The most common cosmetic dermatology treatment sought by both women and men throughout the United States is BOTOX®. Denver’s AboutSkin Dermatology team is surely the most experienced office in the Rocky Mountains region and one of the top in the country. In fact, only a handful of people in the world are as internationally well known for BOTOX® (and injectables, as well as lasers), with Dr. Joel Cohen having authored three textbooks and more than 262 articles, in addition to lecturing all over the world many times a year (prior to COVID). Not only did Dr. Cohen write a 400-page textbook (the largest to date on this topic) on BOTOX® and related treatments (known as neuromodulators), but he is internationally known and respected for his publications, and he teaches and lectures throughout the world on this subject. Dr. Cohen actually studied and participated in clinical trials during his one-year fellowship with the husband and wife credited with discovering the cosmetic use of BOTOX®, dermatologist Alastair Carruthers and ophthalmologist Jean Carruthers.
*Individual results may vary
BOTOX® may be a household name, and surely commoditized in hair salons and spas, but it is still important to choose the right person to inject it. Choosing an experienced, Board-Certified Dermatologists is paramount for anyone who wants to get skin-smoothing results while maximizing safety. The physicians at AboutSkin are ALL Board-Certified Dermatologists and have experience, training, and knowhow. Aesthetics are not a part time “side-gig” for us—we are well-trained on these procedures, are tested on their nuances in residency and as part of our rigorous board certification, and we actually perform these treatments every day in our offices. We store these products properly, and according to the guidelines.
Skin is a living organ that changes over time. Start BOTOX® early, before lines imprint on the skin. There is a whole body of literature on “pre-juvenation” and on starting treatments in a person’s 20s. As skin ages, some structures and structural support are lost through chronologic aging factors, as well as environmental exposures (like sun, smoke, and other pollutants). When people get into their 20s, 30s, and beyond, loss of collagen, elastin, and hyaluronic acid makes the skin less resilient. By this time, facial muscles responsible for expression have pulled on the overlying skin so many times that it has caused lines to imprint in the skin.
Folds and creases gradually begin to appear, and these grow more prominent with each muscle contraction. Over time, the wrinkles become more and more reinforced and thus pronounced, and then are often visible when the skin is at rest.
BOTOX® Cosmetic is designed to address these lines, known as “dynamic wrinkles”—since the word “dynamic” refers to something marked by constant activity. This is in contrast to “static wrinkles,” which are not associated with movement and are visible at rest. A single injection session of BOTOX® is enough to make the targeted muscles pulling on the skin less visible and less imprinted for months at a time.
Specifically, the USFDA has approved BOTOX® for the treatment of:
Routine BOTOX® applications by experienced physicians have also led to the development of many other safe and established uses on which Dr. Cohen has lectured and actually published extensively, including:
Muscles contract when they receive a signal to do so via a specialized cell known as a neuron. BOTOX® blocks contractions in wrinkle-forming muscles by disrupting this typical flow of neuron-signaling. BOTOX® has a similar effect on blocking glands, such as those that produce sweat (especially in the underarm area). This is why BOTOX® is known as a “neuromodulator.”
The key ingredient in BOTOX® is a purified form of botulinum protein. Once injected into a targeted muscle, it works to suppress contractions for months at a time. Because neuromodulators are such effective blockers of muscle activity, injectors must be thoroughly trained in their proper handling, use, and regions of delivery. Dr. Cohen, as well as our team of Board-Certified Dermatologists, are all very well trained in all of these aspects of injecting BOTOX®. At our offices, only doctors inject BOTOX®.
While it is possible for a wide range of people to meet the minimum requirements to perform aesthetic treatments in some more lax states in the United States, Board-Certified Dermatologists are uniquely qualified to administer BOTOX® and a full spectrum of aesthetic procedures. Again, a dermatologist that Dr. Cohen trained with for a year is one of the pioneers. This is due to their rigorous medical school and residency education, their intense study of the skin, their understanding of skin’s relationship to other systems, and their extensive board exam testing on these procedures.
One of our Board-Certified Dermatologists can assess you personally and determine whether BOTOX® would help you to get the results you are seeking, as well as the suitability of the treatment for your specific situation.
Generally, any adult patients who are physically healthy, not pregnant or breastfeeding, have moderate to severe facial wrinkles caused by muscle contractions, and don’t have allergies to the ingredients in BOTOX® would be ideal candidates. More and more commonly, patients start in their 20s and 30s for “pre-juvenation” to minimize imprinting of lines in the first place.
All patients who desire a BOTOX® cosmetic treatment will be seen by a Board-Certified Dermatologists at AboutSkin Dermatology. This allows the patient to describe his or her desired aesthetic goals. It also gives the injector an opportunity to determine the suitability of the treatment, as well as other aesthetic procedures of interest, and explain what to expect. Many people have questions about the length of treatment, as well as cost. BOTOX® side effects and other rare potential post-treatment issues are also a common topic of these discussions with your injector. Again, Dr. Cohen literally wrote, as lead author, a 400-page book on all of this related to BOTOX®.
The BOTOX® injection session itself does not last long. Administering the treatment is done with great care by positioning each tiny-needle injection with precision. The slight pain can often be minimized by pre-treatment with ice or even topical anesthetic applied before our appointment. That said, customized results still take only a matter of minutes. And because a treatment session with BOTOX® alone doesn’t take more than several minutes, people even dub it a “lunchtime procedure.”
Although BOTOX® doesn’t require much preparation, be sure to talk to your injector during your consultation about all the medications and supplements you’re currently taking. You might want to adjust how you’re taking some over-the-counter products, such as aspirin, Ibuprofen, etc., as they are blood thinners. They can increase the risk of bruising and bleeding from injections. To optimize healing, avoid smoking and alcohol for a few days prior to treatment.
