Botox FAQ

Everything You’ve Always Wanted to Know About Botox (But Were Afraid to Ask)

It’s the most popular cosmetic treatment in the United States and canada, but Botox continues to inspire fear and confusion in certain cautious corners. (And, OK, millions of dollars’ worth of admiration.) Is it right for you? That depends on your taste, pocketbook, and tolerance for needles. We explain all.


We wanted to share with you the answers to questions our professionals are most often asked. It’s perfectly normal to have such questions and concerns. If ever you don’t find the answer you’re looking for here, please feel free to contact us. We’ll be happy to take your questions.


Absolutely. Botox (and competitors like Dysport and Xeomin, which will be widely available next January) are highly purified toxins that can temporarily erase or reduce horizontal forehead lines, vertical frown lines, and crow’s-feet. “The injections slow muscles that contract hundreds of times a day, eventually etching lines in the skin,” says New York City plastic surgeon Michael Kane, author of The Botox Book (St. Martin’s Press). Botox can also lift the corners of the mouth that sag with age, smooth out the “pin cushion” look in some chins, soften smoker’s lines around the mouth, and soften vertical neck cords.

What does the procedure entail in terms of a) procedure b) time c) any down time


It will not affect the nerves that cause sensation, or make you feel numb. When it is used correctly, it can lift the brow to give an appealing and sincere look. “But if too much is injected in the danger zone—the horizontal lines in the forehead—you can look Spocked, as in Spock from Star Trek,” says Jean Carruthers, a Vancouver eye surgeon who, with her husband, Alastair, coauthored the first paper on the cosmetic benefits of Botox in 1989. That’s why it’s important to be treated by an experienced doctor who can judge the size of your muscles and how much Botox you will need.


Like most injections, Botox can be slightly painful, especially between the eyebrows. Some doctors offer topical anesthesia ten minutes before the procedure or ice the area to numb it.


Every drug has side effects, and Botox is no exception. Luckily, they tend to be minor and short-lived, according to Kane. In one to five percent of cases, there can be mild droopiness of the eyelid or eyebrow, which usually goes away within two weeks, and some patients experience slight bruising.


Prices vary widely. At PVSC, we made it affordable at $10-12 per unit. Her is the treatment location at the pricing for the max units at $12/unit. The actual cost is probably less than that.
Botox Dose and price


It varies from patient to patient, but good results usually last three and a half to four months. The effect is completely gone in 6 months.


Yes and no. A good result will leave you looking fresher, more cheerful, and perhaps younger. Telltale signs of Botox that has been badly done are a smooth and shiny forehead, or a forehead and crow’s-feet that don’t move when you laugh or cry.


Not much. Results begin to show in a couple of days and develop gradually over the course of two weeks. “I tell anyone preparing for a big event to have shots two weeks ahead of time,. Patients taking medications that contain aspirin or NSAIDs can develop pinpoint blue bruising. Patients can wear makeup immediately but should avoid heavy workouts for 24 hours.


You don’t need it before you have wrinkles to hide. Other than that, a patient can have Botox safely whenever they are bothered by their wrinkles. There is no issue with long term use: “I’ve had patients who have used it repeatedly for over 20 years without bad effects,” says Kane.

Must I prepare for this procedure? How to Prepare for Botox Injections?

The reason that treatments such as Botox® Cosmetic, Dysport®, and Xeomin® are so popular is because they have real, effective results that do not require surgery or any recovery time. That said, each of these is a prescription medication that should be administered by, or under the supervision of, a qualified physician. Be aware that unscrupulous individuals stating that they provide Botox® may not be qualified healthcare professionals and/or may not be providing an FDA-approved medication such as Botox® Cosmetic, Dysport®, and Xeomin®. Others may dilute their treatments, making the cosmetic treatment last for a shorter duration or provide inadequate results. Be wary of unbelievable pricing and always have your treatment done by a qualified healthcare professional.

Botox® Cosmetic, Dysport®, and Xeomin® may also be administered as part of the Liquid Facelift.

Before the Procedure

One of the wonderful aspects about Botox® is the fact that no true preparation is needed. Most of Dr. Youssef’s patients simply arrange an appointment that is most convenient for their busy schedules. That said, there are certain things that will improve your likely results and minimize any risk of bruising that can occasionally occur from injection.

