Many people from Arlington and Alexandria, VA, and other cities near Washington, D.C., have questions about BOTOX injections and want answers from an expert. Read below to find board-certified dermatologist and expert injector, Dr. Melda Isaac’s answers to questions she is frequently asked by her patients about BOTOX.

Q: How often can you do a Botox jaw reduction?

A: Don’t worry about doing your Botox touch-up a tad early: everybody metabolizes Botox differently, so the 3- to 4-month recommendation is just a guideline. One or two weeks either way should be fine. Botox is perfectly safe, so you don’t have to worry about getting “too much.” You may need less in this second treatment if your first treatment is still active. Please be sure to get your Botox from a board-certified dermatologist who has expert injection technique.

Q: Can I have Botox injections for TMJ but just for clenching only, as it’s disrupting my sleep?

A: Your temporomandibular joint disorder (TMJ) should improve with Botox injections, as they will relax the muscles that are now clenching. When treating the jaw, we inject the Botox into the masseters, which are responsible for opening and closing the jawbone. This will allow the masseters to relax and should provide you some relief. The clicking and bruxism should improve as well. There will also be a cosmetic effect: Your face will probably look a bit slimmer. You will need to repeat the injections every three to four months. Please find a board-certified dermatologist who has expert injection technique to treat you with Botox for TMJ.

Q: Does Botox for migraines work immediately?

While Botox usually begins exerting its effects in muscles after just 2 weeks, it’s a little more complicated when used as a therapy for migraines. When I administer Botox for migraines I actually do it as a series. It may take a while  before the migraines begin to respond. Once they do – and it seems in your case that they may have – the effects will wear off after about three to four months, at which time you should get another treatment. I hope that the Botox is indeed beginning to control your migraine pain. If you have any more questions about your migraines and/or Botox, please consult the board-certified dermatologist who treated you.

Q: Can you get a brow lift with Botox?

Botox can be used to gently lift your entire brow area, which will raise your eyebrows and lift the upper eyelid skin that is currently drooping.  Botox will not lift a brow 5mm.  A more reasonable expectation would probably be 2 mm or 3 mm. A couple of millimeters would make a big difference, however, in lightening up your expression. I wouldn’t use fillers on your eyes; they might make your lids heavier. Please consult a board-certified dermatologist who is expert in using Botox to lift the brows.

Q: Can Botox freeze your face?

A: The only time you get a “frozen” look with Botox is when the injector has injected too much Botox into an area. Although a patient may request a completely frozen look, this is an extremely rare preference. This is why it’s so important to always find an expert for your cosmetic procedures. Any time you have to break the skin and/or deal with nerves and muscles, you cannot take your chances with someone who does not have a medical background. Botox can create quite a satisfying “lift” to the nose by relaxing the muscles that pull the nose downward. Which ones should be treated may vary based on the type of nose droop you have. Please take the time to find a board-certified dermatologist who is an expert injector for your Botox nose lift.

Q: I’m 41 years old and am wondering if I could benefit from some Botox and fillers for a more refreshed, youthful look?

A: Botox would work well to soften lines in the forehead, frown lines, and crow’s feet, while hyaluronic dermal fillers such as Juvederm Voluma or Restylane Lift can help restore volume to the midface and reduce the appearance of nasolabial folds. Sculptra injections would also be beneficial to restore more volume to your face.  Please see a board-certified dermatologist for a consultation to come up with a comprehensive plan. 

Q: Is someone who is pregnant allowed to use a neuromodulator, or is it considered dangerous?

A: While there have not been any studies researching the effect of neuromodulators on pregnant women, it is not advised to use them while pregnant. Please wait until after your pregnancy to resume.

Q: I’m 18 years old, but I want to fix my deep forehead lines up by my eyebrows. Can I try Botox?

A: Botox is a great way to prevent wrinkles from becoming deeper. It works by relaxing the muscles that cause the wrinkles in the first place, and is ideal for people who are just starting to see lines in their forehead, glabellar region, and at the corner of the eyes. I would recommend visiting a board-certified dermatologist to see if Botox will meet your expectations in reducing the appearance of your forehead lines.  If you have deep wrinkles even when you are not making facial expressions (resting lines), you may also need hyaluronic filler injections (Juvederm or Restylane) in addition to Botox for optimal results.

Q: When does Botox start to fade? I had 5 units in my forehead and it looks terrible and frozen.

A: On average, the effects of Botox gradually wear off within 3 to 4 months. The dose you had was small, so it might wear off even more quickly. Always be sure to visit a board-certified dermatologist for any wrinkle treatment injections to ensure the best results.

Q: Will a Botox breast job prevent sagging? I have perky breasts and I want to keep them that way.

A:  Botox is not indicated for the breasts, and there is no evidence that it prevents breasts from sagging. Botox works by interfering with the “communication” between nerves and muscles. It prevents the muscles of facial expression from contracting and pulling on the muscles’ attachments to the skin, thereby preventing and relaxing wrinkles in the forehead, frown lines and crows feet. If your breasts are very small, Botox can be injected in the pectoralis muscles of the chest, which is an off-label indication, to lift an A cup breast. It will not prevent sagging.

