December 1st, 2020

Botox FAQ with Dr. Mok

Allure Medical has been offering Botox since 2004. We have been recognized as a top 10 practice in the USA for Botox and Filler from Allergan for several years. You can feel confident in the hands of our experienced and knowledgeable staff with Botox treatments for several cosmetic concerns. We have collaborated with our own Dr. Charles Mok D.O., to address our customers' concerns and most frequently asked questions regarding Botox.

How long does Botox last?

The standard answer is it ranges from 6 weeks to 6 months, but for most people it is about 3 months. There are a few “buts”, however:

When you are new to Botox, it will last the shortest duration as the muscles have been working out and may have developed new lines or creases. But when you stay on top of your Botox by repeating the treatment as it wears off–in usually about 3 months at first–it eventually starts lasting longer and requiring less units. We recommend to schedule your Botox for every 3-4 months for the first year and a half, then you get a sort of permanence when the muscles have de-trained for so long.

Botox is a zinc metalperoxidase, meaning it requires zinc to function. In a clinical study, people were given zinc 3 times daily as well as phytase (to break up whole grains) and the Botox had 30% longer duration. Other studies have found the same effect.

We recommend taking zinc citrate 25-50 mg 2-3 times a day for 2-3 days as well as staying away from whole grains and legumes (nuts and beans) for 2-3 days after your Botox treatment for longer effects.

How often should you get Botox?

Botox lasts about 3 months for most people and works to anti-age the muscles that cause undesirable wrinkles and brow position. It is best to plan to repeat your Botox about every 3 months for the first 1.5 years. After that point, you can start using less units and start spreading the treatments apart as the muscles are no longer as strong and capable as they were when you started Botox treatments.

Does Botox help migraines?

Yes, cosmetic Botox does help migraines. There is also a medical indication for migraines with Botox, however it is a different treatment pattern and medical Botox is not designed to improve your appearance. However, oftentimes with cosmetic Botox, clients may find that their migraines get better even though there are different injection protocols.

Can I exercise after Botox?

There are no restrictions after Botox. Back when Botox was first developed, researchers instructed the patients not to lay down for 4 hours and to rest for 24 hours. We have learned that these restrictions are not necessary, and you can return to your daily routine immediately after Botox treatments.

Some doctors still recommend avoiding activity after Botox, but that recommendation is based on old invalidated beliefs.

What does Botox feel like when it starts working?

You will feel less expressive within a day or 2 where you may notice it is hard to make an angry face, or to scrunch your eyes. This sensation will go away once your body adapts to the Botox.

Does Botox prevent wrinkles?

Yes. We use Botox to treat and minimize wrinkles as well as to prevent them. Your doctor can see where you will likely develop wrinkles over time and preventively treat those muscles with small doses of Botox.

In addition to preventing wrinkles, Botox can be used to maintain an attractive brow position by preventing or treating a droopy eyebrow.

What does it mean to “dilute Botox®”?

Botox® is delivered to our office in a small vial that has a tiny amount of dry powder. It is then reconstituted or “diluted” with normal saline in order to create a usable product.

A vial of Botox® contains 100 units—unit is a measure that is specific to Botox®, as it is too small of a particle to measure in milligrams or other standard measurements.

To prepare the vial for use, the Botox® vial is not opened but a cap is removed and normal saline is injected into the bottle. If 1 cc of normal saline is used to activate the Botox®, then 1 cc drawn out would have 100 Units of Botox® in the syringe.

Once activated Botox® with 1 cc of normal saline, a 0.3 ml syringe is used to administer small amounts of Botox as it is more comfortable to control than with a larger syringe.

However, when people activate Botox® with 2.5 cc's of saline–which is a more common practice than using 1 cc–, then each cc only contains 40 units of Botox®. Typically, a 1 cc syringe is used to administer as it is now “diluted” and contains a smaller amount of Botox.

So what do people really mean when they say, "Is your Botox® diluted”?

They mean, "Am I getting what I paid for?". In other words, if I pay for 60 Units of Botox®, am I actually getting 60 Units?

As detailed above, all Botox® needs to be diluted in order to be used. It comes as a powder and cannot be administered until saline is added. However, the process of reconstitution does not decrease total units, only units per cc of saline.

How much should it be diluted?

That is commonly based on the preference of the provider or how they were trained, but there are some reasons that we may alter the dilution of the number of units. When the volume of saline is increased, the Unit of Botox® doesn’t lose any strength but it will spread further. Let’s break it down:

For the lines between the eyebrows I would want the Botox® very concentrated so it will not spread to the lower forehead and cause the brow to droop. How can Botox® cause the eyebrows to droop?

The face has muscles that alter the appearance of the facial expression. At the eye level we have 7 muscles that depress (lower) the brow: the Procerus, the 2 depressor supercilli, the 2 corrugator supercilli, and the 2 orbicularis oculi muscles. These plus gravity can lower your brow.

However, to raise the brow you have but one muscle: the frontalis. When the frontalis is treated with Botox®, the brow will drop at least a little bit. The muscles that depress the brow can make you look tired, sad, or angry so we like to weaken these. But the frontalis–only muscle that lifts or maintains the eyebrow–is best left alone or treated very minimally.

So for treating the lines between the eyes ("the 11's"), I like to use 1cc of normal saline in the Botox®, to prevent it from spreading into the brow lifting muscle.

For treating the “crows feet” or orbicularis oculi muscle, I either use more shots with a 1 cc mixture or less shots with a 2.5 cc mixture. But keep in mind, I would be using the same amount of Units either way.

When it comes to the forehead, I prefer to stay away from the area in most people, at least at first. This area can usually be treated by weakening the brow depressor muscles alone. However, if I do choose to treat the frontalis I would want a less concentrated, further-spreading dilution of Botox® with as few units as possible for this delicate lifting muscle.

Should I be concerned about expressionless face?

Many times, patients are surprised that after treatment for forehead wrinkles they can still raise their brow and move their forehead. We should not judge Botox® based on whether or not you can move your face afterward. Botox® was designed to make you more attractive and approachable by selectively weakening muscles that create wrinkles or lower the brow.

The frontalis muscle in the forehead lifting conveys emotions of sincerity, paying attention, interest, and positive emotions, whereas the depressor muscles convey anger, sadness, or fatigue.

The biggest mistake I see with Botox® injectors is overtreating the forehead. This droops the brow and gives an expressionless fake Botox® look.

What about non-Botox® toxins?

There are a few products on the market.

Dysport® is a bit stronger and spreads more than Botox® bottle for bottle. It does not produce much eyebrow lift compared to Botox®, but for the forehead and crow’s feet, it may be superior. We don’t use Dysport® much as it is not very popular among our patients and it is more expensive for us to buy than Botox®. In our practice at least, Botox® is a much better bang for your buck.

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