As of September 11th 2013, BOTOX™ Cosmetic (onabotulinumtoxinA) received approval from the FDA for the treatment of lines extending around the corner of the eyes, commonly known as “crow’s feet.” Since its initial FDA approval in 2002, Botox has become incredibly popular for the treatment of facial lines and wrinkles, both on label (glabellar lines – the dreaded “11” seen between the eyebrows) and off-label (all the other lines and wrinkles on your face, including crows feet). Botox, along with its competitors and Dysport™ and Xeomin, are often referred to as “relaxing agents.” Technically, they are paralytic agents produced from sterile derivatives of Botulinum Toxin but most patients prefer not associate Botulism, toxins or paralysis with their face.
Complaints about crow’s feet are common for many of my patients. These lines result from years of repetitive muscle action around the eyes, including smiling and squinting. Repetitive movements are also responsible for many of the other lines and wrinkles that form as we age, especially horizontal forehead lines and vertical glabellar lines. While our lines and wrinkles are evidence of our smiles, quizzical looks and the occasional angry face, they are also dead giveaways of our age. Through their ability to relax our underlying facial muscles, Botox, Dysport and Xeomin are great tools to prevent these lines from forming or soften lines that are already there.
The most common questions I hear from patients relate to how Botox is administered, how long it lasts and whether you have to keep doing it after it wears off. Botox treatments are quick and can be given during a routine office visit (or even on your lunch break). The treatment involves a series of small injections with minimal discomfort. The tiny injections usually result in little-to-no bruising. The effects are not instantaneous, but typically become apparent within 2-14 days later with the effects lasting between 3-6 months. As the effects wear off, muscle activity returns to normal. No more, no less.
Since the injections are an elective treatment, they can be given whenever a patient desires (within reason). Some patients come in every 2-3 months to ensure their Botox is always “working;” others come after much longer intervals or when their budget allows without regard to whether or not they have had a period of normal facial movement and lines.
My best is advice is to think about it like hairstyling. Some people have their hair styled weekly, while others do it every few months or only before big events. Since Botox is a life-enhancing – not life-saving – treatment, there is no definitive answer or required regimen.
Joshua Rosenberg, MD
Assistant Professor of the Division of Facial Plastic and Reconstructive Surgery