Botulinum toxin, commonly known as Botox, is a non-invasive means of eliminating those unwanted facial wrinkles that give you an aged or disgruntled appearance. Dr. Mowlavi is highly regarded as an expert Botox injector, and has successfully treated well over a thousand patients in Newport Beach and Orange County at large. Botox is a molecule that is injected where the nerve enters the muscle, called the nerve terminal, and it prevents the release of the molecule that tells the muscle to contract. In essence, Botox blocks the message from the nerve to the muscle and thereby blocks muscle activation. This allows for the muscles that are not critical for function to be paralyzed so that the undesired wrinkles associated with their motion be eliminated. Examples of undesired wrinkle sites and their associated muscles which can be blocked are provided below:

Wrinkle Site Undesired Appearance Responsible Muscle
Between the eyebrows Frowning or squinting when outdoors Corrugator/Procerus
Forehead Horizontal wrinkles when lifting eyebrows Frontalis
Outside your eyelids Crows feet that appear when smiling Orbicularis Oculi
Around your lips Smokers lines extending out from lips Orbicularis Oris
Chin area Hyperanimated chin muscles Depressor Oris

Why should you choose Orange County Plastic Surgeon for your Botox injections?

Dr. Mowlavi has spent a decade researching and modifying Botox injection techniques to maximize Botox injection efficacy. Dr. Mowlavi is currently completing research studies of the above muscles of interest that will be submitted for publication. Knowledge of muscle depth is essential to Botox therapy as the toxin functions by entering the nerve terminal located at the neuromuscular junction, which is located on the posterior surface(back side) of the muscle belly. As such, improving our knowledge of the location of the nerve terminals will maximize the effects of Botox injections. The results of this study have confirmed that muscle depths vary and that injection depths in fact are not trivial. The aesthetic improvements in wrinkles following Botox therapy have been shown to vary in duration from 3 to 6 months. Dr. Mowlavi feels the wide range of durations observed is partially due to lack of knowledge of botox administrators regarding varying muscle anatomy and depths. If you want to maximize the duration and effectiveness of your Botox therapy, we encourage you to contact our office to make a consultation with Dr. Mowlavi.

Procedure: Strategic injection of Botulinum Toxin Type A into specific facial muscles results in temporary paralysis of facial muscles.
Effects: Inability to contract facial muscles reduces facial wrinkles that have developed from chronic muscle activity due to facial expressions.
Length: Procedure lasts 10 to 15 minutes.
Anesthesia: Although most patients do not require any anesthesia, some clinicians offer topical anesthetic to ease the slight pain associated with injections.
Place of Treatment: Procedure is performed in the office.
Side Effects: Temporary bruising, tingling, headaches, or eyelid droop may be observed by patients.
Risks: 1) Botox® may rarely induce a hyper-allergenic response in patients allergic to eggs or albumin.

2) Botox® may be a risk to the fetus in pregnant females.

3) Botox® effects may be increased in patients consuming aminoglycoside antibiotics.

Recovery: Patients can usually return to work. Light bruising may be evident initially but will resolve by the following day. Botox® effects will be evident within several days.
Duration of Results: Patients should expect 4 to 6 months of wrinkle reduction.

Your physician will utilize very fine needles to inject Botox® into specific facial muscle groups. Botox® is extracted from a bacteria called Clostridia botulinum which paralyzes muscles and had been used until recently for disorders of the eye muscles. Today, primary treatment sites include between the eyebrows, over the forehead, and around the eyelids in order to paralyze the corrugator and procerus muscles, the frontalis muscles, and the orbicularis oculi muscles respectively. Less popular treatment sites include the chin, upper lip, and neck in order to paralyze the depressor anguli oris, orbicularis oculi, and platysma muscles respectively. Typical units of Botox® required per site have been compiled for your convenience below:

Region Units of Botox® U = Units
Between the eyebrows 20 U
Forehead 10 to 30 U
Eyes (per eye) 4 to 10 U
Upper lip 1 U per quarter lip
Chin 3 to 5 U per side
Neck 50 to 80 U

Botox® is currently being used to eliminate facial wrinkles by paralyzing certain muscles used for portraying expressions. Most people are eligible for this procedure unless you are unfortunate to have allergies to eggs or to albumin, a protein found in most organisms. Other exclusions include pregnancy or patients with rare muscular disorders. The effects of Botox® are readily visible within several days but may take up to 1 week. Also, bruising may last for up to 2 days, so you may want to avoid any large social events for a few days.

