The effects of the Botox injection become evident after four to seven days and they last between three to four months. Repeated injections result in muscle atrophy, loss of muscle, which makes the treatments last longer. Other patients become immune to the use of Botox cosmetic injections over time. Current research is being done for approval of one of the seven other types of Botox to use after patients no longer respond to treatment.

The risk of new wrinkle formation can be decreased when physicians use an altered pattern of injection. In other words, when paralyzing the musculature, they not only include those responsible for the wrinkles, but also adjacent muscles that might be recruited to form the original facial expression responsible for the original wrinkle.

Botox can also be combined with resurfacing techniques, and dermal fillers to improve the outcome and the patient’s satisfaction. Botox cosmetic injections are more successfully used in the upper face because the specific muscle groups, which affect facial expression, are more easily located than in the lower face. In the lower half of the face, wrinkles are more often static, non-moving, and caused from gravity and the loss of elasticity in the tissue; whereas in the upper face, wrinkles are more often caused by motion and movement from muscle.

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