Dermatology Center of Northwest Houston Dermatology Center of Northwest Houston - Lisa D Hitchins MD : (281) 256-2000
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Botox Cosmetics, Houston Texas

BOTOX® Injection

BOTOX® InjectionBotox® injection or Botulinum toxin injection is most commonly known for its successful use in cosmetic therapies. Initially, Botox was approved to treat strabismus (crossed eyes), blepharospasm (spasm of the eyelids) and cervical dystonia (muscle contractions in the neck).¬†Added to the list of indications is FDA approval for relaxing frown lines in the area between the eyes on the forehead (glabella). BOTOX® injections reduce facial lines and wrinkles formed from the aging process and by hyperfunctional muscles. It can also be used to treat excessive sweating.

BOTOX® is a purified protein toxin produced by the Clostridium botulinum bacteria. Although BOTOX® is a toxin, there have been no serious side effects reported. This is because it is used in extremely small amounts for medical treatments and does not spread throughout the body.


The area to be injected is cleansed thoroughly. A topical anesthetic cream is applied and the BOTOX® material is injected into the area with a fine needle. When BOTOX® is injected into a muscle, it blocks the conduction of nerve impulses to that area and as a result, the muscle weakens. As the muscle weakens, the skin overlying the muscle relaxes and the wrinkles in the skin gradually soften and often disappear.

The conditions which are contraindicated for the use of BOTOX® injections include:

  • Pregnancy and breastfeeding
  • Previous history of reaction to the toxin
  • Neurological diseases ( myasthenia gravis, Eaton-Lambert syndrome, neuropathies)
  • Age -below 12 years
  • Injecting into the sites of infection or inflammation
  • Use of medications such as aminoglycoside antibiotics (may increase effect of botulinum toxin), chloroquine and hydroxychloroquine (may reduce effect), and blood thinning agents, warfarin or aspirin (may result in bruising)

Adverse Effects

Although Botox is well accepted, it is associated with certain adverse effects such as redness, bruising, infection, and pain at the injection site. Dizziness, difficulty in swallowing, headache and muscle weakness may also occur when this medication is injected into muscles. Double vision, drooping or swollen eyelid, dry eyes, reduced blinking, and increased sensitivity to light may also occur.

BOTOX® Therapy: Frown Lines, Crow's Feet, Neck Bands

BOTOX® Therapy: Frown Lines, Crow's Feet, Neck BandsBOTOX® Therapy is an FDA approved treatment method to smooth and eliminate forehead lines, frown lines, crow’s feet and neck bands. Frown lines are wrinkles which form between the eyebrows and crow’s feet form around the eyes. Overactive facial muscles around the eyes and lower forehead may give a person an angry, tired, or displeased appearance - even when they are not experiencing that emotion. Professional use of BOTOX® can lead to a more relaxed, yet expressive face.  Neck bands are visible bands on the neck formed as a result of aging. The cords or bands that protrude from the neck tend to sag with the aging process and pull the neck down. Certain patients can get significant lift with BOTOX® injection into these neckbands. It works by relaxing the contracted muscles which cause these wrinkles. Botox blocks signals sent from the nerves to the muscles that causes relaxation of muscles and treat these lines.

Procedure: It is a simple office procedure. The area to be treated is cleansed thoroughly. A topical anesthetic cream is applied to reduce discomfort and the BOTOX® toxin is injected with a fine needle directly into the muscle beneath the wrinkle. The muscle function becomes weakened, eliminating part or all of its function. Long standing skin creases will soften and may eventually disappear. The result is a softer, more relaxed and pleasant appearance.

The procedure takes about 10 minutes. You may return to work immediately. It is a painless procedure, though a slight stinging sensation may be felt.

Adverse Effects: Redness and bruising at the site of injection may be seen which will resolve in a day or two. You may experience mild headache also. Double vision, drooping or swollen eyelid, dry eyes, and reduced blinking are other side effects.

Precautions: To reduce bruising after treatment:

  • Avoid alcohol consumption at least 1 week before treatment.
  • Stop taking anti-inflammatory medicines and aspirin 2 weeks prior to treatment.
  • Avoid rubbing the treated area or lying down after your treatment as the injected botulinum toxin can spread to other areas nearby and paralyze nerves.

Results: The outcomes of Botox therapy usually last from four to six months. If you are dissatisfied with the benefits from a single injection, a second injection can be given after 1 week. Once you get a satisfactory result, the next visit is scheduled after 2-3 months.

BOTOX® for Hyperhidrosis (Excessive Sweating)


BOTOX® for Excessive Sweating, Hyperhidrosis BOTOX® (OnabotulinumtoxinA) is a neurotoxin indicated for severe primary axillary hyperhidrosis, commonly called as severe underarm sweating, when other topical treatments fail.


Hyperhidrosis is a condition of excessive sweating in certain parts of the body. Axillary hyperhidrosis refers to severe sweating under the arms. Excessive sweating without any underlying medical condition is called primary hyperhidrosis. If the cause of excessive sweating is due to a medical condition, this is referred to as secondary hyperhidrosis. Hyperhidrosis is caused by overactive sweat glands where increased release of acetylcholine, a chemical from the central nervous system that directs the sweat glands to produce sweat, causes excessive perspiration. Hyperhidrosis may significantly affect the social and psychological wellbeing of an individual. It may cause physical discomfort, social embarrassment, affect occupational and daily activities, and at times may also cause social isolation. 

Several treatment options are available for treatment of hyperhidrosis.

Antiperspirants/deodorants: Aluminum chloride hexahydrate containing agents block the sweat pores and deodorants help control the body odor. These agents may cause irritation and itching of skin.

Medications: Agents that inhibit the release of acetylcholine such as glycopyrrolate (Robinul, Robinul-Forte). These agents may cause drymouth, dizziness and other side effects.

Iontophoresis: A small electric current is used to temporarily block the sweat glands. This is often used for treating excessive sweating of the palms and soles of the feet. A drawback with ionotophoresis is that the results are temporary, require multiple sessions every week, and it cannot be used for underarm sweating.

Surgery:  Surgery may be performed to remove the sweat glands or to interrupt the impulses from the central nervous system in a procedure called Endoscopic thoracic sympathectomy (ETS).  The ETS procedure is considered a last resort as it can cause a side effect of compensatory sweating that can be even worse than the original problem.

Botox: Considering the limitations of all other treatments, BOTOX® may be a better choice for axillary hyperhidrosis. Botox blocks the nerves responsible for sweating in the underarm and prevents excessive sweating. It is recommended by the U.S. Food and Drug Administration (FDA) as well as renowned dermatologists for treatment of severe underarm sweating. The effect of each Botox treatment may last for 6–10 months.

Botox is available in 100- and 200- unit single-use vials.  Your dermatologist commonly injects 50 units of Botox in 2 mL saline at 10–15 sites (0.1–0.2 mL in each) under each arm.


Botox is contraindicated in patients with hypersensitivity to any botulinum toxin and in patients with infection at the site of injection.

Adverse effects

  • Spread of toxin effects to parts of the body away from the site of injection
  • Muscle weakness, double/blurred vision, breathing difficulties, rash
  • Dry mouth, dizziness, pain at injection site, headache, eye problems and allergic reactions
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