About this Article
Written by: BJ Gill
Written on: May 4th, 2004
Tags: health & medicine, lifestyle
Thumbnail by: Boutwell/University of Illinois
About the Author
BJ Gill was a sophomore chemical engineering major and history minor at the University of Southern California who had plans to attend medical school in the spring of 2004. Eventually, he hopes to specialize in plastic and reconstructive surgery. When not working, he can be found wearing a Hawaiian shirt, rocking slowly in his chair whilst listening to a mix of mid-90s pop-rock and sipping on a cool glass of iced tea.
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Volume VI Issue II > The Botox Lowdown: Science, Safety, and Success

Technique and Dosing

Botox is delivered to the muscle using a Teflon-coated needle connected to an electromyography or EMG machine. With the patient contracting the target muscle, the EMG emits sound when the needle finds a patch of high muscular activity [5]. This sound indicates a good area to inject. The EMG thus enables the doctor to target the muscle site that will yield the best aesthetic effect. Doctors usually inject Botox in more than one site on the muscle. In cases where facial lines are easily seen and where muscles can be easily accessed, the use of an EMG machine may not be necessary [9]. In such instances, the doctor may just mark injection sites as the patient contracts the target muscle.
Typically, concentrations of toxin within the injected solution are held between 25 U/mL and 50 U/mL for cosmetic purposes and between 50-100 U/mL for clinical applications [5]. The concentration is important in minimizing complications. The overall dose range varies between muscle groups, depending on the sensitivity of nearby muscles or body parts and the size of the target muscle. For example, less Botox will be injected in the muscles near the lips and eyes, as the risk of unintended effects is higher in these more delicate areas. Accordingly, for crow's feet the average injection amount is 6.2 U, whereas for the forehead, the average injection amount is 17.3 U. [5].

Effectiveness of Botox

As a cosmetic procedure, the best judge to the effectiveness of Botox is examining patient satisfaction. As suggested by the shear numbers of Botox procedures, Botox patients are very satisfied with their treatment. One study reported that 80% of patients found the treatment beneficial, with all patients recommending the treatment for others. Similarly, 76.7% of patients reported that they are more comfortable with their body after injection [15]. The reasons for such enthusiastic endorsement go beyond a simple superficial desire to have a flawlessly smooth and youthful face. Botox's removal of hyperfunctional lines and wrinkles may have deeper health benefits for the patient. One study notes that facial lines and wrinkles are important because the face is a critical communication tool and its appearance affects self-perception, self-esteem and social interactions. It goes on to suggest that such facial lines may have adverse effects on the patient, either by sending emotional miscues or inappropriately indicating aging [13].
Furthermore, lines that inappropriately indicate aging have a tangible effect on self-image and self-esteem because the way one perceives oneself is determined at least in part by the way one is perceived by others [1]. By correcting these lines, the patient's psychological well-being and social functioning can improve [13]). Also, for those older patients whose wrinkles are appropriately representative of aging, Botox treatment may help them psychologically cope with the aging process. For such patients, Botox helps bridge the gap between inner and outer self-perceptions, enabling the patient to look old only when he or she is ready to feel old [1].