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Tips on Botox® Injection Sites and Who Qualifies

Botulinum toxin is a purified protein derived from the bacterium Clostridium botulinum and has been researched for more than 100 years. 

Botox® neurotoxin (Botox® injection) has been approved in more than 75 countries for 20 different indications to provide effective treatment to patients suffering from a range of neurological disorders.

Botox® injections are the most common and successful minimally invasive cosmetic procedure worldwide.

Botox® has been used for cosmetic and medical applications and has been considered a safe and efficacious treatment for many conditions.

In cosmetics, Botox® is mainly used to treat facial wrinkles. Botox® is also an effective treatment for migraines and excessive sweating.

Botox® is a prescription drug and can only be administered by a medical professional. 

A Botox® specialist knows which areas should be injected to treat a certain problem. In order to become a skilled Botox® specialist, approved training is required and you must meet criteria in your state or country.f

Patients are often confused about which areas of their face they need treated. Most of them think Botox® can smooth out all wrinkles.

There are a few areas where wrinkles commonly appear in middle or old age. Read more about them in our article, “The Three Most Common Areas for Botox® Injections.”

The International Association for Physicians in Aesthetic Medicine (IAPAM) offers Botox training to physicians, nurse practitioners and physician assistants to learn the proper Botox® injection techniques in order to meet the growing demand for aesthetic procedures.

Who Qualifies for Botox® Treatment?

The FDA in the United States recommends that only patients between the ages of 18 and 65 should be administered cosmetic Botox® injections. 

As with every other medical treatment, the patient’s complete medical history must be reviewed before proceeding further.

Those who are allergic to any of the ingredients in the drug should not use it. This includes people who are allergic to any of the botulinum toxin brands such as Botox®, Myobloc®, Xeomin® and Dysport®. Anyone who has experienced a side effect from using these products should also avoid using them.

Patients suffering from a skin infection or any other type of condition in the area that is to be treated should certainly avoid Botox®. 

The injections cannot be administered to those with ALS, Lambert-Eaton syndrome, myasthenia gravis or any other type of illness that affects the nerves and muscles.

Patients who have trouble breathing, suffer from asthma or have trouble swallowing are also advised against seeking Botox® treatment. 

Those who experience excessive bleeding or are planning to undergo invasive surgery any time soon are also not candidates.

It is important to ask patients if they have ever had facial surgery and why. Drooping eyelids are a warning sign relative to Botox® patients.

Even though it is not expected of the drug to travel throughout the body and affect the fetus or breast milk it is still not recommended for a pregnant or breastfeeding women to undergo Botox® injections.  

There have been no clinical studies conducted on expectant mothers for ethical reasons so there is no proof to support this.

Common Misconceptions About Botox®

Botox® injections are not painful although, like all injections, the needles can hurt but those used for Botox® administration are very small so the pain is almost negligible.

The medical professional can numb the area using a topical anesthetic cream or an ice pack. This is done 10 to 20 minutes before injections are administered so there is little to no pain felt.

Once the anesthetic wears off, there is some discomfort but it is usually bearable.

There are some misconceptions that getting Botox® treatments done will make the wrinkles look worse.

The injections prevent the lines from deepening and it is only when you stop getting treatments that aging of the skin will resume its natural course.

Typically, in the past, Botox® was usually popular with women, however, according to published statistics, men are also being encouraged to choose this treatment to improve their appearance and look much younger.

How is Botox® Administered?​

Only trained medical professionals can administer Botox® injections even if the purpose of the treatment is purely cosmetic. 

Laws and regulations change from state to state.

You should check with your local regulatory body to determine if Botox® injections are within your scope of practice.

Botox® is injected directly into the muscle and each treatment is administered after a period of at least 3 months. More than one area can be treated at a time depending on the patient.

Patients who are getting treated for conditions related to the eye muscles might need to use an ointment, eye drops or special contacts to protect their eye.

Those who are being treated for excessive sweating in the underarms must shave their armpits at least 24 hours prior to being injected.

Also, they should avoid using antiperspirants or consuming warm beverages or spicy food.

How long does Botox® Last?​

Depending on the patient and their reasons for the injections, Botox® will last somewhere between 3 and 6 months, or even slightly longer. 