Q: Can anything be done to speed up the process of Botox leaving the body? My brows dropped and I have puffy lids, it looks terrible.

A: Unfortunately, there is nothing that can be done to reverse Botox injections. You’ll just have to wait for 3-4 months for the effects to wear off naturally. Side effects such as a droopy brow can occur if too much Botox is injected or if it’s injected into the wrong place by an inexperienced injector. Always be sure to see a board-certified dermatologist with extensive experience in any injectable treatments.

Q: How many Botox units are needed for upper lip plumping?

A: To plump the lips, a dermal filler such as Juvederm or Restylane is better than Botox. Fillers add volume with a gel formulated with hyaluronic acid and are very safe and effective for lip augmentation. Botox, on the other hand, is a neuromodulator used for relaxing the muscles that cause wrinkles. Therefore, it will not help to augment the lips, and may cause difficulty in fully using the muscles around the mouth if used for that purpose.

Q: Can I have filler injections while on antibiotics? I’m taking Metronidazole and Ciprofloxacin.

A: While there is no contraindication to having fillers done while on these types of antibiotics, it would most likely be best for you to wait until your infection clears up before having them done. Fillers involve trauma to the skin, and there is a chance of your infection spreading because of it. Always tell your injector any medications you are on, and make sure to see a board-certified dermatologist for Botox and fillers.

Q: How much longer does Dysport last than other injectables for crow’s feet?

A: There is no significant difference in the longevity of Dysport vs. other wrinkle treatments. Both will last approximately 3-4 months when injected into the crow’s feet. Dysport does diffuse more readily and has a slightly faster onset of action. Always be sure to visit an experienced, board-certified dermatologist when thinking of having Dysport treatments done.

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Q: How soon can I expect to see results from my Dysport treatment for crow’s feet? It’s been 3 days and I don’t see any results yet.

A: While some people may start to see results earlier, results may begin to appear after 5-7 days in some cases. Be patient, and if you are still not seeing results after 10 days, visit your injector again for reevaluation.

Q: How long after receiving Botox do you see the full benefit? Also, how many times can one receive this? I know it is every 4 months, but is there a limit to how long one can continue to receive treatments?

A: Botox starts to take effect andmost patients see results after 3 to 4 days. However, I tell my patients maximum results are seen at 2 weeks. It is best to have injection treatments every 3-4 months, as it will gradually wear off within that time frame. To answer your last question, there is no limit set for how long a person can keep receiving wrinkle treatment injections. It is a fantastic treatment.

Q: I’m thinking about getting Botox injections in my forehead, but I don’t know what qualifications/education practitioners need to do Botox injections.

A: I recommend that you should always see a board certified dermatologist or physician trained in cosmetic injections when receiving Botox, or any cosmetic treatment for that matter. Each state has their own rules and regulations when it comes to allowing certain people to inject wrinkle treatments or facial fillers. However, you should ask questions and get answers about one’s training, qualifications and experience I before having treatment.

Q: Can you exercise after Botox or will it decrease the results?

A: It depends on the type of exercise. I recommend that you wait 2 hours before one lies down (i.e. bench pressing weights) or does any type of inversions (yoga) after receiving Botox. Exercising after wrinkle treatment injections has not been shown to decrease the results.

Q: What should you not do after Botox?

A: One of the beauties of Botox is there are few restrictions after treatment. I advise my patients not to lie down until two hours after their procedure, and not to immediately massage the injection area. It is truly a no downtime procedure.

Q: If you have had too much Botox in an area is there an antidote to help release the effects quicker?

A: Unfortunately, the effects of Botox cannot be reversed. That’s why it’s imperative to choose a board certified dermatologist for your injectable treatment. The best solution is to wait until the Botox wears off, which is usually between 3 and 4 months.

Q: Will Xeomin help with excessive sweating (hyperhidrosis)?

A: Xeomin has been tested and proven to prevent hyperhidrosis under the arms and is FDA-approved for that use. Xeomin works by preventing the release of a chemical, which signals activation of the sweat glands. Results generally last around three months, but depending on the person can last for up to a year.

Q: I stopped breastfeeding my daughter 10 days ago. 3 days later I got 15 units of Botox. My milk has come back in full force. I have had to pump to ease the pain. Can I give this milk to my 1-year-old or is it too risky one week later?

A: Unfortunately, there are no current studies about breastfeeding and Botox, therefore we do not know if combining the two is entirely safe. Until further studies are done, it’s best to avoid Botox if you are pregnant or still breastfeeding.

Q: I am 25 years old and have noticed that I have wrinkles under my eyes that have started to appear. Am I a candidate for wrinkle treatment injections?

