Before and after Botox to remove Crow's Feet

Botox or Botulinum Toxin A can do much more for your health and well being than removing wrinkles from your face. Contrary to popular myth, Botox or Botulinum Toxin A is not like getting food poisoning. Botox or Botulinum Toxin A is a very effective helpful medication for many serious human illnesses.

Botox has been used safely for over 30 years and has helped many thousands of people. Botox or Botulinum A injections do not leave you without facial expression looking like a figure in a wax museum if injections are done by an expert and not at a Botox party. Botox injections can cure headaches, fix a lazy or crooked eye, relieve muscle spasm, help stroke patients, relieve bladder incontinence, stop tics and facial twitches, help back pain, and reduce excessive sweating as well as many cosmetic wrinkle reducing applications.

Botox or Botulinum A has an incredible safety record when administered by an experienced licensed physician, however Botox parties and other unlicensed uses have resulted in complications and unhappy results.

There is, however, much confusion and misinformation about Botox and Botulinum Toxin A in the popular media which has frightened many people who potentially could be helped by this remarkable medicine.

Most negative news about Botox is the result of misuse of this medication by inexperienced or non-licensed users of Botulinum Toxin A often taking place in non-licensed or non-medical facilities.

The most widely used indications for Botox are certainly cosmetic. Wrinkle removal, brow lifting, removal of crow’s feet, frown lines, worry lines, lip lines and the liquid face lift are the most common day to day uses of Botox or Botulinum Toxin A.

Before and after Botox and Restylane to reduce Lip Lines

However, many more serious medical uses are available that can help people lead more comfortable lives after suffering very serious medical illnesses.

In this article I will give an objective description of Botox, how it is used, what it can achieve, and how it can be safely administered. Hopefully, the reader will be more accurately informed about this very helpful medication and learn how Botox may be used to help you, a friend or family member improve very common medical problems.

What Is Botox?

Botox or Botulinum Toxin A is a highly diluted synthetic medical grade medication which weakens muscles when injected directly into the muscle fiber.

Botulinum toxin in nature is produced by bacteria called Clostridium Botulinum whose spores are widely distributed in the soil, ocean sediments, and can be found on many fruits and vegetables. The spores are harmless. However, under the right conditions, that lack oxygen, spores can produce the bacteria, Clostridium Botulinum which can produce the natural toxin. Natural Botulinum toxin which can cause muscle paralysis. The most common cause is food poisoning from ingesting improperly preserved food.

The muscle relaxing effect of Botulinum Toxin has been harnessed to provide many beneficial medical treatments by synthesizing a diluted safe form of Botulinum A toxin called Botox that can safely be used under medical supervision.

How Does Botox Work?

Botulinum Toxin A works directly on the muscle fiber to weaken the contraction of the muscle. All of our muscles are attached to nerves. When we flex, tighten or contract a muscle, the nerve sends electrical impulses to the muscle to make the muscle tighten. The nerves connect to the muscle at a specific point called the neuromuscular junction (nerve to muscle connection). Actually, the end of the nerve is not in direct contact with the muscle.

There is a small space between the nerve ending and the muscle. When the nerve impulse or electrical message gets to the end of the nerve, a chemical called Acetylcholene is released from the nerve, travels across the small gap to the muscle, and stimulates or causes the muscle to contract.

Botox works by blocking the action of Acetylcholine on the muscle, thus the muscle relaxes when the Acetylcholine is blocked.

This muscle relaxing effect is very useful medically in any condition in which increased or excessive muscle tone or spasm is causing pain or disability.

In addition, all of our muscles have a normal resting muscle tone or tension even when we are not actively contracting the muscle. In our facial muscles that cause expression lines such as crow’s feet, worry lines and frown lines, this resting tone causes these lines. Injections can relax the resting muscle tone that is pulling on the skin and causing lines.

This is a direct effect and is produced by the direct injection of the Botulinum Toxin A into the muscle.

How to Use Botox–What Can Botulinum Toxin A Do for You?

• Headache-Botox injections into painful trigger points where headaches and migraine headaches start can produce dramatic relief for people who suffer headache.

• Excessive sweating-Because Acetylcholine also causes sweat glands to produce sweat and Botox injections can significantly reduce sweating in the palms, feet and underarm areas. This can eliminate wet lines caused by sweating on dresses during high stress times such as weddings.

• Bladder control-Many people suffer from urinary incontinence from spastic bladders. Urologists can use injections of Botox to relieve bladder spasm and reduce incontinence.

