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What causes wrinkles and expression lines?

One day you looked in the mirror and studied those lines that furrowed your brow, and you wondered: Where did they come from?
Too much stress? In general, how skin ages and wrinkles is a complex process. It isn't just about cellular changes, collagen depletion, hormone loss, damage caused by free radicals, and so on; it's a combination of many factors.

The Anatomy of the Wrinkle

The lines that appear between your brows (glabellar lines) actually result from muscle movement and the passage of time. You may have heard the expression "wearing your emotions on your sleeve," but in reality you wear them on your face. If you're angry or annoyed, for example, you knit your brows together. Underneath your skin, your facial muscles contract, cause a pleating of the overlying skin, and then, as anyone can see, you're frowning.

After years of crinkling and wrinkling, those glabellar lines start to linger longer and can become more pronounced. For women, whose faces tend to be more animated than men's, and whose skin is typically more delicate, these lines may appear exaggerated and more permanent.

Fortunately, there is a way to reduce moderate to severe glabellar lines. Treatment with BOTOX® Cosmetic can visibly smooth and soften moderate to severe frown lines between your brows. An improvement can be seen within days and may last up to 4 months, although results may vary. In clinical trials, nearly 90% of men and women surveyed rated the improvement in the appearance of frown lines between their brows as moderate to better 1 month after treatment.

BOTOX® Cosmetic is a simple, non-surgical, physician-administered treatment that can temporarily smooth moderate to severe frown lines between the brows in people from 18 to 65 years of age. It is the only treatment of its type approved by the Food and Drug Administration (FDA).

One 10-minute treatment—a few tiny injections—and within days there's a noticeable improvement in those persistent lines between the brows, which can last up to 4 months. Results may vary.

BOTOX® Cosmetic is a purified protein produced by the Clostridium botulinum bacterium, which reduces the activity of the muscles that cause those frown lines between the brows to form over time.

A million people have been treated with FDA-approved BOTOX® Cosmetic. There's only one BOTOX® Cosmetic. Talk to your doctor to see if BOTOX® Cosmetic is right for you!

When it comes to selecting a physician-administered cosmetic treatment, chances are you’ll want proof, not just claims. The proof for BOTOX® Cosmetic is in the numbers.

In clinical trials, nearly 90% of men and women surveyed rated the improvement in the appearance of frown lines between their brows as moderate to better 1 month after treatment. Results vary.

Results can last for up to 4 months, and may vary.
BOTOX® Cosmetic has been used to treat a million people in the United States since it was approved by the Food and Drug Administration (FDA) in 2002 for the temporary treatment of moderate to severe frown lines between the brows in people ages 18 to 65.
The American Society for Aesthetic Plastic Surgery ranked BOTOX® Cosmetic as the most popular of all physician-administered cosmetic procedures (surgical and nonsurgical combined) in 2002 and 2003.

Will I be able to make facial expressions?

After treatment with BOTOX® Cosmetic, you may look in the mirror and see a marked improvement in the moderate to severe frown lines between your brows. But BOTOX® Cosmetic will not radically change your facial appearance. You can still frown or look surprised—without the wrinkles and creases between your brows.

BOTOX® Cosmetic works by temporarily reducing the contractions of the muscles that cause those persistent frown lines that have developed between your brows over time.

Within days, you may see an improvement that can last up to 4 months. Results may vary. If you do not continue treatments, the frown lines between your brows will gradually look like they did before treatment.

BOTOX® is a formulation of botulinum toxin type A. It is derived from the bacterium Clostridium botulinum. This bacterium produces a protein that blocks the release of acetylcholine and relaxes muscles. Type A is just one of seven different types of botulinum toxin (A, B, C1, D, E, F, and G), and each has different properties and actions. No two of these botulinum toxins are alike.

More than 100 years of research have expanded our knowledge of botulinum toxin type A from the identification of the bacterium Clostridium botulinum to the commercialization of botulinum toxin type A as BOTOX®.

Important Safety Information

BOTOX® treatment is contraindicated in the presence of infection at the proposed injection site(s) and in individuals with known hypersensitivity to any ingredient in the formulation. Serious and/or immediate hypersensitivity reactions have been rarely reported. These reactions include anaphylaxis, urticaria, soft tissue edema, and dyspnea. If such a reaction occurs, further BOTOX® injection should be discontinued and appropriate medical therapy immediately instituted. BOTOX® should only be diluted with 0.9% non-preserved sodium chloride. Other diluents, including lidocaine should not be used for reconstitution. Individuals with peripheral motor neuropathic diseases (eg, amyotrophic lateral sclerosis, or motor neuropathy) or neuromuscular junctional disorders (eg, myasthenia gravis or Lambert-Eaton syndrome) should only receive BOTOX® treatment with caution.

The most frequently reported adverse reactions in patients with cervical dystonia are dysphagia (19%), upper respiratory infection (12%), neck pain (11%), and headache (11%). The most frequently reported treatment-related adverse reactions in blepharospasm patients are ptosis (20.8%), superficial punctate keratitis (6.3%), and eye dryness (6.3%).

No. BOTOX® has been used for more than 15 years to help patients worldwide, and it is approved by the health ministries of at least 70 countries.

How is BOTOX® different from other botulinum toxin treatment?

BOTOX® is Allergan's brand of botulinum toxin type A. A brand of botulinum toxin type B is also now available. The two toxins are different in several ways:

They are different serotypes
They have different manufacturing processes
They work differently
They require different doses

How does Botox work?

