In Botox® injection, facial wrinkles are smoothed through injection of Botulinium toxin into muscles. The toxin blocks the nerve impulses, temporarily paralyzing the muscles that cause wrinkles.   Background* Botulinum toxin (BTX) injections are often referred to by the product names Botox® or Myobloc®, biological toxins transformed into a therapeutic agent. Work with BTX began in the late 1960s to treat neurological disorders. Today, BTX is used for the treatment of frown lines, forehead furrows, "crow’s feet," lines and wrinkles of the lower face, and even nasal muscles (to decrease nostril flaring). BTX injections have proven to be a very popular nonsurgical cosmetic procedure. Aesthetic plastic surgeons have found that the type of lines and wrinkles that respond to BTX injections are those caused by the muscles—specifically those muscles that contract during facial expressions such as frowning or squinting.   Technique The patient is asked to contract the muscles in the area being treated so the surgeon can determine the proper location for injection. In most cases, BTX is injected directly into the muscle with a tiny needle. It takes a few days to realize the effect of BTX injections.   Benefits No downtime. Patients can immediately resume normal activities. Long experience has proven BTX to be safe. To date, no systemic complications associated with BTX injections have been documented. Treatment is reversible within several months. May be beneficial for treatment of migraine headaches.   Other Considerations BTX injections are a temporary solution for the treatment of wrinkles. The effects last from 3-4 months and require repeat treatments. Possible side effects include local numbness, swelling, bruising, or a burning sensation during injection. Some patients have reported temporary headache and nausea. Most complications are of short duration and can be avoided with proper injection techniques. A small percentage of patients are reported to experience no improvement at all.   ASAPS Position The American Society for Aesthetic Plastic Surgery (ASAPS) maintains that BTX injections for aesthetic purposes appear to be safe and effective. Patients who show early signs of aging, as well as those who may not be suitable candidates for more extensive aesthetic facial surgery, may be good candidates for this procedure. Certain medications (some antibiotics, anti-inflammatories, or aspirin) and even some vitamins and herbs may increase the potency of BTX and may increase bleeding and bruising at the time of injection. Therefore, patients should be candid with their surgeon about all medications and supplements. Pregnant or nursing women should postpone undergoing this procedure. It is not known whether injection of BTX has any effect on a fetus or whether it is found in breast milk.   *Source: The American Society for Aesthetic Plastic Surgery (ASAPS)