BOTOX® Cosmetic

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 and 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. 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.

Again, a dermatologist that Dr. Cohen trained with for a year is one of the pioneers of Botox, making Dr. Cohen and his team uniquely experienced in the nuances of this treatment.

Skin is a living organ that changes over time. 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, the 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.

The decision to start Botox treatments can be proactive, focusing on prevention rather than correction. This concept, known as “pre-juvenation,” suggests beginning treatments early, often in a person’s 20s, before expression lines become permanently etched into the skin. The rationale behind this approach is rooted in the mechanics of how Botox works and the natural aging process of the skin.

The Science of Pre-juvenation

Botox functions by blocking nerve signals that cause muscles to contract. Repeated muscle contractions over years contribute to the formation of expression lines, such as forehead lines, crow’s feet and frown lines. By inhibiting these contractions, Botox can effectively delay the onset of wrinkles — those visible even when the face is at rest.

The Benefits of Early Intervention

Starting BOTOX® treatments early has several advantages:

• Prevents the Formation of Deep Wrinkles: Regular use of Botox in your 20s and 30s can prevent the development of deep lines that are more difficult to treat later.
• Reduces the Need for More Invasive Procedures: By maintaining a youthful appearance with Botox, individuals may delay or avoid the need for more invasive anti-aging treatments.
• Cultivates Long-Term Skin Care Habits: Early users of Botox often become more aware of their skin health, leading to better overall skincare habits.

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 Healthy Skincare Regimen

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.

Sun Protection

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 and titanium oxide 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. Reapply 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.

Don’t Smoke

If you want to preserve smooth skin, avoid smoking because the toxins in cigarettes and other nicotine products can accelerate skin aging.

Don’t Stress

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 temporarily paralyzes the muscles where it is injected, which can reduce the formation of wrinkles caused by expressions. When administered correctly by experienced professionals, Botox should not significantly impact the ability to make natural facial expressions. The goal is to soften expression lines, not eliminate the ability to express emotions.

Over time, regular use of Botox can lead to a decrease in the overall severity of facial wrinkles. Patients often find that they look more rested and less “angry” or “tired” as a result. Importantly, with continued regular use, the results of Botox treatments can gradually last longer. This extended duration effect is thought to be due to the muscles becoming trained to relax, reducing their habitual contracting actions that contribute to wrinkle formation. As these muscles remain relaxed over longer periods, the intervals between treatments can potentially increase, providing a sustained youthful appearance with less frequent need for re-treatment.

Regular consultations and following a tailored treatment plan can help maintain natural facial expressions while enjoying the anti-aging benefits of Botox.

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 many dermal filler products (like Restylane®, Juvederm®, Voluma® and Radiesse®). These injections are often combined with neuromodulators on the same day to address both dynamic and static wrinkles.

Botox can indeed be combined with other cosmetic procedures, and doing so often enhances overall aesthetic outcomes. Combining Botox with treatments like chemical peels, microneedling or laser therapies can address multiple skin concerns simultaneously, leading to more comprehensive improvements in skin appearance and texture.

It is crucial to time these treatments properly to avoid overwhelming the skin and to maximize the benefits of each. Our Board-Certified Dermatologists can provide guidance on the best schedule for combining treatments based on your individual skin conditions and desired outcomes.

• Chemical Peels: Botox and chemical peels can work together to rejuvenate the skin. While Botox relaxes the muscles and smooths wrinkles, chemical peels improve skin tone and texture by removing the outer layers of aged or damaged skin, promoting regeneration and collagen production.
• Microneedling: This procedure can be paired with Botox to enhance skin firmness and reduce fine lines. Microneedling stimulates collagen production, and when used with Botox, the relaxation of muscles can allow for a more pronounced and lasting effect, particularly in areas with dynamic wrinkles.
• Laser and Light-Based Treatments: Laser and light devices focus on skin resurfacing and pigmentation issues and can be effectively combined with Botox to achieve a more youthful appearance. Botox addresses the underlying muscle activity that contributes to wrinkles, while laser treatments improve skin surface conditions.

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® and Daxxify® — for relaxing the muscles responsible for dynamic wrinkles. The alternatives work very similarly 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). He and his team can help determine which neuromodulator is right for you.

When considering neuromodulator treatments for cosmetic purposes, it’s essential to understand the distinctions between the available options. Each brand has unique characteristics in terms of onset time, duration of effect and specific uses, which can influence your choice based on your individual needs and goals.

Onset Time

• Botox: Typically, the effects of Botox begin to appear within three to four days after injection, with full results visible in about two weeks.
• Dysport: Dysport is often chosen for its slightly quicker onset, with patients sometimes noticing improvements as early as one to two days post-treatment, with full effects in about a week.
• Daxxify: Similar to Botox, Daxxify generally shows results within a few days, but it can take up to two weeks to see the complete effects.

Duration of Effect

• Botox: The results from Botox injections typically last three to four months, depending on the patient’s muscle activity and metabolism.
• Dysport: Similar to Botox, the effects of Dysport usually last for about three to four months. However, some patients report slightly shorter durations, depending on the area treated.
• Daxxify: Daxxify stands out for its longevity, with effects potentially lasting six months or longer, making it a favorable option for those seeking a longer duration between treatments.

Specific Uses

• Botox: Approved for use in treating forehead lines, crow’s feet and glabellar lines (“11s” between the eyebrows), Botox is versatile and widely used for both cosmetic and medical purposes, including treating excessive sweating and chronic migraines.
• Dysport: Dysport is specifically formulated to spread a bit further from the injection site, making it ideal for larger areas such as the forehead. It’s particularly effective for treating glabellar lines.
• Daxxify: Being the newest among the three, Daxxify is approved for treating frown lines. Its unique formulation and longer-lasting effects make it suitable for patients interested in less frequent treatments.

Dr. Cohen has performed many clinical trials on Botox as well as these other products 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. 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.