Please note that any changes to prescribed prescription medications should be discussed with a primary care physician or similar professional prior to altering any doses or schedules. Maintaining your health is of primary importance.
Each tiny-needle stick feels like a slight pinch. Patients can expect the treated area to sometimes be slightly tender shortly after their session, with the possibility of bruising, redness, and swelling. These BOTOX® side effects and post-injection issues are typically very mild and temporary. Some of the most appealing aspects about this treatment are that it is fast and there’s no recovery time needed after injections.
You can go back to your routine right away, but try to relax for the rest of the day after your treatment. Don’t engage in heavy exercise that increases blood flow to the injection site for a day or two, as this can potentially increase bruising and swelling. Also, avoid placing too much pressure on your face the day of treatment by massaging it or having a face-down massage, as this can cause the injectable to potentially migrate to an adjacent undesired muscle and lead to less-optimal results.
Each individual BOTOX® patient experiences unique results—depending on the prominence of their musculature, the dose used to treat them, and their aesthetic goals. Your skin will generally look smoother, younger, and more refreshed after BOTOX®, but if desired you’ll often still be able to move your face and make expressions. BOTOX® works more on the muscle than resting lines (which are caused by the muscle contractions over time).
The results of a BOTOX® treatment do not appear right away, as it takes some time for the medication to take effect. Patients should start to see the results of their BOTOX® injections within three to four days, as the facial muscles and nerves respond to the active ingredient—but they peak 10 to 12 days later. The smoother-looking skin can be expected to last for roughly three to four months (but often some results are still visible for up to six months).
The average lifespan and efficacy of the BOTOX® depends on a number of factors, including the age of the patient, the elasticity of their skin, and the severity of the wrinkles. In FDA studies, some patients’ results lasted longer and some patients’ results lasted shorter than the average durations mentioned, of typically three to four months. As the neuromodulator effects begin to wear off and muscle activity resumes, patients can schedule a new treatment session. Patients can go back for additional BOTOX® treatments roughly every three months if they so choose.
Generally, since BOTOX® is a treatment that provides temporary results, patients will need to come back for additional treatments if they like their results and want to maintain their more youthful look long-term. However, there are things you can do to prevent BOTOX® from wearing off too quickly—as well as prevent new wrinkles from developing. A good, daily skincare routine can potentially extend the lifespan of injections between your appointments and will contribute to efforts to delay the effects of aging. Ask our AboutSkin doctors or aesthetic team members about skincare based on scientific data and clinical trials (which, in many cases, our AboutSkin research team participated in under the direction of Dr. Cohen, with the results published).
Simply cleansing your skin to remove toxins, dead cells, dirt, and residual makeup is the first step. If you have had injections, hydration will be especially important for maintaining results, so be sure to moisturize and drink plenty of water. Moisturizing helps to keep your skin plump and hides any fine lines that aren’t smoothed by BOTOX®. Additionally, you can use antioxidant-rich products to help undo existing damage and ward off additional harm from free radicals, as well as choose collagen-boosting products to strengthen the skin.
One of the most important things you can do to fend off wrinkles is apply broad-spectrum sunscreen with an SPF of 30 or more on your face each day, even if the weather is overcast or it’s wintertime. Zinc or titanium are the most effective “broad-spectrum” ingredients, and many formulations that we carry at AboutSkin rub in well and can be very cosmetically elegant. Limit sun exposure and wear protective clothing like sunglasses when you go out. Re-apply sunscreen every two hours at minimum. UV rays from sunlight are highly damaging to the skin cells, and extensive, unprotected exposure will cause wrinkles, rough patches, and hyperpigmentation to form on your skin.
If you want to preserve smooth skin, avoid smoking, because the toxins in cigarettes and other nicotine products can accelerate skin aging. Using relaxation techniques will not only help to improve other skin issues, but can also make BOTOX® last longer, as stress causes us to use our facial muscles to frown and scowl more.
BOTOX® Cosmetic is the most popular cosmetic treatment globally, but it is not the only neuromodulator. AboutSkin Dermatology also offers other type-A botulinum brands—like Dysport®, Xeomin®, and Jeuveau™—for relaxing the muscles responsible for dynamic wrinkles. The alternatives work in a very similar way to BOTOX®, but there are a few differences in the way they are formulated, so some patients might have a preference for one type over another. Dr. Cohen and our AboutSkin researchers performed the clinical trials on all of these products, and Dr. Cohen has performed trials on products in the potential pipeline of FDA studies (like Revance’s botulinum toxin injectable).
Dr. Cohen has performed many clinical trials on BOTOX®, as well as these others over the years—and some patients prefer to continue treatment with the product they received during these clinical trials at our office. You and your doctor can make that decision together.
While BOTOX® relaxes facial muscles that imprint wrinkles, women and men who want to address static wrinkles caused by a loss of volume can choose dermal fillers to volumize the skin. Again, we have performed clinical trials on so many of the dermal filler products (like Restylane®, Juvederm®, Voluma®, and Radiesse®). These injections are often combined with neuromodulators on the same day to address both issues: dynamic as well as static lines and wrinkles.
No matter what your treatment specifics are, the goal will be the same: to safely give you a more youthful and relaxed face that looks natural.
As director of AboutSkin Dermatology, the nationally renowned Dr. Cohen oversees the practice.READ MORE
Dr. Stoler has provided medical and surgical services at AboutSkin Dermatology since 2011.READ MORE
Dr. Ho joined AboutSkin Dermatology in 2012, and provides medical and surgical services.READ MORE
Dr. Fettig came to AboutSkin in 2019 after completing her Boston University residency.READ MORE