Normally, your brain sends electrochemical messages to your muscles to make them contract and move. These messages are transmitted from a nerve to the muscle by a substance called acetylcholine. When too much acetylcholine is released, muscles become overly active and spasm or tense up.

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BOTOX® blocks the nerve from releasing acetylcholine. As a result, the muscle spasms stop or are greatly reduced, providing relief from symptoms. Your healthcare provider will know how much BOTOX® is needed to treat you effectively.

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It's important to remember that botulinum toxin treatment is not a cure. For many people, however, its effects have been dramatic. With BOTOX®, the nerve will take about 3 months to recover and begin to release acetylcholine, and the muscles may become overactive again. At that point, another injection will be needed to provide relief, as long as no allergic reactions or other significant side effects occurred and clinical response was obtained.

How long can I be treated with Botox?

Each treatment typically lasts up to 3 months and can be repeated as long as your condition responds to BOTOX® and you do not have any serious allergic reactions or other significant side effects. BOTOX® has been used for more than 15 years to help patients worldwide, and although formal, long-term clinical evaluations have not been conducted, its safety in long-term use has been well established.

Although most people continue to respond to BOTOX® injections, some people have experienced a diminished response over time. There may be several explanations for this:

Changes in your condition - If the pattern of your muscle activity changes, your healthcare provider may need to inject new muscles and/or change your dose. Identifying and injecting the affected muscle can be difficult, complicated by the changing pattern of muscle involvement and progression of the disorder.
Setting appropriate expectations - You may believe your first BOTOX® injection was more helpful than subsequent injections. That's because your condition was perhaps quite severe when you had your first injection. Subsequent injections are usually given before your condition becomes that severe again. Therefore, the relief you experienced with subsequent injections may not have been as dramatic as the first time.
Antibody formation - When foreign proteins, like botulinum toxins, enter your body, antibodies may form. If antibodies to botulinum toxin develop, you may no longer respond to treatment.

How can I maintain my Botox results?
While the critical factors for neutralizing antibody formation have not been well characterized, you may be able to help maintain your response to BOTOX® by minimizing your total exposure. The potential for antibody formation may be minimized by injecting with the lowest effective dose given at the longest feasible intervals between injections. Topical cream such as BOTOXES® also inhibits acetylcholine can also prolong the effects of BOTOX.

How is Botox given?
BOTOX® is injected into the affected muscle(s). Your doctor will determine which muscles need to be treated.

Does the injection hurt?
Some people report discomfort from the injection. BOTOX® is reconstituted with sterile, preservative-free, normal saline for injection. The neutral pH of the injected solution, in combination with the fine-gauge needle your doctor will use, can help to minimize any injection-related pain. Ice or a topical cream can be used to minimize any discomfort but most patients tolerated the injection without the use of either

When will Botox start to work?
If you're receiving BOTOX® for cervical dystonia, you'll usually see the effects within 2 weeks of the injection. If you're receiving BOTOX® for blepharospasm, you'll usually see effects within 3 days.

How long will the effect last?
BOTOX® offers sustained relief, dose after dose. The relief you'll feel from 1 treatment of BOTOX® will normally last for up to 3 months. Treatments can be continued as long as your condition responds to BOTOX®, and you do not have any serious allergic reactions or other significant side effects. When the relief begins to fade, you'll return to your doctor for your next treatment.

Usually, BOTOX® treatment is required approximately 4 times per year. Because symptoms can change over time, the amount and duration of relief you'll experience can vary. Consult your doctor, who can determine how to achieve the best possible results

What side effect have been seen with BOTOX ?

The most frequently reported adverse reactions in patients receiving BOTOX® for the treatment of cervical dystonia are dysphagia (difficulty swallowing, 19%), upper respiratory infection (such as a cold or flu,12%), neck pain (11%), and headache (11%). Dysphagia is a commonly reported adverse event following treatment of cervical dystonia patients. In these patients, there are reports of rare cases of dysphagia serious enough to require the insertion of a gastric feeding tube (a tube for introducing nutritious, high-calorie fluids into

The most frequently reported treatment-related adverse reactions in patients receiving BOTOX® for the treatment of blepharospasm are ptosis (droopy eyelids, 21%), superficial punctuate keratitis (inflammation of the cornea characterized by small erosions of the tissue covering the cornea, 6%), and eye dryness (6%). Reduced blinking from BOTOX® injection of the orbicularis muscle can lead to corneal exposure, persistent epithelial defect (a defect in the corneal covering), and corneal ulceration (a hollowed-out cavity in the cornea), especially in patients with VII nerve disorders.

Please seek immediate medical attention if swallowing, speech, or respiratory (breathing) disorders arise.

Please seek immediate medical attention if swallowing, speech, or respiratory (breathing) disorders arise.

Is BOTOX right for me?
Your healthcare provider can help you decide if BOTOX® is right for you. In order to make the right treatment decision, you should discuss the following with your healthcare provider before choosing treatment:

Clinical experience with the drug
Effectiveness and side effects

Make sure your healthcare provider knows if you are pregnant, nursing, or taking any medications before receiving BOTOX® injections. Additionally, you should not receive BOTOX® if you have an infection at the injection site.

BOTOX® should be used with caution if you have other neurological diseases or disorders, or if you are taking aminoglycoside antibiotics or other drugs that interfere with neuromuscular transmission. Be sure to tell your healthcare provider about any prescription or over-the-counter medications you are taking before receiving BOTOX®.

This information is not meant to diagnose, prevent, treat, cure or mitigate any disease. Please see your doctor about any medical problems or you may use this information in discussion with your doctor.