Botox And Muscle Placement


Botulinum toxin, better known as Botox, is an injectable substance that gently paralyzes or weakens muscles in the face. Going back to the 1970s, a purified form of botulinum toxin Type A was developed by a San Francisco doctor who in search of a way to correct strabismus, or crossed eyes. By purifying this potentially lethal poison and injecting it into an overactive muscle, he discovered it relaxes or paralysis it temporarily. It wasn’t until 2002 that Botulinum toxin became FDA approved to be used for cosmetic purposes. It is now also used as a treatment for eye spasms, migraines and a disorder called hyperhidrosis, a condition which causes an individual to sweat profusely.


If used for cosmetic reasons, an individual needs to know all their facts before stepping into the world of cosmetic surgery. The results can be beautiful and help patients feel good about themselves as they get older. It will help to banish wrinkles and lines, keeping one’s face looking youthful. It can be used on men and women and there is no set age for when it’s the right time to receive Botulinum toxin Injections. It is more commonly done for older patients but can be performed on younger faces to help slow the development of lines and wrinkles. Below is some helpful information about where Botulinum toxin is injected.


Where is Botox Injected?


Botulinum toxin can be injected into almost any part of the face depending on where the client and doctor think it would be most beneficial. Some of the most common areas of injection are the forehead, frown lines, and crows feet. These are some of the areas of the face that are used the most to show emotion or when we are speaking.

The Frontalis Muscle controls the forehead and is responsible for raising and lower the eyebrows. This movement causes fine lines to appear over time as any other continuous movement will do. By injecting 5 to 25 units, depending on the patient, is usually the right amount to create a smooth youthful forehead without causing the brows to droop.  

Connected to the Frontalis are the pyramid-shaped Corrugator Supercilii and Procerus muscles which control the furrowing of the eyebrows causing frown lines. These lines can often become deep creases between the eyebrows causing a person to look angry even when their face is in a resting position.  

Around five injections can be done in this area, ranging from 20 to 25 units. The doctor should avoid injecting pass the middle of the brow and should not go above or past the pupil. If injected too close to the eyelid area the chance of brow ptosis, the dropping of the brow is greater.  

Another common area where Botulinum toxin is place is the Orbicularis Oculi around the eyes. The Orbicularis Oculi is responsible for closing the eyelid and also functions to help the passing and draining of tears. This is the area where crows feet happen due to squinting, laughing, and smiling. Typically, 5 to 15 units are using in this area to help smooth lines and wrinkles.  

Botulinum toxin is also used around the mouth on the Orbicularis Oris Muscles, known as smoker’s lines and also round the transverse nasal. The mouth is one of the most used areas of the face and is used to make the most facial expressions. Around 5 units per line are usually enough to give the patient the results they are looking for.


How is it Injected?


Before the procedure, the patient needs to make sure the doctor is aware of any previous injections and any medications such as muscle relaxers, sleeping aids, and blood thinners that they are currently taking.  

A numbing agent is applied to the area of choice to prevent any discomfort during the injection process. The needles used are very thin to control the amount of Botulinum toxin that is being injected. The number of injecting depends on the area being treated and the patient's needs.  

The whole procedure is done in-office and there is no downtime. It is best not to rub or touch the area that has been treated, as this may cause the Botulinum toxin to move to other areas.  

Patients will see results after a few days and depending on the treated area, it may last three months or longer. If the patient wishes to maintain the effects, they will need to go for regular follow-up treatments.


Where to go?


Researching a doctor is one of the most important steps a person can do after making the decision to receive Botox treatments. Check into their background and history, also look for testimonials from other clients. It is best to go to a doctor who specializes in Botulinum toxin and cosmetic surgery.  

After creating a manageable list of doctors in the area make an appointment with each doctor to get a feel for them and see which one feels right. Great questions to ask are: Can they show pictures of their work and who does the actual injections? If a nurse or physician’s assistant is responsible for the injection, will they be working under the doctor’s supervision? It is also a good idea to ask about the price and what you can expect after the procedure is completed.  

Dr. Anurag Agarwal, M.D., F.A.C.S. is the owner and medical director for Aesthetic Surgery Center located in Naples, Florida and has been practicing for 19 years. He is board certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology- Head and Neck Surgery. In 2016 The American Academy of Facial Plastic and Reconstructive honored him as the 5th recipient of the “Maintaining Excellence in ABFPRS Certification Award.


Some of his specialties include skin cancer reconstruction of the face, facial injectables, fat transfer to the face, lip enhancements, and many other procedures.