BOTOX – A Plastic Surgeon’s Perspective

Written by Chuma Chike-Obi, MD, Board Certified Plastic Surgeon on August 18, 2015 One Comment

Botox treatments

Are you considering a Botox treatment? Learn more about Botox and other dermal fillers from the perspective of Dr. Chuma Chike-Obi, board-certified plastic surgeon who currently sees patients at our Westlake Dermatology Downtown Austin location:

What exactly is Botox?

Botox belongs to a class of products called neuromodulators that act specifically to reduce wrinkles and fine lines by targeting the muscles beneath them. Of the three neurotoxins currently available for cosmetic purposes in the United States, Botox (onabotulinumtoxinA) has the longest track record; receiving FDA approval in 1989 for the treatment of moderate to severe crow’s feet lines and frown lines between the eyebrows (glabellar lines) in adults.

Collectively, botulinum toxin injections are the most commonly performed cosmetic procedure in the world as of this writing. Millions of patients benefit from these products, so I have decided to write this piece to share some information about them with our readers.

What is the difference between Botox, Dysport, and Xeomin?

Dysport (abobotulinumtoxinA) and Xeomin (incobotulinumtoxinA) are the two other neuromodulators that are currently FDA approved for treating moderate to severe glabellar lines in adults. These products are closely related to Botox, but there are some differences in how they perform once injected. These differences are related to the presence and size of protective proteins that come with the product. Your plastic surgeon or dermatologist can help counsel you and select the appropriate product with you.

Is Botox safe?

Before its cosmetic approval, botulinum toxin was used for a wide variety of medical conditions starting in the late 1970s. In addition, there are at least 3000 peer-reviewed scientific publications on these substances to date. Though derived from a toxin, the doses available for cosmetic use are extremely low and have demonstrated a very safe track record. Pregnant or breastfeeding women and those with certain neuromuscular disorders should avoid treatment with these agents.

What is the difference between Botox and a ‘filler’?

This question often comes up with perspective patients. Dermal fillers are different from neuromodulators such as Botox in that they do not act on the muscles beneath the wrinkles of interest. Fillers are products that are injected to add volume to an area that has become hollow, or ‘emptied out’ due to the aging process. The nasolabial fold is a commonly requested area for filler treatment. The most commonly used fillers in my practice are the hyaluronic acid fillers (examples: Juvéderm, Voluma, Restylane, Belotero).

What are the cosmetic benefits of Botox?

First, Botox induces the temporary improvement in the look of fine facial lines by softening the ‘grip’ that the underlying muscle has on the skin in the treated area. These lines appear finer or potentially fade after multiple treatments which provide a more graceful appearance. Second, there is an increasing trend of younger patients expressing interest in this ‘skin preserving’ benefit. In other words, evidence suggests that if Botox is started earlier in life (late twenties), the onset of etched wrinkles and lines can be delayed significantly. Lastly, because our facial muscles are linked to our emotions in ways that we are just beginning to understand, some researchers are demonstrating that Botox may alleviate negative emotions, and even clinical depression.

Am I a candidate for Botox?

Most adults who are healthy, not pregnant or breastfeeding, and have visible, dynamic (get deeper when you frown, raise your eyebrows, squint, etc) lines in specific areas, and do not have a preexisting neurological condition or relevant allergy are candidates. However your surgeon will be able to interview you to determine your candidacy.

How is Botox administered?

A small needle is used to introduce the product directly into the treatment area. The discomfort is minimal for most patients.

How long will the effect last?

A Botox treatment will last three to four months on average.

Does getting Botox mean I have to get a ‘frozen face?’

Absolutely not. The beauty of this product is that it can be used by a skilled injector who has a deep understanding of human facial anatomy to achieve different effects. Most patients I treat are interested in softening the problem areas without causing a drastic change in appearance. An increased dose can be used for patients seeking a more aggressive change.

I get anxious about needles. Is there another way to get Botox?

Currently, no. However there is a promising botulinum product (RT001) that is currently in phase 3 clinical trials. If approved, RT001 will be applied topically to the crow’s feet area in a gel formulation, without needles.

What else is on the horizon?

Revance Therapeutics, the same company that is responsible for RT001, is working different product (RT002) that is injectable and expected to last approximately 7 months. This is compared to the 3-month duration for the currently available injectable botulinum products.

What other interesting plastic surgery applications are there for Botox?

Botox has been shown to help decrease pain in some types of breast surgery, such as in breast reconstruction after mastectomy. It also makes sense that Botox may decrease muscle spasms after submuscular breast augmentation which would decrease postoperative discomfort.

Some have advocated the use of Botox to achieve a breast lift. Unfortunately, this is too good to be true. The ‘Botox Breast Lift’ as currently described is not supported by scientific evidence, and sounds impractical.

How much does a treatment cost?

Treatment plans are individualized and generated after consultation. The pricing is quite reasonable. Please call 512-615-3280 to schedule an appointment today.


Chuma Chike-Obi, MD

Chuma Chike-Obi, MD completed a 6 year residency with the Division of Plastic Surgery at Baylor College of Medicine and Affiliate hospitals in Houston, Texas. Dr. Chike-Obi specializes in cosmetic surgery, including facelift, blepharoplasty, breast augmentation, liposuction, rhinoplasty, and reconstructive breast surgery.

One Response to “BOTOX – A Plastic Surgeon’s Perspective”

  1. Avatar Margaret says:

    great post Dr. Chike-Obi – thanks for sharing

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