A: Botox can be used as a preventive measure to stop future wrinkles from forming, so starting treatment earlier is better. Botox is typically not used to treat wrinkles under the eye. Other options including fillers and laser or radiofrequency treatments may be more appropriate. I strongly suggest you have a consultation with a dermatologist or plastic surgeon who specializes in this area.

Q: I have wrinkles pretty much across my entire face! So where would Botox be best suited/safe/effective?

A: Botox is a safe and effective treatment for reducing wrinkles formed from facial expressions, for example, forehead lines that form when one raises his or her eyebrows in surprise or frown lines that form between the eyes when one squints, concentrated or is angry. If you have “wrinkles all over your face” you may benefit from wrinkle injection treatments only where lines are accentuated with facial expressions (forehead and around eyes and lip lines). I suggest you seek a consultation to find out if another treatment may help you in addition to Botox.

Q: I have congenital ptosis in my left eye and have had surgery. Will Botox cause my eye to again droop temporarily or permanently? Will it weaken an already weak muscle?

A: Botox does not cause permanent ptosis or even a temporary droopy lid if properly injected. You may have successful treatment as long as muscles that elevate the lid are not affected by the neurotoxin.I assume your surgery for congenital ptosis was successful and that you have had complete recovery. I recommend waiting a minimum of 6 months after surgery to have wrinkle injection treatments.

Q: I’m 27,  stopped getting Botox and noticed that my eyes have started to droop. Is this normal?

A: If you feel your eyelids are droopy at 27, I highly recommend that you see an ophthalmologist to rule out any other contributing conditions that can make your eyelids appear droopy. I also suggest you bring along photos of yourself from one or two years prior to your current age to visualize the change in your kid appearance. Botox does not cause permanent ptosis or droopy lids. Even if you “over did” your injections, its effects will wear off.

Q: How does Botox work?

A: Years of smiling, laughing, and frowning can leave wrinkles and expressions lines on our face. Botox is an injectable neuromodulator that works by relaxing the muscles that cause fine lines and wrinkles. When the muscles in our face are unable to contract, the appearance of wrinkles is diminished.

Q: What areas can neuromodulators treat?

A: Neuromodulators can treat many areas of the face including frown lines, forehead wrinkles, crow’s feet, lip lines, and even neck and chest wrinkles.

Q: Is Botox a filler?

A: Botox is not a filler. Fillers replace lost volume and fill in wrinkles that are present without facial expressions in order to obtain a more youthful appearance. Botox is a neuromodulator that relaxes muscle movement.

Q: How long do Botox injections last?

A: Typical Botox results last 3-4 months, although experiences vary. Patients are encouraged to receive more injections once the effects have worn off.

Q: Is Dysport the same as Botox?

A: Dysport is another neuromodulator that works similar to Botox. Patients can alternate between Dysport and Botox to determine which treatment they prefer.

Q: Can you alternate Dysport and Botox shots?

A: There is no problem alternating among all neurotoxins: Botox, Dysport or Xeomin.  Dr. Isaac encourages patients to see if they get better duration of benefit with one product over another. The products are similar if prepared/reconstituted and injected properly.

Q: Can Botox help treat excessive sweating?

A: Yes, Botox, Dysport or Xeomin injections can be used to treat hyperhidrosis, also known as excessive sweating. Strategically placed neurotoxin injections are placed into the underarms or palms of the hands in order to significantly reduce the amount of sweat.

Q: Can I wash my face and have a bath after wrinkle treatment injections? What about driving?

A: It’s fine to drive your car and wash your face immediately following a wrinkle treatment injection, but it’s important to avoid vigorous massaging of your face. The only other restriction I offer my patients is to avoid lying flat for 2 hours post injection.

Q: What is the best option for plumping up thin lips?

A: If you are looking to add volume to thin lips, you may want to consider a hyaluronic acid filler such as Restylane or Juvederm. Botox works by relaxing muscles that cause wrinkles, and is a great choice for the forehead, frown lines, and crow’s feet, but fillers actually inject volume into the desired area, and are the injectable of choice for lip augmentation. I use Botox to reduce the strength of the muscles that purse the lips around the mouth thereby reducing the vertical lip lines or “smoker lines”. One can often see a mild plumping of the lip with as little as 4 units, but Botox is not my treatment of choice for plumping the lip. I recommend visiting a board-certified dermatologist for a consultation and evaluation to determine how much filler you would need for optimal lip rejuvenation.

Schedule a Botox Consultation in Washington, D.C., Today!

For more information, schedule a consultation with expert injector Dr. Melda Isaac by calling MI Skin Dermatology Center at (202) 393-7546 today!

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About Dr. Isaac

The founder and director of MI Skin Dermatology and Laser Center, Dr. Melda Isaac is consistently recognized as a top dermatologist in Washington, DC. An award-winning, board-certified dermatologist, she provides both medical and cosmetic dermatology services with professionalism and compassion. Her specialized expertise in injectables and her eye for creating natural-looking results have made her a sought-after source for excellent dermatological care.

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