Botox is commonly used to improve wrinkles around the eyes, to shape the mouth, and to alleviate the pain of migraine headaches and temporomandibular joint spasms.
Around the eyes:
Botox is most commonly injected into the corrugator muscle, which creates the vertical frown lines in the glabella, the region between the eyebrows and above the nose. Botox is also approved for injecting the orbicularis muscle around the corner of the eye, where squinting and smiling create radial creases called “crow’s feet.” With skilled injection of the procerus muscle and other eyebrow depressors, the physician can encourage unopposed upward movement of the eyebrows. This is sometimes referred to as a chemical eyebrow lift.
In the forehead:
Botox can be used with caution to relax the horizontal creases across the forehead. Excessive treatment can cause flattening of the eyebrow arch, or even sagging of the brow. Complete elimination of forehead muscles is usually not desirable, as it creates an expressionless “mask.” This is considered an “off-label” use.
In the lips:
A popular site for Botox injection is into the corner of the mouth muscle, called the depressor anguli oris (DAO). DAO injections improve the shape of the mouth, reducing frowns and elevating the corners of the mouth. Very tiny doses of Botox may be injected into lip lines to relax the vertical creases or “smoker’s lines” in the lip skin. Botox injections around the mouth can be especially effective when combined with injectable fillers.
For migraine headaches:
Botox can be extremely helpful for some patients with migraine headaches, offering 3-4 months of relief to patients who have averaged over 15 headaches per month despite medical management. Typically, we inject the forehead and around the eyes, as well as the temples and back of the skull.
For temporomandibular joint pain:
Botox can be helpful for patients with excessive jaw clenching and tooth grinding, relieving the pain caused by excessive muscle activity.