One of the best things you can do to minimize the possibility of a small injection site bruise is to avoid any aspirin or aspirin containing products. This will include similar medications, including ibuprofen, Alleve®, Motrin®, and most over the counter analgesic pain medications other than acetominophen (Tylenol®). If you take prescription medications that thin your blood, including (but not limited to) Coumadin® (warfarin) and Plavix®, you should be aware that you are more likely to have bruising from your injections. If you smoke, your likelihood of bruising is also increased. If you bruise easily, you may choose to take a natural supplement called Arnica Montanna. This has been associated with a decreased incidence of bruising.

Naturally, before any treatment, Dr. Youssef will evaluate you in order to determine that you are a safe candidate for the procedure. If you have a pre-existing medical condition that leaves you with muscle weakness, swallowing difficulties, speaking difficulties, or breathing difficulties, you should definitely let Dr. Youssef know. Every new patient will undergo a full history and expert exam in order to determine if a treatment such as Botox® will be a safe way to achieve that person’s aesthetic goals.

If you wear makeup on a daily basis, you should plan to have some with you so that you can touch up any makeup that is wiped away from your face in order to clean that area for the procedure. If you exercise on a daily basis, you may choose to work out prior to your treatment at the PVSC, since Dr. Youssef recommends waiting at least four hours before physical exertion following your Botox treatment.

What are payments requirements / process?

The cost of Botox is between $10-12/unit. Depending the amount of treatment that is required. We take cash or cards (debit or credit cards) after the procedure as we need to know how many units where needed.

Any warning signs if something has gone wrong? Botox Side Effects

Botox Side Effects

Potential Botox side effects include pain at the injection site, infection, inflammation, swelling, redness, bleeding and bruising. Some of these symptoms may indicate an allergic reaction; other allergy symptoms are itching, wheezing, asthma, a rash, red welts, dizziness and faintness. Tell your doctor immediately if you have any breathing issues or a faint or dizzy feeling. Also, dry mouth, fatigue, headache and neck pain have been reported.

You may have heard of other side effects as well, such as numbness, droopy eyelids, muscle spasms or twitching, and migration of the substance.

Numbness as an absence of physical sensation is not really an issue with Botox, because Botox is not an anesthetic. Numbness as the result of the inability to move a muscle is an issue for some people.

Muscle spasms in the area of the Botox injections do not occur while the Botox is effective. After all, Botox is used to treat spasms related to benign essential blepharospasm, hemifacial spasm, cerebral palsy, fibromyalgia and temporomandibular joint disorder.

It is possible for the Botox to spread a little beyond the intended injection site and affect surrounding tissues. For example, if you receive injections into the forehead close to your eyebrows or your upper eyelids, they could be affected and may droop temporarily.

The best practitioners know the correct sites of injection to avoid side effects such as droopy eyelids. A small, highly concentrated dose of Botox dose is less likely to spread from the injection site than a large diluted dose.

This underscores the importance of finding a practitioner who has long experience with giving Botox injections.

What You Can Do To Avoid Botox Side Effects

The list of possible side effects mentioned in this article is a long one, but it would be extremely rare for anyone to experience all of them. And following these six tips will minimize or prevent most Botox side effects:

  1. Make sure your practitioner is very experienced at Botox injections and is a respected medical professional. A salon stylist, for example, is not an appropriate person to administer Botox, because he or she would not have emergency equipment or sufficient medical knowledge if something went wrong. Some disreputable people have reportedly administered injections that were over- or under-diluted with saline, as well as counterfeit solutions that didn’t contain Botox at all.
  2. Before having injections, tell your practitioner about any health problems you have.
  3. Also tell your practitioner about medications, vitamins, herbal preparations or other supplements you take, since some combinations of these supplements with Botox could cause serious side effects. It’s especially important to mention having taken injected antibiotics, muscle relaxants, allergy or cold medicines and sleep medicines.
  4. Follow your practitioner’s pre- and post-injection instructions very carefully.
  5. Report all side effects — especially those that are bothering you or won’t go away.
  6. Beware of Botox injections at a “Botox party” at someone’s house. You need to be in a medical setting, where any side effects can be treated immediately. You may not see the final effects of the injections during the party anyway, as they usually take a few days. A Botox party isn’t such a bad idea if it’s held by a doctor in a medical setting, but even then there’s a risk of the doctor’s attention being divided between you and the other attendees.

The Botox Procedure?