In general, it is beneficial to obtain Botox® injections prior to acquiring static wrinkles. Static wrinkles refer to the stubborn wrinkles that persist even when you are not actively expressing. Once these wrinkles set in, Botox® can only prevent them from getting larger; in contrast, if you start Botox® before the static wrinkles take hold, then you can avoid these wrinkles all together.

Since Botox® injections can result in slight bruising, it is wise to schedule your treatment several days prior to any social events. In addition, it is wise to avoid any blood thinners such as aspirin or herbal products for two weeks prior to treatment. For patients susceptible to migraine headaches it is advisable that they take their prophylactic headache medications to avoid post-injection headaches.

Since Botox® treatment requires only superficial injections, no preparation is required by clients. Most clients tolerate the treatment during their lunch hour and can return to their daily routine without any delays. Following their Botox® treatments patients are advised to avoid lying down for approximately 6 hours and avoid any exercise for one day in order to avoid migration of the Botox® away from the injection site.

Clients can expect a softening and/or elimination of wrinkles caused by certain facial muscles of expression. The most common wrinkles treated include: a) forehead wrinkles created by raising of the brows; b) wrinkles between the eyebrows caused by squinting; and c) wrinkles around the eyes (crows feet) caused by smiling. Most clients observe relaxation of strained muscles and note feeling rested for 6 months.

Since Botox® treatment requires only superficial injections, treatments may be performed in a clinic examination room.

Since Botox® treatment requires only superficial injections, minimal anesthesia is required. Patients are offered either a topical anesthetic cream immediately prior to injections, topical cooling with a blowing coolant device during injection, or no anesthetic at all. Most repeat clients elect to complete their Botox® treatment without any anesthetic.

Immediately following Botox® treatments, clients may note slight bruising of the skin at the injection sites. Fortunately, bruising is easily covered with touch up make up and is temporary. Patients should avoid aspirin products for 1 week prior to injections to avoid bruising.

Most clients tolerate the treatment during their lunch hour and can return to work without any delays. Following their Botox® treatments patients are advised to avoid lying down for approximately 6 hours and avoid any exercise for one day in order to avoid migration of the Botox® away from the injection site.

In general, Botox® is extremely safe and effective but there are a few side effects that clients should be aware of. First, Botox® may not work on you or be effective for only a few months. There are several reasons for this. First, the injector may not fully appreciate muscle physiology and thus inject into the improper layer. Second, Botox® is most effective in a concentrated form. Unfortunately, some clinicians may over-dilute their Botox® stock making it less effective. Finally, Botox® may be outdated if it has been sitting around too long prior to injection. Since Botox® is dispensed in 100 unit bottles and most clients only need 20 to 50 units per session it can be difficult to use up an entire bottle in a single day after it has been reconstituted, i.e. prepared. Typically, Botox® should not be administered after 3 days following preparation.

The most common side effect following Botox® injection is bruising. Although this is a nuisance, bruising is minimal and usually resolves within 2 days. All aspirin containing products should be avoided for one week prior to and following injection to minimize risk of bruising. Another uncommon side effect is a post-injection headache. Fortunately, headaches are manageable with Tylenol administration and resolve within one day.

The most troublesome side effect involves the unintended paralysis of a functional muscle. This is due to the undesired migration of the Botox® from the initial area of injection. If the levator muscle is inadvertently paralyzed, the patient develops a temporary eyelid droop. This complication occurs several days following injection and results in eyelid asymmetry and a patient who looks sleepy. Fortunately, antidote eye drops are available and will counter this effect allowing the levator muscle to regain its strength. Two weeks of eye drop administration is usually sufficient to correct the problem.

