The Medical Procedure Center, P.C.

Pfenninger Aesthetics Procedures Center, P.C.

“We treat people, not just problems.”


John L. Pfenninger, M.D.

Salena Dodman, R.N.

4800 N. Saginaw Road

Midland, MI 48640

(989) 631-4545

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What does Botox do?

Botox injections improve the appearance of “worry lines”, “frown lines”, “crow’s feet”, and other so-called “dynamic” or aging wrinkles.  “Dynamic” wrinkles occur when we smile, laugh, or frown.  The delicate muscles under the skin contract, causing the skin to wrinkle.  Botox is injected into these muscles and temporarily weakens them to prevent them from working.  By weakening these tiny muscles, the overlying skin will smooth out.  Untreated facial muscles still contract normally, allowing most facial expressions to be unaffected.  Yet, those severe frown lines between the eyes, forehead creases, and crow’s feet around the eyes can be smoothed out creating a more youthful appearance.  Lines that are present at rest will not be improved with Botox injections.


Although the use of Botox is relatively new for treatment of wrinkles, it was approved by the FDA in 1989 and has been used safely and effectively for over a decade for many neurologic disorders.  No irreversible clinical effects or side effects have been reported.  Today the use of Botox has emerged as an exciting new treatment for erasing the visible consequences of aging skin.


Other uses for Botox:

Botox injections may also be given into the muscles of the forehead to treat headaches, especially tension or migraine headaches.  Additionally, injections into the axilla (armpit) can be done to treat hyperhidrosis, or excessive sweating.  These Botox injections for medical problems may be covered by your insurance.


How are the injections done?

Injecting Botox is a simple and safe procedure.  A small amount of diluted solution is injected with a very fine needle into several locations of the muscles of the face (particularly the areas of the frown creases of the forehead and the crow’s feet lateral to the eyes).  Because the needle is so fine and only a tiny amount of liquid is used, the pain associated with the injections is usually tolerated without anesthesia.  We try to minimize the discomfort by applying cold compresses before each area is treated.  The medicine stings during the injection and has been compared to the sting of an insect bite, but it clears rapidly within minutes.  You will be able to drive and engage in your normal daily activities immediately after your injections.  A small number of people will have some temporary bruising of the skin at some injection sites, which fades over several days.  Otherwise there will be no visible signs of your treatment.


What are the contraindications?  Who should not be treated with Botox?

Botox is not recommended for the following:

-          Persons allergic to human albumin or botulinum toxin

-          Pregnant or breastfeeding women

-          Those with neuromuscular disease such as myasthenia gravis

-          Those being treated at the same time with tissue fillers (collagen)

-          If you are taking aspirin, vitamin E, or other blood thinners, it would be best not to take them a few days before being injected.  Talk to your doctor to discuss this.

-          If you are taking a class of drugs called “calcium channel blockers”, (e.g. Norvasc, Plendil, DynaCirc, Cardene, Adalat CC, Procardia, Cardizem, Calan, Covera HS, Verelan) the effects of Botox may be increased so be sure your doctor knows.


Are there any side effects?

Mild, temporary bruising or redness may occur.  Rarely there will be a headache for a few hours.  Very slight droopiness of the upper eyelid occurs in about 2% of people who have their frown lines injected.  About 5% of people who have their forehead injected immediately above the eyebrows may notice this effect, too.  A much smaller number of people will notice slight asymmetry of the lower face after injection of the crow’s feet muscles.  These effects are not usually noticeable by others and fully recover after 3 to 5 weeks.  An extremely rare side effect – temporary double vision – has been reported in the literature.  To minimize the possibility of such rare effects, please be sure to follow the post-treatment instructions. 


It is important to remember that there have been no long-term adverse effects or health hazards related to the use of Botox for any cosmetic indications thus far.  The incidence of complications is low, the severity is usually mild, and they are short-lived (a matter of months).


A very small percentage of people will not notice much effect from the treatment.  A rare patient may develop resistance to response over time.  Usually, just the opposite occurs -- they respond more to the same dose as time goes on.


What kind of results can I expect?

If dynamic wrinkles (those that occur with muscle contraction) are making you look older and more “serious”, Botox can usually smooth these out and give you a more youthful and rested appearance.  However, this treatment will not improve the more common “static” wrinkles (those present all the time) that are unrelated to facial muscle contraction, nor does it improve loose or sagging skin.  Results from the injections are typically seen within 2-10 days of the treatment and last for 6 weeks to 6 months (typically 3-4 months).  Occasionally, there is a muscle that does not respond, and a “touch-up” may be needed in 2-3 weeks.


How long do the results last?

Initially most people require a repeat injection every 3 months to maintain the effect.  However, after three to five injections, the effect may last longer and a repeat injection may only be required every 6-12 months.


What instructions should I follow after treatment?

  • Do not rub the injection sites for four hours, since this may spread the solution to adjacent muscles and cause effects where it’s not wanted.
  • Do not lie down or participate in vigorous exercise for four hours for the same reason.
  • Exercise the face muscles by raising your eyebrows, furrowing your brows, and frowning deeply, smiling, etc., ten times every 15 minutes for four hours.  Botox attaches better to active muscles.
  • A small number of people will require a higher dose than that given with the first treatment to obtain an effect.  If you have seen no improvement after two weeks, please call us to schedule a “touch-up”.


How much will it cost?

The cost per treatment will vary depending on how many areas you want treated and how many injections it will take.  The cost is $______ per unit.  The average Botox injection session will take 25 units. Insurances (including Medicaid and Medicare) do not pay for “cosmetic” medical care and will not therefore pay for Botox therapy. You will need to pay at the time of your visit, by cash, check or credit card.





Copyright, 2011.  John L. Pfenninger, M.D.                                                                                                                                                           jw02/11