• Relieve spasms, twitches, back pain-Muscle spasms are painful and disabling in many conditions such as Torticollis (neck spasms), back spasms, cerebral palsy, after stroke and other spastic conditions. Relaxing muscle spasms with Botox can help both function and pain control

• Correct lazy eye-Ophthalmologists can use Botox to specifically relax eye muscles that cause lazy eye, strabismus and crossed eyes.

• Facial and Eye Spasms and Tics-Many people suffer from facial and eyelid twitches called tics that can be relieved by Botulinum Toxin A injections.

• Help Stroke victims-Many people are disabled by spasm and over activity of muscles affected by stroke. Properly placed Botox injections can be very helpful in relaxing spastic muscles that interfere with normal activities.

• Reduce squinting-Botulinum Toxin A injections can reduce unwanted facial grimacing and squinting

Before and after Botox to remove Crow's Feet and squinting

Before and after Botox for Brow Lift and reduce Frown Line

Does Botox Get Rid of Wrinkles?

Botulinum Toxin A relaxes the muscles that cause specific wrinkles or lines in the face. These lines or wrinkles occur because of tension or contraction of the muscles of facial expression. These muscles only function is expression. They are not involved in necessary function such as chewing smiling, eye blinking and other important functions.

The lines or wrinkles that can be helped or reduced are the frown lines, worry lines, crow’s feet, lip lines and lines that pull the lower lip down and accentuate the jowls.

Some wrinkles are permanent indentations in the skin caused by years of muscle pull and aging of the skin caused by sun damage. These wrinkles will not be helped. Other wrinkles on the face caused by aging and sun damage that are not caused by muscle pull cannot be helped with Botulinum Toxin A.

Does Botox Lift the Face-Is Botox Non-surgical Face Lift True?

No. Botulinum Toxin A relaxes muscles and does not tighten or lift any part of the face. However, some muscles around the mouth pull the lower face down and create jowls and marionette lines. If these muscles are relaxed with Botox, the lower face is lifted by the upper face muscles, thus a Botox lower face and mouth lift is possible.
Botox is used along with Facial Fillers like Restylane, Perlane, Juvederm, Sculptra, and Radiesse to relax muscles that are pulling the corners of the mouth down which allows the corner of the mouth to be lifted by unopposed muscle action and the plumping effect of the filler. These techniques are referred to as a liquid face lift.

How is Botox Given?

Injections are done through a very tiny 32 gauge needle and are relatively painless. I use a topical anesthetic and cool the muscle and skin with ice or a special chilled Titanium roller. When using these techniques, many patients say they do not even feel the injection.

How Close to A Special Event Should I Get Treatment?

I recommend at least a week or two before a special event. The Botulinum Toxin A works fast, in a day or so but full effect can take two weeks. The main reason to start early is in case you bruise. You will need 10 days to two weeks for the bruise to completely resolve.

Will I Bruise After My Botox Injection?

Bruising after injection happens 10-20 per cent of the time and nearly 100% of bruises occur during injection of the crow’s feet area. This is because there are so many tiny blood vessels around the eyes and the skin is very thin and fragile. I try very carefully to see and avoid these tiny vessels but sometimes they are invisible and a small bruise occurs. We apply pressure and cold packs immediately after injection which also helps avoid bruising.

How To Avoid Bruising After Injection?

Be sure to avoid aspirin or any blood thinning agent before Botulinum Toxin A injection. Careful technique to avoid any small blood vessels helps a great deal. Cold packs prior to injection shrink the vessels and lessen the risk of a bruise. Pressure and cold packs immediately after injection also helps avoid bruising.

I also recommend taking the herb Arnica Montana either before or immediately after injection which also can help with bruising.

When Will I See Results of My Injection?

You will see results in 24 hours after injection. Full effects can take up to two weeks to be seen.

What If I Do Not Respond To My Injection?

Very small per cent ages of patients just do not respond to Botulinum Toxin A. In my experience only about 1 or 2 % of patients fail to have a response. In all cases, the non-responders have been dark skinned people of Mediterranean or Southern European extraction and have had larger than usual muscles. In contrast, Northern European people, very thin skinned fair complected people usually have excellent results that can often last longer than usual.

Another possibility if you do not respond is that diluted, out of date solution was used or the injection technique was not proper. Be concerned if the price is lower than average-you usually are getting diluted Botulinum Toxin A which will not be effective. Also, only have injections by board certified plastic surgeons and dermatologists who do a lot of these treatments. Experience and technique are very important to achieve the best result.

