Botulinum neurotoxin, or Botox®, causes local paralysis or weakness when injected into the muscle. As certain muscles are weakened, this results in a softer and more relaxed appearance of the face. In addition, certain desired features can be achieved like widening and elevating the brows by deactivating the muscles responsible for pulling the brows down. Eliminating or improving the wrinkles that appear with animation gives the face a smoother and more rejuvenated look.

The Consultation

During your first consultation, Dr. Alghoul will study your face and analyze how you animate. Based on your desired goals, a treatment recommendation will be made. The number of units used depends on the strength and bulk of the treated muscle and number of areas treated. The most commonly treated areas are the frown lines, forehead, and smile lines (crow’s feet). It is advisable to abstain from taking aspirin or non-steroidal anti-inflammatory medications to minimize bruising.


There is always a concern that Botox treatment to the face may result in an unnatural look. This usually results from several scenarios following the injection:

  1. Over elevation or peaking of the brows, which occurs in certain patients and is common in males. Although Dr. Alghoul uses an injection strategy to specifically avoid this situation, it still may happen in some people, therefore there is a re-touch visit 10 days after the first visit to fix any problems including an over-elevated brow.
  2. Sagging of the brow; which should be avoided by not injecting close to the brow. However, there are patients who have heavy brows and upper eyelids or may be suffering from a droopy upper lid (ptosis) and are relying on constant brow elevation in order to clear their vision. Those patients are at a particularly high risk for drooping of the upper lid and therefore Dr. Alghoul injection strategy accounts for this by keeping the brows elevated. For this group of patients, it is generally advised to surgically treat the underlying problem such as sagging of the brows with brow lift, removing the extras skin in the upper lid, or fixing a droopy upper lid before botox treatment.
  3. As we age, the skin on the upper eyelids loses its elasticity and becomes loose. This causes the upper eyelids to become puffy and the eyes to appear hooded. Eyelid hooding can be caused by the natural aging process, genetics and lifestyle factors such as lack of sleep. Often times, people with droopy eyelids and/or hooded eyes look tired, exhausted and older than what they really are.
  4. What I call a dissociated or unnatural smile. When we smile, the orbicularis muscle which is the circular muscle around the eye fires and squeezes the area on the side of the eye which makes the eye vertically narrower. This phenomenon is natural but it gets exaggerated as we get older and it tends to pull the brow downwards. This muscle, the lateral orbicularis, is routinely treated with Botox, however if overtreated to the point where it doesn’t move, the smile becomes unnatural as the cheek moves while the side of the eye is frozen. Injection strategies have to be modified and adjusted to each individual to make sure that his or her smile remains natural.

What to Expect

Dr. Alghoul personally performs the injection treatment. Treatment is usually performed during the first visit. A very small needle is used, however if you are sensitive to the treatment you can ask for topical anesthetic to be placed prior. It takes six to ten days for the full effect of the treatment to show. Minimal bruising may occur and resolves over a few days. It is preferable to come back for a follow-up visit in two weeks to evaluate the treatment effect and determine whether adjustments are needed in the number of units administered and location of injection. It is advisable to refrain from exercising the first 24 hours after treatment.

Contact Dr. Alghoul

If you’d like to schedule a consultation with Dr. Alghoul to discuss Botox treatment and how it can rejuvenate your facial appearance, please call . During your consultation you can also learn about the dermal fillers that Dr. Alghoul offers for facial rejuvenation.