Managing Patient Expectations

Cosmetic denervation with botulinum toxin is suitable for all skin types. It provides relaxation of dynamic rhytids giving patients a more youthful appearance. Deep furrows or rhytids may require higher doses and/or more yearly treatments. Overall, doses will vary from person to person. It is important for patients to understand that they are not being paralyzed; rather, hyperkinetic muscles are being relaxed. They should also be made aware that Botox treatment does not improve the more common static rhytids that are unrelated to facial contraction. Moreover, cosmetic denervation will not improve loose or sagging skin and does not serve the same function as a facelift. For patients with a combination of dynamic and static rhytids, improvements may be limited if Botox treatment only is used. To optimize a treatment program, many options are available to use botulinum toxin in combination therapy, including injectable fillers and microimplants. Early results from clinical trials suggest that the duration of benefits from Botox treatment increases with time so that a patient may require less frequent injections in the future, but this varies from person to person.