What Should I Avoid Before Having An Injection?

Avoid aspirin and other blood thinning medications prior to injection.

Also avoid heavy exercise and exertion before and the first day as increased heart rate and blood pressure will increase the risk of bruising.

How Long Does Botox Last?

On average, to maintain the best possible correction, plan on repeating your treatments every 3-4 months.

While the effect may last 6-12 months in some people, especially fair thin skinned people, as the effect wears off wrinkles will return.

Is Botox safe?

Yes, when pharmaceutical grade Botulinum Toxin A manufactured by Allergan is injected in the proper dosage, with proper technique by an appropriately trained and experienced physician.

What Are Potential Complications?

The most common complication is inadvertent injection into the wrong muscle. If this happens, the eyelid can droop temporarily for about 2-3 weeks, but this is reversible once the injection wears off.

Occasionally when used to correct lip lines pursing action of the muscle when whistling or drinking through a straw can be compromised. This also will return to normal in 2-3 weeks.

Other uncommon temporary side effects can include headache, flu like syndrome, and nausea, but they are very unusual in my experience. A definite causal relationship of these symptoms with Botulinum Toxin A has not been established.

How Will I know If I Have A Bad Reaction?

You will notice any weakness in the eyelid or mouth within 3-4 days. Be patient, notify your doctor and you will recover.

If you develop a headache or flu like syndrome in the first few days afterinjection, notify your doctor, and discuss whether you are a candidate for further injections in the future.

Who Should Give These Injections?

This is a controversial topic. Many physicians have delegated injections to a nurse or PA which is legal in some states.

My own policy is that I do the injections myself. I have knowledge of the muscle anatomy from direct observation in surgery and the aesthetic experience and judgment to evaluate what technique and location of injection will give you the best result.

I personally believe that an experienced board certified plastic surgeon or dermatologist who does these injections frequently is your best chance for the best possible result.

How Much Do Injections Cost?

Prices vary according to geographical location and the experience and skill of the doctor doing your injection.

Nationally cost is $15-$20 per unit injected and the average treatment uses 25-50 international units (IU’s). Thus a treatment can cost $350 to $1000 depending on the amount used and the experience, skill and reputation of your doctor.

Be suspicious of low priced injections. Unscrupulous providers can dilute the product and your result will be compromised. Obviously less experienced, less busy doctors may cut prices to stimulate demand.

Where Can I Learn More?

There is a great deal of information on the web. However, much of it is advertising and marketing that often makes outrageous claims.

Allergan, the company that makes this medicine, has a good website which provides objective information.

You can also read answers to patient questions about Botox in Boston.

You can also see before and after pictures of Botox treatments for frown lines, crow’s feet, brow lift and lip lines.

For more infromation on Botox and Botulinum Toxin A call 978-369-4499 or email us. Read our free newsletter to learn more about non-surgical face and body rejuvenation. Read Save Your Face to learn how to prevent facial aging.

Dr. Seckel
Concord, Massachusetts
Boston Massachusetts

Botox can remove wrinkles, lift the brow, lift the corner of the mouth and improve jowls, all common signs of facial aging. When used properly by an experienced board certified physician who is an expert at facial rejuvenation techniques, Botox injections are safe, effective and can produce dramatic beautiful results.

Botox is a safe, laboratory produced pharmacological agent and is not the food poisoning toxin as so often stated in the media. Botox injections, done properly, leave the face looking natural and refreshed, your smile and facial expressions will still be natural, just without the frown lines and crow’s feet. None of my Boston patients over the past 10 years have ever looked like “figures in a wax museum”.

There are so many myths about Botox injections it is helpful for you to see before and after pictures of my Boston area patients who have actually had Botox injections. Below you can see for yourself how Botox can remove crow’s feet, frown lines, jowls, lip wrinkles, and lift the brow.

Before and After Pictures of Boston Botox Removal of Frown Lines:

Before and after Botox to remove frown lines

Before and after Botox to relax frown lines

Before and After Pictures of Boston Botox Removal of Crow’s Feet

Before and after Botox to remove Crow's Feet

Before and After Pictures of Boston Liquid Facelift with Botox, Juvederm and Restylane to remove Lip Lines and Jowls

Before and after Liquid Facelift with Juvederm and Botox

Before and After Pictures of Boston Botox Brow Lift

Before and after Botox Brow Lift

Botox is a very safe, effective, revolutionary non-surgical method for significant facial rejuvenation and wrinkle removal. The key to achieving an excellent safe result with Botox is finding an experienced physician who understands facial aesthetics, facial aging and how to reverse facial aging using Botox.

