Dr. Alexander Rivkin
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FAQ’s – BOTOX®

What is BOTOX®?

BOTOX® is the brand name for Botulinum Toxin Type A. This is a protein made in the laboratory from the toxin of a bacterium called Clostridium Botulinum. The toxin is a potent poison. The protein is not.

During the manufacturing process, the toxin is diluted, processed and purified. The resulting protein is absorbed completely by the muscles into which it is injected. The body does not absorb the protein and this is why BOTOX® is so safe. Because it is not absorbed, BOTOX® does not affect the body, only the muscles into which it is injected. After 3 to 6 months, BOTOX® disappears from the body without leaving a trace.

What can BOTOX® do?

BOTOX® is injected into muscles of the face to partially relax specific muscles and temporarily lessen the appearance of certain wrinkles that are caused by these muscles. BOTOX® has been used for this purpose for the past 15 years all over the world. The wrinkles that are due to muscle contraction (such as frowning or raising the eyebrows in surprise) are called dynamic or expressive wrinkles. These are the wrinkles that soften with BOTOX® treatment.

Which wrinkles can BOTOX® soften?

BOTOX® can soften the following wrinkles:

  • the vertical “11” lines between the eyebrows that appear when we frown.
  • the horizontal lines on the forehead that appear when we raise our eyebrows in surprise
  • the horizontal “crow’s feet” lines next to our eyes that appear when we smile

Is that all that it can do?

No.

As an expert in BOTOX® injection, Dr. Rivkin commonly uses certain advanced techniques. Dr. Rivkin uses BOTOX® to:

  • contour the position of the eyebrows via strategically placed injections. In this way he can create a pleasing arch, even out asymmetric eyebrows or give a “chemical eyelift” – raising the eyebrows and opening up the eyes.
  • soften the “bunny lines” that appear on the sides of the nose when, during a
    smile, one crinkles the nose.
  • decrease the flare of the nostrils
  • decrease the droop of the tip of the nose in some people when they speak.
  • decrease the severity of a “gummy smile”
  • straighten the corners of a mouth that are turning down with age
  • decrease the appearance of vertical lip lines – “smoker’s lines”
  • smooth out the wrinkly “orange peel” chin that some people get when they speak
  • stop teeth grinding and relieve TMJ
  • eliminate neck bands
  • stop excessive sweating on the face, palms, underarms or soles of the feet

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How do I choose a good place to get BOTOX® injection?

BOTOX® injection is a medical procedure that requires the injector to have aesthetic training, skill and experience. As such, it should be performed in a physician’s office, under conditions of cleanliness by an experienced doctor or nurse injector. Prior to getting injections, you should inquire into the specialty and experience of the physician responsible for the facility. You should know how often the doctor is in and you should know how experienced the nurse is if your injections are to be performed by a nurse. There are a great many medical spas in Southern California, some of which are run by non – physicians for a quick profit. Some of these are franchise chains in malls. Some of these kinds of places have very attractive prices. Fast, cheap BOTOX® is like fast food. It can be bad for you. It is risky and can result in 3 months of uneven features, droopy eyes or worse. It’s not worth it.

How experienced is Dr. Rivkin at BOTOX® injection?

Dr. Rivkin has been injecting BOTOX® for a decade. He was chosen by Allergan – the company that makes BOTOX® – to be a member of their National Education Faculty. This is a select group of physicians nationwide who, due to their experience and knowledge in the aesthetic field, educate other physicians and nurses on the best BOTOX® and Juvederm™ injection techniques. Because his practice is exclusively devoted to non – invasive aesthetic procedures and because he does most of the BOTOX® injections himself, Dr. Rivkin is one of the most experienced BOTOX® experts in Los Angeles. He is also involved in developing and refining new BOTOX® injection techniques and applications, such as BOTOX® for teeth grinding.

Is BOTOX® safe?

BOTOX® is one of the safest medications we know and it has the backing of the FDA. It is also one of the most tested and studied drugs in medicine. Millions of procedures have been performed worldwide and serious side effects are unheard of. In the United States alone, 3.5 million injections are performed each year. There are no long term or permanent side effects and this fact has been established through extensive research. Rare temporary side effects include: bruising, redness at the injection site, headache or flu-like symptoms. Injecting BOTOX® into the wrong place can result in a temporary eyelid droop. Because Dr. Rivkin is one of the most experienced BOTOX® injectors in Los Angeles, these side effects areextremely rare at Westside Aesthetics.

