Botox, a medication available in the US for over 20 years, was first approved by the FDA for treating wrinkles in 2002.  Botox has truly revolutionized the field of cosmetic dermatology by providing a safe and effective way to reduce expression lines of the upper face with minimal downtime.  Many wrinkles are caused by repeated contraction of facial muscles, which cause creases in the skin that gradually deepen over time. Botox is injected into these underlying muscles and works by blocking the nerve impulse to the muscle, thereby weakening the muscle. By relaxing the muscles that cause these lines, the creases themselves will soften and can often even disappear.  Botox is especially helpful for those habitual frowners and squinters who often appear stressed when they are actually just concentrating.  Botox can weaken those overactive facial muscles and break the habit of frowning.  Results are dramatic but appear natural, giving you a relaxed appearance that can last for 3-5 months.  Mostly people will notice that you look "rested" or as though you "just returned from a vacation."  Repeat injections should be done periodically to maintain the effect.  Botox is most commonly used to treat forehead creases, frown lines between the eyebrows, and crow's feet around the eyes.  It can also be used to raise the arch of the eyebrow (the "Botox brow lift"), to lift the corners of the mouth, and to decrease lines of the upper lip and the sides of the nose.  Botox is also FDA approved to decrease excessive sweating in the underarms and to lessen the frequency and intensity of migraine and tension headaches.  Many patients have concerns about appearing frozen or lacking facial expression with Botox; however, with proper placement of the injections, results look natural so that you can still smile, look surprised, and even angry if need be.  There is usually no downtime aside from occasional small areas of bruising from the needle.  Additional information regarding Botox is available at

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