the area. Everyone is different, and some patients require more units to see a noticeable difference. I recommend visiting your injector again for a touch-up, and once you find the right number of units you can get that same number done in the future. It’s always best to start conservatively, especially if it’s someone’s first time, since it’s easier to add more units later than to fix over-injection.

Q: Is it ok to get an IPL treatment after Botox?

A: Yes, it is perfectly fine to have IPL and a Botox treatment on the same day. In my practice, we generally prefer to do the IPL first lying down and then do the Botox in an upright position. These two treatments work well in tandem as the IPL addresses skin textural and pigmentation issues while the Botox smooths wrinkles in the forehead, frown lines, and crow’s feet, leading to a nice comprehensive effect. This type of combination therapy gives great results.

Q: Can you get red eyes from Botox? I had it done 10 years ago and noticed that my eyes were bloodshot before going to bed. It was gone the next day. If I have Botox again, will the same thing happen?

A: Most likely, your bloodshot eyes were merely a coincidence. Botox is not known to cause bloodshot eyes as a side effect, and I’ve never seen it happen at my practice. If you do decide to have Botox again, be sure to visit a board-certified, experienced dermatologist for the best results.
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