Finally, a long-term side effect of frequent Botox® treatments is alteration of facial anatomic landmarks. For example, if the patient starts out with minimal arching, then it is likely that the eyebrow shape will become even flatter after routine Botox® use. Once again, this side effect can be avoided with modification of routine injection sites in an infrabrow site so that an arch is created.

As a patient you should be aware that for any services rendered, physicians are mandated to obtain informed consent. To obtain informed consent, physicians should explain all risks and undesirable effects that might result from the procedure. In general, Botox® is extremely safe and effective but there are few risks associated with Botox®. First, clients may be allergic to Botox®, eggs, or albumin which could result in a hypoallergenic response. Such a reaction could be life threatening if the client is not treated in a medical clinic setting where appropriate measures can be taken to care for the client.

Another risk associated with Botox® treatments is that to a pregnant female. Since Botox is a paralytic agent, it may translocate to the fetus via the blood stream and have harmful effects on the development of the fetus. All clients should be asked a detailed history regarding pregnancy status and menstrual cycles. Finally, Botox® can have detrimental effects on patients who have certain neurological disorders such as ALS, Myasthenia gravis, or Lambert-Eaton syndrome. A similar overdose can be observed in clients who are currently taking aminoglycoside antibiotics. Neurological paralysis can occur requiring emergent therapy and transportation to the hospital emergency room.

Botox® is a registered trademark of Allergan, Inc.

Is Botox® the most popular procedure? I used to talk to my friends about getting our hair done, now it seems like they are talking about Botox®?

According to the American Society of Plastic Surgery, Botox® was the most popular cosmetic procedure overall, with more than 3.8 million Americans having had Botox® injections.

Is Botox® safe? Doesn’t Botulinum toxin kill people?

Botulinum toxin causes paralysis of skeletal muscles. In theory, in a large enough dose, it could paralyze a human being, and lethal doses it would paralyze the breathing ability of an individual. But, at doses that we are administering, it would be impossible to affect one’s entire system like that. It is important to recognize that only Botox® made in the United States by F.D.A. centers should be offered to patients. This will assure that the doses being administered are safe and effective.

Why did the last Botox® injections I received only last me two months?

There are several reasons why your Botox® may have lasted only two months. You should know that the Botox® molecule is very fragile and can be weakened in multiple ways prior to being injected. Several reasons may lead to Botox® not lasting as long as it should (typically 5 to 6 months) and these include:

  1. The Botox® is ruined during the mixing process by not gently handling the solution. In general, Botox® is diluted with 2.5 to 4.0 cc of sterile saline without preservative. The solution will lose its potency if it is mixed by shaking instead of gentle swirling.
  2. The Botox® is ruined if it is injected too soon after wiping your skin with alcohol. Alcohol will instantly ruin the Botox® molecule, so it is important to let the alcohol evaporate prior to injecting Botox®.
  3. The Botox® may be over-diluted so that the injections are being delivered using less than optimal Units. In general, each region injected requires a range of Botox® units; often less units are injected by practitioners in an attempt to make more money. If you want to get lasting results, you should have your Botox® injections performed at a reputable physician’s office.
  4. The Botox® may have been sitting around for too long. In general, Botox® should be injected as soon as possible after being mixed with the saline solution, termed reconstitution. At our office, we like to use the reconstituted Botox® within 3 days. Although Botox® will work if injected within 1 week of reconstitution, this could be a reason for it lasting only two months
  5. Ideally, the Botox® should be delivered to the neuromuscular terminals. This medical term refers to the spot where the nerves enter the muscle and provide the muscle stimulation to contract. Botox® paralyzes the muscle by temporarily chemically disengaging the nerves from the muscle. Thus, injection technique is critical to getting the best Botox® results. I would recommend that you have Botox® injected by a surgeon who has operated and directly seen the muscles that are being injected since he/she will have a better appreciation for where the Botox® needs to be injected.

Who came up with the concept of injecting a poison into our body?