For more information on Botox injections in the Boston area, call 978-369-4499 or email me. Read our free newsletter to keep up to date on new face and body non-surgical rejuvenation. Read Save Your Face to learn how to prevent facial aging.

Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts

As we reach our 30′s all of us see early facial aging changes. Sagging of the brow and eyebrow over the eyes, especially at the outside corner of the eyes is a very common early sign of facial aging. This sagging of the brow is called brow ptosis and as the eyebrow drops down the skin below the eyebrow falls over our eyelid and makes us look tired. Our eyes actually begin to look smaller, less bright and older.

A new Botox brow lift technique can now lift the eye brow non-surgically with a simple Botox injection of the frown muscles and the muscles which cause the upper crow’s feet. This new Botox brow lift technique works for many people with early brow ptosis and is a way to avoid a plastic surgery brow lift which can cause scarring.

How Does The Botox Brow Lift Work?

Botox brow lift works by relaxing facial muscles that pull the brow down when you are frowning, wincing and smiling. When you frown or wince, the frown muscles at the base of your nose between the eyes, the Procerus and Corrugator Muscles pull the brow down over the eyes. See before and after photo below which shows how these frown muscles pull the brow down and how Botox can relax the frown muscles and allow the brow to be lifted up-the patient is frowning hard in both photos:

Before and after Botox to relax frown lines

Botox also creates a brow lift by relaxing the same muscles that cause crow’s feet. Crow’s feet are caused by the contraction of muscles around the eye called the Orbicularis Oculi Muscles.

When you grimace or smile tightly, these muscles contract and pull the outside or lateral part of the eye brow and brow down over the eye. See before and after pictures below which show how Botox injection can lift the brow and open the eyes by relaxing the upper Orbicularis Oculi Muscle which causes the crow’s feet and pulls the eye brow down over the eyes. Notice how the eye looks larger and Crow’s Feet are gone even when grimacing-pt is smiling hard in both the before and after Botox injection of the muscle which causes Crow’s Feet:

Before and after Botox Brow Lift

Are Botox Injections Safe?

Botox injections are very safe and effective when done by an experienced board certified plastic surgeon who understands facial aesthetics, aging changes of the face and how to rejuvenate the face. Botox is a sophisticated modern synthesized pharmaceutical and not “food poisoning” toxin as often described in the media.

Botox combined with filler injections like Restylane, Juvederm, Radiesse and Evolence can also be used in the liquid face lift to lift the cheeks and the drooping mouth and jowls, and correct lip lines and lip wrinkles. See before and after photos of lower liquid face lift and lip wrinkle removal using fillers and Botox:

Before and after Liquid Fcelift

How Will I Look After Botox Injection?

After your Botox injection your face should look normal and refreshed. You will be able to smile and look natural, but your frown lines and crow’s feet will be significantly lessened. After the Botox brow lift, your eyes will look more open, refreshed and less tired. See before and after picture of botox treatment of crow’s feet below:

Before and after Botox to treat Crow's Feet

For more information on Botox or the Botox brow lift call 978-369-4499 or email me. Read our free newsletter to keep up to date on the latest methods for non-surgical face and body rejuvenation. Read Save Your Face to learn how to prevent facial aging.

Dr. Seckel
Concord. Massachusetts
Boston, Massachusetts

Why Our Faces Begin to Look Older-Loss of Fat
We talk to so many people every day in our Boston area office about some type of facial rejuvenation. Most men and women feel that their faces look aged because they are sagging and worry that they need to be nipped and tucked or have a face lift to look younger. In fact, there are many things that contribute to an aging face: lines, wrinkles, discoloration and sagging skin. The one factor that most people don’t consider is loss of fullness.

A youthful face is plump with full rounded cheeks.
The cruelness of aging is that people lose fat in their faces and gain it elsewhere. Sadly, fat in a face contributes to filling out the skin and keeping a face looking smooth and supple while fat tends to do the opposite in other areas of the body.