The Procedure

Most people find that talking about Botox® takes far longer than the procedure itself. Most patients choose to have topic anesthetic ointment applied to the areas which will be treated in order to dull sensation in the area. At PVSC Dr. Youssef uses ice packs to numb the skin and decrease bruising. Others prefer nothing at all. You will have the opportunity to choose before your treatment.

Just prior to injection, any topical anesthetic ointment that has been applied will be gently removed and an ice pack applied to the area. After a short time, typically measured in seconds, the ice pack will be removed, the treatment area will cleaned with alcohol or an antiseptic such as betadine, and Botox® (or other neuromodulator) injections will be performed. All injections are performed by Dr. Youssef.

Botox® (Dysport®, Xeomin®) to the Brow

This is the most common treatment for Botox® Cosmetic, Dysport®, or Xeomin®, and is used to treat those vertical lines and can form between the eyebrows. As the years pass, frowning, squinting, or even simply concentrating while reading can lead to contraction of the corrugator muscle and result in unsightly lines that make us look tired, angry, stressed, or sad. For many folks who spend hours every day working in front of the computer, lines in the brow can form simply from the constant need to concentrate while looking at a bright screen.

The treatment takes less than five minutes to perform. Results are usually seen a few days later, and usually last three to four months.

Botox® to the Forehead

Age, sun exposure, and a host of other environmental factors can lead to horizontal lines on the forehead caused by chronic muscle contractions. Over time, these lines deepen and become permanent.

By administering Botox®, Dysport®, or Xeomin® to the forehead alone or together with treatments to the brow and crows feet, the forehead, brow, and eyes can be rejuvenated. For younger individuals getting these lines for the first time, Botox® treatments can be preventative and retain a youthful appearance much longer. Deep, permanent lines are less likely to form if the lighter temporary creases are never made!

Botox® to the Crow’s Feet (Around the Eyes)

Concentrating at work and while reading can also cause constant squinting, which eventually can become a habit that creates lines (commonly known as “crow’s feet”) outside each eye. Unfortunately, constantly making these wrinkles by squinting eventually makes them permanent over time.

By treating these lines with Botox®, Dysport®, or Xeomin®, you can soften the appearance of these lines and even completely eliminate them in some cases. Depending on the technique and your personal cosmetic concerns, Dr. Youssef may even be able to make your eye appear larger because the muscle around it is no longer squeezing the eye shut (as it does when you squint).


Botox® to the Lip(s)

Vertical wrinkles that appear around the lips as we age may have any number of causes. One prominent etiology is the overuse of the muscle around the lips responsible for causing them to purse together. We use this muscle (the obicularis oris muscle) to keep our mouths closed when eating and drinking, to express ourselves, and even unconsciously as part of a habit.

Some prominent and unnecessary reasons for overuse of this muscle, leading over the years to wrinkles around the mouth include:

  • Chewing gum
  • Drinking through a straw regularly
  • Smoking
  • Pursing the lips frequently as a facial expression or nervous habit

At the PVSC, Dr. Youssef can administer Botox® to gently relax this muscle, reducing the amount of wrinkling it causes in the lines around the lips. This procedure takes less than a minute in most patients and has no recovery time. Make up can be applied before leaving the office.

Botox post-injection instruction: Any special measures that are needed after the procedure, ie. keep out of sun, etc…or any such measures ..

Not much. You do not need to keep out of sun. I normally tell my patients to:
1)  Avoid alcohol for a day
2)  Avoid strenuous activity for a day
3)  Avoid blood thinning medications if possible for a day

If you do bruise, I would continue to avoid the above until you no longer feel the bruise is getting worse.

I also tell my patients to avoid blood thinning medications if possible for a week before the treatment.

After the Procedure

Generally, you will be able to leave the office within minutes of your treatment. Many patients choose to return to work, go shopping, have lunch, attend social engagements (dinners, lunches, parties, etc.), or are on the way home. If you wear makeup, you can reapply or touch up make up before you leave the PVSC.

Dr. Youssef does not recommend exercising or lying down (flat on a bed) for four hours after a Botox® treatment. In addition, if you have Botox®, Dysport®, and Xeomin® around the eyes, you should avoid vigorously rubbing towards your eyes for a few days after your treatment.

In order to maintain your results, be sure to schedule your next treatment session before you leave the office.

Where does it go in my body?