Within the last 2 decades physicians realized they could use Botox® to treat clinical conditions. At first, the F.D.A. approved Botox® to be used for cases of abnormal eye movements, called strabismus. Today, Botox® is used most commonly to treat unwanted aging and sun damaged skin lines.

How do you inject Botox®? Does it hurt?

The injection of Botox® is like a bee sting, but not nearly as painful! Several techniques can be used to minimize the pain including placement of a topical anesthetic ointment, ice, or a topical freezing blowgun. Most patients who receive Botox® regularly prefer to forego the above-mentioned techniques used to minimize pain.

Are there any restrictions following my Botox® treatments?

Following Botox® therapy, clients are asked to not lie down for 6 hours, to avoid exercise for a day and a half, and to not have facials performed for 1 week. These restrictions ensure that the Botox® does not migrate from its injected area in order to ensure the highest efficacy.

Why is there such a price difference in Botox®; some charge by area and not units?

Although Botox® should be sold by the number of units administered, some clinicians charge for Botox® by the treated region/area in order increase their profit margin. Unfortunately, charging by the area allows clinicians to dilute their Botox® which often results in under treating an area. Charging by the unit allows the clinician to estimate how many units a particular area will require for an effective treatment.

Why did my Botox® not work at all?

Assuming that the Botox® was prepared properly, administered in a timely fashion, and injected in the proper areas, there is a culprit that has been identified which may destroy Botox. The culprit is an antibody that is formed against the Botox®. In essence, antibodies are created by our bodies to fight off harmful entities such as virus, bacteria, and foreign bodies. If Botox® is injected too frequently, then your body can generate antibodies which will neutralize and ruin the Botox® molecule. To avoid this nuisance, it is recommended that Botox® be administered no sooner than every 5 to 6 months.

What about the eyebrow shape?

Botox® acts by paralyzing facial muscles of expression thereby eliminating expression lines. The muscles that are routinely injected between the brow do attach to the eyebrow and function to pull the brows down and in. Thus, when these muscles are paralyzed, the net effect is that central brow does migrate up and out. If the lateral arch of the brow is weak, i.e. there is minimal arch, Botox® will further flatten the appearance of the brow. When a qualified surgeon performs your injections, he/she can gauge and counter this effect thereby still maintaining the aesthetics of your brow.

Is it possible to get an eyelid droop?

There are two ways to get an eyelid droop. First, if the forehead is injected too close to the brows, the brow may droop laterally since the muscle paralyzed can no longer raise the brow. To avoid this complication, injections should be performed no lower than one fingerbreadth above the brow. Another complication involves the Botox® migrating down to the eyelid muscles, effectively reducing the ability of the eyelid to open. This complication is a nuisance but it is temporary and will subside with special eye drops over a 2-week period.

How our patients feel about us:

He made me feel very comfortable... I am so pleased with the work I had done with Doctor Mowlavi. He made me feel very comfortable with my decision to have a breast reduction. Its only been two weeks and I am feeling really good. I would recommend him to anyone looking for a plastic surgeon.

Sonia B. Mission Viejo, CA

So pleased with the work I had done... I am so pleased with the work I had done with Doctor Mowlavi. He made me feel very comfortable with my decision to have a breast reduction. It has only been two weeks and I am feeling really good. I would recommend him to anyone looking for a plastic surgeon.

Kayla S. Laguna Niguel, CA

A comfortable and easy experience... I first went to Dr. Arian Mowlavi a couple years ago for my septoplasty and rhinoplasty (amazing results on both by the way), and then on and off for botox for the past couple years. I finally made the decision to have a breast augmentation in July 2015 and have to say that Dr. Mowlavi and his staff made something that normally would have been a very nerve racking experience into a very comfortable and easy one. Dr. Mowlavi is a caring doctor that really wants the best for everyone he treats. He took his time to listen to what I wanted and suggested what would be the best for me. I find him to be a very empathic human being that sincerely cares for each of his patients. I highly recommend him to everyone. Thank you so much Dr. Mowlavi, you are the best :)

Marie N. San Clemente, CA

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