American Academy of Facial Plastic and Reconstructive Surgery
American Academy of Facial Plastic and Reconstructive Surgery

I’ve been thinking about getting Botox but…

Question: Do Botox injections hurt?

Answer: Injecting anything with a needle can cause mild discomfort but that all depends on the physician’s skills and use of ancillary methods to reduce discomfort.  Numbing cream can be used for the very sensitive patient or ice can also be applied immediately before injection to chill the skin and thereby anesthetize it.  Some doctors tend to vibrate the skin a bit before injection to help with discomfort.  Finally, something that I have done in my practice that has truly helped is to stop using preservative-free saline in the reconstitution.  It is simply unnecessary and causes undue burning sensation during injection.

I am 35 years old and have a lot of facial wrinkles.

Question: Would Botox be a good alternative to a facelift?

Answer: Yes, absolutely.  Botox, or neurotoxin, is the preferred method to manage facial wrinkles of the upper face.  Facelifts really do not offer any benefit to wrinkles since a facelift is used to lift and suspend sagging of underlying facial muscles.  With repeated injections of Botox, the facial muscles of the upper face start to relax, and the skin begins to heal.  Long-term neurotoxins are so powerful in terms of their ability to help you with helping skin have better texture, tone, and fewer wrinkles.  Early-on consistency is the key so that over time you need less Botox.  The earlier you start the better.  If you wait until wrinkles get very deep, it takes longer to heal the skin.

I have a lot of wrinkles on my face and forehead.

Question: Would you recommend a facelift?

Answer: Facelifts really do not work to help wrinkles.  Facelifts are intended to help with sagging muscles like jowls and neck hanging.  Depending on how the surgeon defines “facelift” it can either describe a lift of just the lower face and neck or also to include the sagging cheek and/or brow region. 

Even though when you pull your face up with your fingers the wrinkles go away, this type of movement is really not indicative of what a lift can do.  I call this the “two-finger rule”, meaning when you lift with two fingers this really does not indicate what a facelift can achieve.

So how do we fix wrinkles?  We have to divide the wrinkles into two types:  static (not moving, present all the time) and dynamic (wrinkles only appear during movement like during smiling, frowning, etc.)  Dynamic wrinkles of the upper face (but rarely of the lower face) are managed with botulinum toxin (e.g., Botox) since neurotoxins block the upper face from moving so that dynamic wrinkles do not appear.  Recurrent and steady use of neurotoxins every 3 to 4 months can lead to ongoing diminishment of wrinkling even sometimes to the point that dynamic wrinkles do not appear as deep when the neurotoxin has completely faded away.  Also, steady use of neurotoxins can help even diminish static lines if they are not too deep.

With the occurrence over time of static wrinkles, neurotoxins can still help diminish them with steady application, as mentioned above.  However, sometimes sun-damaged skin with significant wrinkles may require chemical peels or laser resurfacing to help modify these types of wrinkles.  Wrinkles of the lower face are harder to manage a with a neurotoxin.