BOTOX Cosmetic® stays local to the muscle where it was injected.
After the injection, BOTOX Cosmetic® is simply metabolised & broken down into natural byproducts within a few hours.

I have heard that you can get a drooping eyelid – is this true?

Side effects are rare and are not permanent and this can include a drooping eyelid.
The incidence of these side effects in Dr Rouzati’s experienced hands are extremely low and in the rare event that they happen they would not be permanet and would last a few days to a few weeks before resolving.

What are the side effects?

Side effects are RARE and are NOT PERMANENT.
Rarely, there can be some minor bruising (which is easily covered up with makeup) or a slight short term headache. Most patients do not experience any side effects at all

I don’t want to look like a mask without expression – will that happen?

No. We ensure you get the look you want – as natural as you want.
Most people simply want to look NATURAL, RELAXED and REFRESHED, without looking “done”.
In the experienced hands at our clinic – patients typically say that no one knows that they had anything done. Friends simply say that they look well rested and great!

How is it done?

It is injected with a very tiny needle (it only feels like a little pinch). Done directly into the muscles that need to be relaxed.

How long does the procedure take?

Generally, after the consultation, the procedure only takes up to 15 minutes.
Since there is no downtime – you can do it on your lunchtime – and no one would know you have had it done!

Do you offer financing?

At PVSC, we understand that laser vision correction is an investment. We offer various financing options—ranging from short-term, no interest to long-term plans through a patient financing company, Medicard. Feel free to contact our patient education staff to learn more.  You can visit their website at

Canada’s Patient Financing Company


I have high blood pressure (hypertension). Is Botox safe for me?

When injected appropriately, Botox should not have a direct effect on blood pressure. Always consult with your physician prior to considering Botox injections. If the pressure is not will controlled, the probability of bruising with the botox would be increased.

Is it considered safe to have Botox around your eyes shortly before or after LASIK surgery?

The decision to have Botox injections before or after LASIK surgery should be left up to your LASIK surgeon. The injections should be safe. However, the effect of Botox around the eyes can reduce the strength of the blink reflex, which might create a sense of dryness of the eye. This might affect the healing process of the LASIK surgery. LASIK surgery is known to create temporary dry eyes immediately after the procedure.

What happens if I discontinue Botox after the first time or after several times? Will my forehead look worse than before I started treatment? Some people tell me once you start using it, you can never stop.

The wrinkles of your forehead should return to their original appearance when the Botox wears off. Discontinuing the Botox will not worsen your wrinkles.

The reason “you can never stop” using the Botox is because after seeing the disappearance of your wrinkles, you “never want to see the wrinkles” again. You can stop anytime you want without consequences (other than the return of the wrinkles).

I’m getting married and want to have Botox to “freshen” my face. How far out do I need to have it? I don’t want to be bruised or swollen on my wedding day!

Botox takes about two to four days to take effect. Its maximum effect occurs around 10 to 14 days and lasts up to three months. A bruise from a needlestick usually lasts five to seven days. With an impending event, such as a wedding, I usually suggest that my patients get their Botox injections one month before the event.

Is anesthesia used for the procedure? I’m a bit of a chicken when it comes to needles!

Some doctors will anesthetize the surface of the skin with a topical anesthetic cream. This makes the stick of the needle much more tolerable. At PVSC we use freezing packs to decrease pain and prevent bruising.

Is it true that the more I have Botox, the less I need to use it?

This has been a topic of discussion among many physicians. Muscles that are not used tend to atrophy and weaken over time. Muscles that have been continually injected with Botox may actually fall into this category and produce a similar effect. This might result in using less Botox.

How many Botox treatments are needed before you see results, does it hurt, and what is the healing period and aftercare?

When injected appropriately, the results will be seen after the first treatment. Botox takes two to four days before the muscle weakening effect takes place. The maximum effect occurs at about 10 to 14 days. The effect then lasts up to three months.

Pain and discomfort depends on one’s tolerance for needle injections around the face. There is typically no “healing period and aftercare.” Most physicians suggest that the areas of injection should not be rubbed or manipulated for a few hours after the injections.

Is there a rebound effect when Botox wears off and one does not go for repeat injections?

No, the muscle activity should return to its original state when the Botox wears off.

How does Botox work?

Botox works by weakening the muscles into which it is injected. As facial muscles contract, the loose skin above those muscles wrinkles. By weakening the muscles, the wrinkles are reduced.

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