If the patient would like to maintain the effects for longer than this, they can simply return and get further treatments once the initial injections start to wear off. 

The clinic will be able to answer questions about how long this treatment will typically last for any particular usage.

Is Botox® a Profitable Procedure?

Botox® injections are the most popular non-invasive cosmetic procedure and an absolutely must for your practice if you’re going to start offering aesthetics.

However, will they help you increase your practice profits

Watch this video from the IAPAM’s Executive Director, Jeff Russell, to find out.

Uses for Botox®

When Botox® is used cosmetically to treat wrinkles, for example, an injection is done through the skin into the muscle beneath, which causes the muscle to be temporarily weakened. 

This is accomplished by blocking the number of impulses the nerve receives. 

This allows the skin to have time to recover, due to the skin not being constantly stretched and contracted, due to regular facial movements in those areas.

Botox® can be used to treat much more than wrinkles, however. 

It is a very effective treatment for muscle spasms in the face, eyelids, or many other areas of the body. 

For those that have been diagnosed with cerebral palsy, for example, Botox injections are able to prevent or reduce some of the muscle spasms associated with that condition. 

Some patients are able to find relief from chronic migraine headaches by getting Botox injections, and it has been successfully used to treat people who have overactive sweat glands, among other conditions.

After patients receive Botox procedures, the full effect of the injection will not be apparent for several days, and at times can be up to 2 weeks. 

Botox® injections have been an effective treatment option for millions of people to date, and it continues to increase in popularity due to a more informed public perception.

Botox® is used for a variety of conditions and is a popular solution for excessive underarm sweating, although it is most often recognized as an aesthetic procedure. 

Jaw clenching and teeth grinding can also be treated with it. It is a great way to smooth out wrinkles, however, Botox® is good for various other physical and aesthetic complaints. 

A more youthful appearance can be a result of Botox® treatment, but so can sculpting of your features, easing of physical pain, and even improvement to your smile. Here are a variety of uses for Botox®:

Overactive Bladder

Yes, Botox® can even help a problematic and embarrassing medical condition. 

The bladder muscles relax, which helps prevent them from contracting and causing the need to urinate frequently when a doctor injects a small amount of Botox® into them. 

The procedure is fairly simple and the results can last longer than six months. 

This treatment improves the quality of life for those who undergo it and makes them feel much more comfortable overall.

Excessive Sweating

Excessive sweating can be both embarrassing and irritating. 

You might get sweats in different parts of your body. The two most popular places in your body for sweating are underarms and face. Every person wants to get rid of this embarrassing problem as soon as possible.

The technical term for foo much sweating is ‘hyperhidrosis’. Sometimes the problem occurs due to medical condition while sometimes due to other reasons.

The effects of the treatment wear off after 12 to 15 months, so you will have to go for the injections again if you want the same result after that.

Migraines

Botox® also helps relieve migraine pain. Anyone who has ever suffered from a migraine understands the debilitating pain that results from this condition. 

Migraine pain can be treated with Botox® injections, although we don’t know yet exactly why this works. 

The simple procedure is also thought to treat migraines by blocking the sensory nerves that send pain signals to your brain. 

It seems that the toxin reduces sensitivity to the migraine pain by relaxing the muscles. 

The use of Botox® in the treatment of migraines has been reported to cause their reduction by half or more.

Specialists can now take years off your face in just a few hours because non-invasive cosmetic, aesthetic and wellness procedures have advanced to such a degree — fantastic if surgery is not your thing. 

There are more options than ever when it comes to looking and feeling younger these days – that’s a fact.

All You Need to Know About Baby Botox®

People who undergo Botox® injection treatments prefer to preserve their natural look while reaping the benefits of Botox® treatment on their lines and wrinkles. 

Current Botox® treatments are aimed at getting rid of almost all lines and wrinkles on the face, and can result in a look that can to some appear unnatural. 

On the other hand baby Botox® is aimed at treating just a few lines and wrinkles while preserving certain natural expression lines.

In most cases, baby Botox® treatments are directed at treating crow’s feet (fine lines and wrinkles seen at the corner of the eyes), frown lines and a few wrinkles on the forehead. 

