About us Location Skin, The News Home

New Patient Form
Laser Hair Reduction
Botox® for Wrinkles
Botox® for Sweating
Acne & Complexion
Warts & Moles
Dark Spots & Peels
Skin Cancer
Spider Leg Veins
Facial Blood Vessels
Lipoatrophy/Facial wasting

sports dermatology
persons of color
skin care tips & myths

  Photo Gallery


Botox® Treatment To Crow’s Feet


What causes wrinkles on the lower forehead, between the eyes? How about those on the forehead? And those smile lines around your eyes called crow's feet?

The vertical lines between the eyebrows are the direct result of repeated muscular action of the muscles of facial expression. Years of squinting and frowning leave deep wrinkles in the skin between the eyebrows. After many years of frowning combined with the weathering action of the sun, the skin is left with deep vertical lines, which there even when the face is at rest. You look like you're mad even when you're not.

The laugh lines around your eyes and the horizontal lines on your forehead are often caused by your expressions, as well as sun damage.

There has never been a satisfactory solution to these problems until Botox® Cosmetic. Once Botox® Cosmetic has immobilized the muscles for several weeks, many of the noticeable lines between the eyebrows, on the forehead or around the eyes may relax and be less noticeable.

What are the alternative treatments?

For the mid-forehead, filler injections such as Restylane® can fill some of the wrinkle, but as long as the underlying muscles continue to move, the fold will quickly reappear.

Conventional surgery involves a large incision, raising the hairline, and cutting the muscles. Newer endoscopic plastic surgical techniques avoid the large incisions, but still involve prolonged healing and the expense and inconvenience of major surgery. Some surgeons try to remove the wrinkle surgically, but this is often not effective and is a surgical procedure.

Dermabrasion and chemical peels are generally not effective in this area. Similarly deeper laugh lines around the eyes and those on the forehead can rarely be helped except by the laser, deeper surgical procedures or peels, but many patients do not wish to undergo these procedures.

What are the risks and complications?

Botox® Treatment To Lines Between Eyebrows

The most common problem with injecting Botox® is that it is ineffective, resulting in no change and a need to retreat. Since it can take some time to see improvement, if you do not see a difference in your ability to knit your brows together after two weeks, please call and schedule a follow-up treatment. Rarely (less than one in 500 cases), some of the Botox® may temporarily weaken some muscle fibers that help raise the upper eyelid. Eye drops can be used to reverse the effect, which often spontaneously resolves in a few weeks. Prior skin testing with Botox® Cosmetic is not needed, as allergy to the medication is rare. Occasionally, a headache lasting a couple of days or facial asymmetry has been reported. Loss of skin is very rare. There is no change in sensation in the skin. Similarly, the treatments on the forehead and the crow's feet around the eyes may need to be repeated as well.

Side effects most often reported during clinical trials of Botox® Cosmetic included headache, respiratory infection, temporary eyelid droop, nausea and flu syndrome. Less frequently occurring adverse reactions included pain in the face, erythema (redness) at the injection site and muscle weakness. These events are thought to be associated with the injection and occurred within the first week.

Botox® Treatment To Forehead

What can one expect immediately?

Minimal bruising and redness may occur at the injection sites. Usually there is virtually no sign of treatment within an hour or so of the injections. Makeup may be used directly after treatment, but care should be made not to press or massage the area for several hours after injection. We also recommend not lying down or napping for several hours after the procedure. Heavy physical exercise should be avoided until the day after the procedure.

Botox® Cosmetic does not treat your existing lines and wrinkles, but does frequently prevent new ones from forming. We sometimes use Restylane® injections in order to treat the existing lines and wrinkles.

When will Botox® Cosmetic take effect?

You will not see the effect for a few days as it generally it takes about a week or two for the full effect.

Botox® Treatment To Upper Lip

How long does Botox® Cosmetic last?

The range that has been observed is between 3 and 8 months, although the average duration of effect is about 4 months. After the muscles have been less active for several months, they actually atrophy and shrink. By keeping the muscle inactive for several months, for example, you may lose the habit of frowning, preventing lines, from coming back. However, should one wish to regain the ability to knit to brows, one only has to wait until the effect of the Botox® Cosmetic has worn off and all voluntary muscle action will return.

Botox® Cosmetic can immobilize the underlying muscles so the muscles underneath are not tethering the skin down. Once the muscles "let go" of the skin, the wrinkles and folds will smooth out on their own.

Other muscles, such as those needed to raise the eyebrows up are not affected so natural expression is maintained.

Botox® Cosmetic is a genetically engineered product, which can be used to treat the vertical lines between the eyebrows, the squint lines or "Crow's feet" lines at the corner of the eyes, and the forehead horizontal lines. Botox® Cosmetic is still being tested on the smile lines or folds around the mouth.

Botox® Treatment To Forehead Lines

A very small needle is used to inject Botox® Cosmetic, and the discomfort is minimal, as only a few drops are needed.

Who should not use Botox® Cosmetic?

If you are an actor or in a profession in which you need all of your expression lines, such as a psychologist, then Botox may not be for you.

Can Botox® Cosmetic be used in other areas?

Botox® Cosmetic is also being used in some other facial and neck areas as well.

Botox® Cosmetic is an FDA approved medication for the cosmetic treatment of vertical wrinkles between the brows. The FDA recognizes the common practice among physicians to use FDA approved drugs in their professional discretion in so-called "off label" uses, such as the use for wrinkles elsewhere on the face or body.

Because of his expertise, our dermatologist is a consultant for Allergan, the manufacturers of Botox® Cosmetic. In addition, our dermatologist has been quoted about Botox® Cosmetic in a major daily New York City newspaper.

If you have any questions or wish to set up an appointment, please call our office now at (212) 557-2600. Frequently, only one session is needed to see results.