Am I going to be numb after BOTOX®?

No. BOTOX® weakens muscles temporarily, but has no effect on the nerves that control sensation.

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My friend couldn’t move her face after she got BOTOX®. Does that always happen?

Absolutely not!

However it does mean that you should not get BOTOX® from the person who injected your friend. BOTOX® injection is a bit of an art, and the tough part is to make the patient look relaxed and younger without taking away their ability to make facial expressions. When Dr. Rivkin teaches doctors and nurses how to administer BOTOX®, he stresses the critical importance of a natural result. The patient should be able to move their face. Their forehead should not look too tight. Their smile should be natural. Their eyebrows should not arch like Dr. Spock!

The way to do it right is to always customize the dose of BOTOX® to the individual. That means taking the time to watch them move their facial muscles and knowing where and how much to inject. This is something that Dr. Rivkin has learned from experience and it is the reason why he is known as one of the best BOTOX® injectors in Los Angeles.

What happens during the treatment?

After a brief medical history and examination, ice is applied to the area that is going to be injected. This is important to prevent bruising and to make the injections completely painless. Then several quick injections are performed using an extremely small needle. The whole procedure takes less than a couple of minutes and really doesn’t hurt.

Really – no pain.

With experience, Dr. Rivkin has refined his injection technique to the point where most patients barely feel it.

Is there anything that has to be done after treatment?

We recommend that you make an effort to move the injected muscles for the next hour more than usual. You should be making exaggerated facial expressions for that time. This will help more of the BOTOX® to get into the right muscles faster. You also should not rub the area injected. You can lie down and you can exercise if you feel like it (although we recommend taking it easy for a few hours).

Does the BOTOX® take effect right away and how long does it last?

No, you will usually start to feel the relaxation of the muscles injected with BOTOX® the next day or the day after. BOTOX® takes about a week to be maximally effective in most people. The effects last about 3 to 4 months. Some people who get regular BOTOX® injections notice that they need smaller doses of BOTOX® and that their BOTOX® starts to last longer – up to 6 months.

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Do my wrinkles get worse if I stop doing BOTOX®?

Absolutely not.

After BOTOX® wears off, your face looks like it did before BOTOX®. There is no loosening of the skin, no sagging due to BOTOX®. Using BOTOX® for a prolonged period of time does not cause sagging of the face due to atrophied muscles. On the contrary, prolonged use of BOTOX® over several years is very common and actually results in visible softening of the wrinkles, even after the BOTOX® has worn off. Whether this is due to a weakening of the muscles that cause the wrinkles or your body reprogramming itself to not make certain facial expressions when you want to communicate an emotion is unclear.

Who is a good candidate for BOTOX®?

BOTOX® is safe and effective for anyone who is bothered by expressive wrinkles on their face, except:

  • people with neuromuscular diseases like Amyotrophic Lateral Sclerosis, Myasthenia Gravis or Lambert Eaton syndrome.
  • patients with an active infection at the injection site
  • women who are pregnant or breast feeding

Why can’t I get BOTOX® when I’m pregnant or nursing?

There is no evidence linking BOTOX® with birth defects or infant damage. There is no reason to think that having BOTOX® injections would expose the baby to harm. However, there is also no evidence to prove that BOTOX® does not harm the baby. Therefore, we feel that the risks outweigh the benefits and do not administer BOTOX® to patients who are pregnant or breast-feeding.

Is it bad to receive BOTOX® regularly for a long time?

Intuitively, its not a great idea to use any medication for too long of a long time. In this case, however, there have been a number of good, long-term studies of patients using BOTOX® for neurologic diseases. Over many years of use, BOTOX® has shown no side effects or toxicity. These studies followed patients who were receiving amounts of BOTOX® several times higher than the highest doses that cosmetic patients get. We therefore feel comfortable saying that using BOTOX® regularly over many years is not dangerous.

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11645 Wilshire Blvd., Suite 800. Los Angeles, CA 90025  |  (310) 443-5273

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