Why Have a Face Lift
If loss of fullness is a significant reason for our aging, why do people need and get facelifts? Why not just add fullness to achieve a youthful look again?
The complex answer is that some people need volume, some need surgery and some need both. A properly done face lift in the appropriately selected patient can produce an excellent result-see before and after photo below:

The Liquid Face Lift
Rarely are people excited to have surgery, so many people that come to see us ask about other options or things to do in the present time to possible delay the eventual need for a surgical procedure. The internet and media have discussed and promoted the liquid face lift and many patients ask about it. This lift is a lifting, plumping, filling, smoothing and re-contouring of the face with a combination of various injectable dermal fillers and neurotoxins.
The injectable dermal fillers that we use in our office for facial re-contouring are hydroxyl apatite (Radiesse™) and hyaluronic acid (Juvederm™, Restalyn™ and now Perlane™). Most people know these products when used to treat nasal labial folds (the lines connecting your nose to your face) or to plump the lips. Results can be very nice-see before and after photos of filler treatment of the nasal labial folds shown below:

Patients achieve nice improvement of these lines with injectable dermal fillers but these products can also be used to increase fullness in other areas of the face. This is what the liquid face lift achieves-see before and after liquid face lift below:
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The mid cheek area can be augmented with fillers and this new volume significantly enhances a youthful face. In fact, cheeks with more volume typically have less dramatic nasal labial fold lines. A third area treated in this lift is the pre-jowl sulcus. These are the vertical lines that are on either side of the mouth. They connect the edges of the mouth to the jaw. These are also known as Marionette lines.
To achieve these results, often a few different fillers are used in each procedure. Each filler listed above has its own specific characteristics. They are made in different ways and are intended to be used for different situations. The use of fillers for facial augmentation is very patient specific and surgeon specific.

Botox™ Also Helps Enhance the Liquid Face Lift
The use of botulinum toxin (Botox™) in addition to injectable dermal fillers can make for better, longer-lasting results. Botox™ blocks the nerve impulses that cause muscle contractions. When injected into specific areas, it effectively relaxes the muscles that are responsible for making certain facial expressions; these repeated facial expressions contribute to the breakdown of collagen in certain areas, leading to deep creases and expression lines. Lines that can be reduced with Botox™ are frown lines, worry lines, crows feet, bunny lines, and lip lines. No, Botox™ does not make you look like a figure in the wax museum! You look like yourself after Botox™, just you without frown lines, worry lines, crows feet and lip lines. Botox™ has been safely used in young children with spastic muscle problems since 1978 and is widely used around the world. Results of Botox™ injection in the crows feet can be dramatic-see photo below of patient smiling before and after Botox™ injection:

Botox™ can be very useful when dermal fillers have been used to fill in expression lines, such as the creases that formed when smiling. The repeated over-use of the surrounding muscles will cause the filler to break down more quickly. This breakdown shortens the length of time before more injections are needed to maintain results. With less muscle contraction after Botox™ the filler used for your liquid face lift should last longer.

How Long Does It Take to Have A Liquid Face Lift?
Facial recontouring as described above can be accomplished in an office visit. A combination of nerve blocks and local anesthetics makes for the treatment to be very easily tolerated. What must happen first though is a thorough consultation with a plastic surgeon. In our office, we perform a lengthy review of your past medical history, allergies, previous facial treatments and ultimately your facial concerns and goals. The whole visit including treatment may take 45 minutes to an hour.

How Will I Look Right After?
You will see the early results immediately-we hand you a mirror and let you see. The results will improve over the next 3-6 weeks as the filler absorbs fluids and the body starts making new collagen in response to the filler.

Usually there is minimal or no bruising. The area may be slightly swollen and pink from the injection, but ice packs take care of this. With makeup you should be fine right after treatment or certainly the next day.

Who Is the Best Candidate for the Liquid Face Lift?
Ideal candidates are realistic men and women who are beginning to notice gaunt, sunken features and suffering from loss of tissue volume causing wrinkles, lines, and folds. These patients should have good skin texture and elasticity, be in good physical and psychological health and non smoking. Most patients are in their mid to late thirties up to patients in their fifties and sixties. Age does not matter, what matters is whether you have lost facial volume and want to plump your face to a more youthful appearance

Please call or email us for a consult or to discuss facial rejuvenation and what your “liquid face lift” should be! Be sure to read our free email newsletter to stay up to date on the newest techniques in aesthetics, non-surgical facial, eyelid and body rejuvenation techniques and plastic surgery. Read Save Your Face to learn how to prevent facial aging.

Dr. Brooke Seckel
Dr. Sean Doherty
Boston, Massachusetts
Concord, Massachusetts