What is Botox®?

The injection of Botox®, a purified toxin produced by the bacterium clostridium botulinum, can be injected into a muscle to weaken or paralyze the muscle. This allows the muscle to relax and improves the lines or wrinkles that have formed from contraction of the muscle. At a molecular level, Botox® works by inhibiting presynaptic release of Acetylcholine from the muscle so the muscle cannot contract.

Our faces are dynamic. Smiling, frowning, squinting, etc. are possible because of the numerous muscles of facial expression that are present under the skin. The movement of these muscles over time eventually leads to wrinkles. Men and women seek Botox® treatment as it is one of the most popular ways to reduce facial wrinkles outside of surgical procedures. Wrinkles can make people appear tired, or even angry, when they are not. Botox® can be used as a wrinkle treatment to smooth frown lines, crow’s feet, forehead furrows, and skin bands on the neck.

Is Botox® safe?

One of the quickest and safest remedies to remove wrinkles is an injection of botulinum toxin.

Can Botox® be combined with other procedures?

Dr. Hewell and Dr. Fischer recognize that Botox® is an important component of facial rejuvenation and often combine it with other procedures including facelift, upper and lower eyelid lift, facial fat injections, and/or dermabrasion to improve results. At your consultation, Dr. Hewell and Dr. Fischer will discuss if Botox® is an appropriate procedure for you.

About the Procedure:

Injection of Botox® may seem like a simple procedure because it is just a few shots performed in the office. In reality, the injection of Botox® is both an art and science that should only be performed by an experienced healthcare professional. There are 43 muscles in your face and it is vital that the person who performs Botox® injection understands and pinpoints the correct spots to optimize your result.

Before injection, you will be asked to animate your face so that the muscles responsible for the unwanted wrinkles can be evaluated. A short, very thin needle is used to inject small amounts of Botox®, a clear liquid, into specific muscles. This weakens only the wrinkle-producing muscles while preserving some of your natural facial expressions.

Botox® treatment usually takes less than 15 minutes and is performed in our office. The number of injections you need will depend on multiple factors, including your facial features and the extent of your wrinkles. Crow’s feet, for example, usually necessitate three injections, while furrows between your eyebrows can take approximately five injections. No anesthesia is required. There is no downtime or recovery time.

You may notice results within a few days, but it can take up to a week to see the full effect. This improvement typically lasts about three to four months. When the effects of botulinum toxin begin to fade, your muscle contractions and the wrinkles will return.


Aspirin, vitamin E, ibuprofen, other non-steroidal anti-inflammatory drugs, warfarin, or other blood thinners may increase risk of bruising. These drugs should ideally be stopped 7 days before treatment to minimize risk of bruising. Check with your medical doctor prior to stopping any blood thinners that may be necessary for your overall health.

Don’t rub or massage the treated areas after Botox® injection for facial wrinkles because it could cause the Botox® to migrate to another unwanted area of your face. If this happens, you could have temporary facial weakness or drooping.

Dr. Fischer performs all of the Botox® injections independently. This is ideal for our patients because a person with a high knowledge of facial anatomy and experience with Botox® is performing all of the injections.

We do not recommend Botox® injection for people with muscle or nerve conditions such as ALS (Lou Gehrig’s disease), myasthenia gravis, Lambert-Eaton syndrome, etc.

No, Botox® injection should not be performed while you are pregnant or breastfeeding.

Procedures 3



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