Areas such as those under the eyes are not injected. 

The eyebrow may also be injected to help open up the eyes a bit more, and this can have remarkable effects on the overall appearance of the patient.  

In a nutshell, treatments are strategically limited to only certain areas of the face, preserving the natural look while offering all the benefits that Botox® brings with it.

As is the case with Botox® injections, patients report a significant improvement in their look and feel a lot younger following baby Botox® treatments. 

Confidence levels are also a lot higher as their natural look is preserved as some of the common wrinkles are still present. and the risks with baby Botox® injections are the same as the ones seen with regular Botox®, as the nature of the injection given does not change. 

Patients report mild bruising and bleeding at the site of injection, which resolves spontaneously without leaving any scars. 

Infections are rare as the procedure is performed under sterile conditions. 

Allergic reactions may occur to components within the Botox® injection but these are rare and there are hardly any reported cases of severe reactions.

Common Side Effects of Botox®

After receiving Botox® injections patients may experience trouble swallowing for a few weeks following the treatment. 

The muscles near the injected area may also get weaker and in some cases, there is bleeding, bruising, redness, pain and swelling at the site of injection.

It is usual to get headaches, neck pains, stiff muscles and joint pain after Botox®. Some patients may experience nausea and symptoms of a cold. 

These reactions are also completely normal.

Botox® is a completely safe, medically and FDA approved cosmetic treatment. 

The International Association of Physicians in Aesthetic Medicine (IAPAM) states that Botox® injections should only be performed by a properly trained Botox® administrator who has all the necessary certifications, information on the side-effects and interactions of the treatment. 

For more information on how to become Botox certified, visit IAPAM’s Botox training courses and certifications!

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Botox Training Physicians

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Where Should Botox® be Injected?

Forehead, Temples and Eyes

Starting from the top of the face, there are three major types of wrinkles that appear in this area:

  • Surprise lines that appear on the forehead as horizontal creases, and become more prominent when the eyebrows are raised.
  • Frown lines, the vertical wrinkles between the eyebrows and they are more pronounced when a person frowns. They are also referred to as “the number 11 lines”.
  • Crow’s feet are small fan-shaped lines that begin at the outside corner of the eye and extend upward toward the forehead. They are called crow’s feet because they are similar in appearance to the bird’s feet. These lines are visible when a person is squinting.

Surprise lines, crow’s feet and frown lines are the areas that clients mostly ask to be treated and they also produce the most successful results as well.

When treating frown lines, one common side-effect is the frozen forehead. 

This entails the face not moving at all and the patient appearing emotionless and unnatural. 

The corrugator muscle that is associated with frown lines is completely relaxed in the beginning to reduce the wrinkles. 

However, once they are gone the Botox® dose should be altered to allow some movement of the face. 

The goal of the Botox® administrator should be zero wrinkles, not zero movements for the Botox® patient.

A larger dose of the Botox® injection to the forehead can result in a heavy feeling on the eyebrows. 

The frontalis muscles in the temples, which are employed while raising eyebrows are over-Botoxed resulting in this side-effect. 

The forehead is too relaxed and therefore the weight of the eyebrows feels like a mountain. 

The administrator has to accurately judge how much Botox® is needed to correct the frown lines or worry lines.

One other side-effect of Botox® in this area is the eyelid drooping, making the eyebrow drop and the lid feel heavy. 

This is the most unappealing complication and if this happens immediate action should be taken. 

A possible option is to give prescription drops to the patient to reduce the dropping until the effect completely wears off.

Injecting the eye and brow area to remove crow’s feet can result in one or both eyebrows being raised too high. 

Part of the eyebrow is elevated to an angle bigger than what it normally should be giving the person a perpetual surprised look. 

This also promotes the formation of wrinkles over the brow. 

To prevent such a thing from happening, Botox® is strategically injected into a specific Botox® location.

