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posted: 1/16/2012 6:00 AM

Be realistic about what Botox can fix

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Q. I'd like to do something about my wrinkles. Is Botox a good choice?

A. Botox is a brand name for botulinum toxin type A. This treatment for wrinkles and frown lines has gained quite a following since it was introduced in the late 1980s.

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Botulinum toxin is made naturally by certain bacteria. It's a nerve poison. If the toxin gets into the body, such as from eating contaminated meat, it can cause serious disease. But injecting very low concentrations of the toxin into overactive muscles can relax them. The effect lasts for three or four months. The constant tug of overactive muscles beneath the skin is a major cause of wrinkles and frown lines.

Botox can temporarily smooth a wrinkled face, brow or neck. Over time, Botox prevents deeper, more permanent facial lines from forming.

The injections are relatively affordable, starting at about $300 per treatment. They have very few risks and require no recovery time. (Bear in mind you must repeat the injections every few months to maintain their effect.) Botox works on muscles in the face and neck that control facial expressions. It blocks these muscles from contracting. As these muscles relax, creases in the skin smooth out. And because the muscles can't contract, new creases don't form.

Botox procedures take just minutes and don't cause much discomfort. You may notice mild redness for a few hours, minor headaches or occasionally minor bruising. You should be able to hide this bruising with makeup.

You may worry that Botox injections will leave you with an unnatural expression or with frozen or uneven features. But when done well, Botox injections shouldn't drastically change your ability to form facial expressions.

It helps to be realistic about what Botox will and will not accomplish. Botox acts on so-called dynamic wrinkles. These are the lines etched by facial expressions such as laughing, smiling, frowning, wincing, squinting and pursing your lips.

However, Botox does not effectively treat the deep creases that extend from nose to mouth. It also doesn't improve the appearance of wrinkles that form due to aging or ongoing sun exposure.

Botox is best known as a treatment for wrinkles and frown lines. However, it also is effective in treating many other conditions: neck muscle spasms, twitching eyelids, excessive sweating and possibly even migraine headaches.

We have a lot more information on skin rejuvenation procedures in our Special Health Report, "Skin Care and Repair." You can find out more about it at my website.

Make sure that your Botox procedure is handled by a trained, licensed practitioner. The health professionals who give Botox treatments include plastic surgeons, dermatologists, dentists, nurse practitioners and physician assistants.

If you are thinking of having a Botox procedure, do some homework. Get recommendations from your doctor. Talk to friends who have had the procedure. Even if you trust these recommendations, ask the practitioner about the number of procedures he or she has done. Not surprisingly, the more experience a practitioner has, the better the result is likely to be.

Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: AskDoctorK.com.

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