An exciting non-surgical approach to the treatment of facial wrinkles has recently emerged, involving a new way of using a medication that has been around for years. This fascinating new procedure has created a lot of excitement across the country among cosmetic dermatologists and their patients who seek to reverse the visible effects of aging on the face. The product, known as BOTOX® (manufactured by Allergan, Inc.) is actually a purified toxin that is naturally produced by the bacteria clostridium botulinum. BOTOX® has been used by ophthalmologists and neurologists since 1980 to treat lazy eye, eye spasms and certain other neurologic disorders. More recently, cosmetic dermatologists have been using it to treat the muscles we use for facial expression. It works by causing weakness of specific facial muscles when minute amounts of the toxin are injected into them. The resulting weakness forces these muscles to relax, causing facial wrinkles to become less deep, or even disappear.    Before and After BOTOX® For those men and women who have frown lines between the eyebrows, "crow's feet" around the eyes or deep forehead furrows, this procedure is ideal. BOTOX® can be combined with other procedures such as laser resurfacing, chemical peels,and collagen injections to provide even better, longer-lasting results. Some patients choose to have laser resurfacing first to remove the wrinkles and then receive BOTOX® treatments to prevent their return.    Before and After BOTOX® This is a simple procedure, and is done on a physician's office. It takes approximately fifteen minutes. While the patient is seated upright, a small needle is used to inject the BOTOX® directly into the areas being treated. Patients must remain upright for 3-4 hours after the procedure. In order to enhance the results, patients are instructed to avoid touching the treated areas and to actively use the muscles during the following hour. It takes a few days after the treatment for the BOTOX® to take its full effect on the facial muscles. BOTOX® treatment is not permanent and usually needs to be repeated on average every 4-6 months. However, the effect generally lasts longer with each repeat injection. Some patients report good results over a year after treatment. BOTOX® has an excellent safety profile. A few uncommon side effects can occur, including mild stinging during injection, bruising, temporary drooping of the eyelid (in 1-2% of patients) that lasts a few weeks, or no response to the treatment. BOTOX® can not be given to women who are pregnant or breastfeeding, to patients with a known allergy to BOTOX®, or to those with certain neurologic diseases. BOTOX® is FDA-approved for the treatment of glabellar frown lines. When used for other areas, it is considered an off-label use of the medication. An ideal cosmetic procedure is one that is safe, has few side effects, a rapid recovery, is inexpensive and reversible if the results are unsatisfactory. BOTOX® meets these criteria and consequently, many are enthusiastic about this new procedure. Dr. Stetler's office is a National Training Center for Allergan, Inc. She trains physicians across the country in the proper use of Botox®.