Mouth and its Surroundings

The mouth and its surroundings are another prime Botox® location and the common problems faced by patients in this area are:

  • Smile lines that start at the outside edge of the nose and go down to the mouth. They form significant creases in the face when a person is smiling. The medical term for these lines is nasolabial folds.
  • Marionette lines are creases that appear around the mouth and extend towards the chin. The lines resemble the jaws of marionette dolls which allow their mouths to open and close.
  • Smoker’s lines are defined as vertical creases around the lips. These wrinkles are commonly found in smokers’ faces as the action of puckering up the mouth to inhale a cigarette makes the lines more significant.

Smile lines and marionette lines that form deep creases even when the face is at rest cannot be diminished by Botox® injections. 

Injecting the muscles responsible for these lines can lead to serious complications and not make any difference on the wrinkles either.

Smoker’s lines can also be reduced by Botox® but if the individual is a chain smoker then there will be little or no effect because the constant act of puckering the lips is what creates the lines in the first place.

It is important to note that Botox® smooths wrinkles by relaxing the muscles. It does not tighten the skin and only affects the facial muscles. 

Wrinkles form when the muscles are constantly in use and pull at the skin. 

The injection minimizes the motions of the muscles in the Botox® location.

When the muscles are less active, the skin does not come under motion stress, therefore, reducing the number of lines and wrinkles on the skin. 

Botox® has a better effect on elastic and well-hydrated skin. The younger the person is, the faster the results will be. 

Botox® does not tighten sagging or drooping skin. Neither can it stretch out wrinkles. It only relaxes the muscles responsible for those wrinkles and lines.

Because Botox® relaxes the muscles, those facial muscles that are in frequent use benefit from the injections the most. 

However, care must be taken so that muscles are not involved in creating facial expressions and other important functions or unpleasant side-effects such as drooping, frozen expressions and asymmetric features may occur.

Is Botox® for Men?

There is a common misconception that Botox procedures are sought after by women and women alone. 

This is far from the truth. Granted that the majority of the people who undergo Botox® injections are women, these days’ even men are undergoing these procedures. 

Some newspaper reports have even gone to the extent of calling it ‘bro-tox’! Some clinics now report that up to 50% of their patients undergoing botox are male!

Who can Administer Botox®?

In the United States, a number of differently trained professionals can administer the injections. 

These include board-certified plastic surgeons and dermatologists who are trained in this area. 

In some states, nurse practitioners, physicians assistants, nurses and even pharmacists may be permitted to inject Botox® the collaboration of a physician (when required). 

It’s important that you check with your local governing body to determine if you are working within your scope of practice prior to choosing a Botox® training program.

Whatever the training they have received may be, it is still essential to look at their experience they possess i.e. the number of years they have been performing the procedure for. 

Eye plastic surgeons can also inject botulinum toxin, especially around the eyes. 

While most states require a doctor to prescribe and inject botulinum toxin, states like Texas and Florida allow for other health care professionals to inject as well, such as NPs and PAs.

However, in most cases where non-MDs are injecting botulinum toxin, it is recommended by the Physicians Coalition for Injectable Safety (PCIS) that the injections be performed in the presence of a trained doctor. 

This would include registered nurses. The rules can vary between different states in the US, and if in doubt, the medical board can always be contacted to confirm the physician’s credentials to see if they can inject botulinum toxin. 

As far as most state regulations go, medical aestheticians or medical assistants (MAs) are not licensed to prescribe or inject botulinum toxin.

In Canada, the rules are similar. In most cases, botulinum toxin can only be prescribed and injected by a certified physician (MD, DO, or ND):

In summary –

  • Board-certified physicians and licensed physicians, physicians assistants and nurse practitioners can prescribe and inject botulinum toxin.
  • Registered nurses cannot prescribe botulinum toxin but can inject it under the supervision of a trained certified physician.
  • Medical aestheticians cannot prescribe or inject botulinum toxin.

Botox is a trademark of Allergan Inc.

Recommended Reading

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How to Pick the Best Botox® Training Program

There are many different programs for you to choose from. Read our tips on how to pick the best Botox® training program for you.

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Why Botox® is Increasing in Popularity Among Mean

Men are now becoming conscious about their appearance and it has led to a surge in interest in Botox. Find out how you can take advantage of this growing trend.

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Three Common Areas for Botox® Injections

The three most commons sites for Botox® injections include: forehead, eyes and eyebrows. Find out more about these popular injection locations.

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