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November 2017
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How do Botox® injections work? Dr. Emily Altman

How do wrinkles form?

Botox cosmetic injections relax overactive muscles of facial expressionLines and wrinkles form by repeated movements of the muscles of facial expression.  These movements are a normal daily part of our lives:

  • smiling
  • frowning
  • concentrating
  • raising our eyebrows
  • squinting
  • engaging in emotional discussions.

We pay no attention to them – they are automatic.  Over time these movements cause the skin to crease.  At first, these  “expression lines” are present only when the muscles contract (dynamic wrinkles), but smooth out when the face is relaxed.

As the skin loses elasticity, these wrinkles become more visible. Eventually, these creases may be present even when the face is at rest (static wrinkles).

For example, the eyebrow muscles, the procerus and corrugators, bring the eyebrows together and down, forming a frown.  Eventually, frowning forms the now famous “11′s.”

how does botox work muscles of facial expression

Muscles of facial expression: How are wrinkles formed?

How does Botox® Cosmetic work?

Muscle movement is controlled by signals that muscles receive from nerves.  This signal involves a chemical message (neurotransmitter) released by the nerve cell into the the space between nerve and muscle cells (neuromuscular junction).

Botox® is a type of botulinum toxin type A, a purified, natural protein, one of seven neurotoxins produced by the bacterium Clostridium botulinum.  Botox® decreases muscle activity by temporarily blocking overactive nerve impulses that trigger excessive muscle contractions.

So why would you want to inject a neurotoxin into your body? It’s simple!  If a muscle does not contract, it can’t form a wrinkle. 

Mechanism of Botox® Action

Phase I – Nerve-Muscle Communication is Blocked

Botox® blocks the transmission of overactive nerve impulses to the targeted muscle by selectively preventing the release of the neurotransmitter acetylcholine (ACh) at the neuromuscular junction, temporarily preventing muscle contraction.  How does that work?

A. Binding

Botox mechanism of action binding

Botox® molecule (BoNTA) binds to the surface of the nerve cell (motor neuron)

B. Internalization

Botox mechanism of action internalization

After attaching to the motor nerve surface, the Botox® (BoNTA) molecules are brought into the cell in small vesciles

C. Blocking

A series of proteins, VAMP, syntaxin and SNAP-25, are essential for the release of acetylcholine (1).  Botulinum toxin A affects SNAP-25.

botox mechanism of action blocking

Once inside the motor nerve cell, Botox® cleaves the SNAP-25 and prevents the release of acetylcholine into the neuromuscular junction, thereby preventing muscle contraction.

What can be treated with Botox® Cosmetic?

Under the effect of Botox®, the muscles are at rest creating a more natural and relaxed appearance.  Botox® is used to reduce wrinkles and the signs of aging in the face and neck, including:

  • Frown lines (between your brows)
  • Worry lines (on the forehead)
  • Drooping eyebrows
  • Crows feet
  • Smile lines
  • Drooping lip corners, lines around the mouth
  • Chin dimpling
  • Horizontal and vertical neck lines

Botox® Cosmetic can also be used for facial sculpting, such as lifting the eyebrows and creating a beautiful eyebrow arch, giving a more open and youthful appearance to the eyes.


Botox Cosmetic Before and After

Botox Cosmetic Before and 2 Weeks After Injections

Our patient: Botox Cosmetic Before and 2 Weeks After Injections. The "11's" are relaxed with resulting smoother, more youthful look.

After 30 days, nearly 90% of Botox® Cosmetic patients surveyed rated the improvement of their glabellar lines as moderate or better.

What happens next?

Phase II – Nerve-Muscle Communication is Restored

Botox® blocks nerve signals temporarily.  The effect of Botox® injections lasts approximately 3-4 months.

A. Nerve Sprouting

botox_mechanism_of_action nerve sprouting

New nerve endings sprout and connect to the muscle after the original nerve ending is blocked, renewing the ability of the nerve to cause muscle contractions.

B. Original Nerve Connection Re-established

botox mechanism of action reestablishing original connection

Eventually, the new nerve sprouts retract and the original nerve ending regains its function.

What to expect with Botox® Cosmetic ?

Treatments are fast, simple, minimally invasive and take only 15-20 minutes.  Botox® Cosmetic keeps the muscles that cause lines relaxed for three to six  months.  Results are visible within 7-10 days after injection.

What are Botox® injections like?

  • In this simple 15-minute procedure, a few drops of Botox® Cosmetic are injected with a tiny needle into the muscle that is causing the wrinkle.
  • No anesthesia is required, although you may numb the area with a cold pack or anesthetic cream before injections.
  • There is minimal to no discomfort—most patients compare the sensation to a bug bite
  • There may be slight temporary bruising at injection sites, which is easily covered up with makeup.  Bruising resolves within a few days.

If you’re considering a wrinkle treatment and are interested in learning how Botox® Cosmetic or a dermal filler (Juvéderm®, Restylane®, Radiesse®, or Sculptra Aesthetic®) can help you look younger please schedule your consultation with us at (973) 992-0550.

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