Botox is the most popular cosmetic medical treatment in the U.S., and is a favorite among men and women looking for non-surgical facial rejuvenation. Botox has a long history in ophthalmology and was first used for spastic eyelid disorders in the 1980s. It is still the most effective treatment available for blepharospasm, and most ophthalmologists have many years of experience in its use.

Facial fillers are an enormously popular alternative in non-surgical facial rejuvenation. They are sometimes used alone, but can also be an adjunct to Botox. They work safely by restoring lost volume under the skin thereby effacing wrinkles and emptiness from aging, most commonly at the lips and creases around the mouth. They are also quite effective at restoring volume to the areas around the eye. Recent advances in technology have resulted in far more long-lasting and natural improvements than ever before.

Botox is a safe, naturally occurring substance that causes muscle relaxation typically lasting three to four months. In high doses, Botox will weaken muscles substantially, while in lower doses, the relaxation and weakening are subtle. These effects are harnessed by your physician to improve frown lines between the brows, crow's feet at the outer corners of the eyes, horizontal lines in the forehead, and eyebrow height and shape. Botox can also be used to treat vertical lip lines, down-turn at the lips, and twitching or spasm of the eyelids, cheeks, and face.

Botox is injected with a tiny needle directly into the muscle(s) causing wrinkles, spasm, or facial aging. Mildly uncomfortable, the injections take only a few seconds. Effects are visible at two to three days and are usually fully evident by one week. Bruising rarely occurs and fades naturally. Improvements in facial appearance and muscle relaxation typically last three to four months.

The most commonly used facial filler is hyaluronic acid, a naturally occurring substance already present in your skin (brands include Restylane, Perlane, and Juvederm). Hyaluronic acid typically lasts six to twelve months and is used to improve lip shape and/or size, creases around the mouth, frown lines between the eyebrows, facial scars and depressions, and dark circles below the eyes.

Your provider will review your specific concerns and medical history and advise you about the best uses for facial fillers in your situation. Fillers are injected with a tiny needle directed in the area of concern, sometimes with ice, anesthetic cream, or anesthetic block injections to minimize discomfort. Effects are visible immediately, but mild local swelling occurs rapidly and lasts for about 24 hours. Bruising infrequently occurs and fades naturally.

Bruising can occur with any injection. Infection is very uncommon. Botox can rarely introduce weakness in a nearby muscle, causing asymmetry, or a droopy eyelid or lip. To minimize this risk, your physician will recommend that you avoid touching the injected areas for several hours so that the Botox will bind to the intended muscles only. Fillers can also cause asymmetry, and rarely, a local sensitivity reaction.