Fascinating Surprises of On-Label and Off-Label uses of Botox® Cosmetic


Botox is probably one of the most common products that we use for facial rejuvenation. It is arguably the one of the most recognized words by people that enjoy the benefits of Botox and by those that make fun of it because they haven’t realized its full potential or they are afraid of looking “frozen” which is not usually the goal. I sometimes hear people say that they will never use Botox. I think that they may say that now, but they haven’t really started aging or they say they will embrace the wrinkles. Then people panic as they get older and want to come in for the magic wand to soften signs of aging. The problem is that now they have let the wrinkles become deeper and the creases have become more permanent so much more needs be done for correction. It may have been easier to keep the wrinkles at bay with a little sustained Botox. We do recommend that Botox be done around every 3 months for around 19 months. That way the muscles are relaxed so the wrinkles don’t re-appear and over time people may only need it every 4-6 months.

So how does Botox work? It is a relaxer of muscles.  For the face, is it FDA approved (On- Label use) for the area between your eyebrows (the glabella), crow’s feet (around eyes), and the forehead. Everywhere else we use it on the face is considered an Off-Label use but still acceptable. The magic of Botox is that it will relax the wrinkles, but it can also elevate tissue since it works by opposites. Think about a tug of war, where one pulls harder to win. For example, the forehead has several series of muscles. Some of the muscles elevate the brows or forehead and others depress these areas to cause frowning or the “11’s”. So, if Botox is strategically placed to soften the depressing muscles then the elevating muscles will lift up the eyebrows to give a more open-eyed appearance. But Botox is an art and a well-qualified provider should be doing this injectable treatment. Poorly placed Botox can be more than disappointing but well-placed Botox can really make one look younger and less ‘frowny’. It turns out that this might be particularly important to focus on these areas during our current season of mask wearing.

So now let’s focus on the fun part and the art of Botox for Off-label uses for cosmetic purposes. The Botox Lip Flip is a common treatment by slightly relaxing muscles and elevating other muscles to create a poutier lip by rolling the lip outward.  A “nose lift” can be done if injected into the base of the nose and so the nasal tip elevates. If you are concerned about slightly downturned corners of your mouth, then an injection into the DAO (depressor anguli oris) will relax so the other muscles can elevate for more of a smile and not a frown on your resting face.  If you have gummy smile, then muscles can also be relaxed for a more natural smile. The masseter muscle on the side of our jaw can masculinize a person and make their lower face look wide but Botox in this area can soften this to look slimmer. Botox into the platysmal neck bands can also soften that appearance. Microtox, into our Aquagold microinfusion device, can deliver microscopic amounts of Botox all over the skin to decrease oil production, smooth the skin and decrease pore size. It is also possible that it might slightly weaken the most exterior of the platysmal muscle so that the interior part might pull back making your neck look better.

In addition to Botox cosmetic uses there are also myriad of Botox® Therapeutic uses which have On-Label and Off-Label uses. A common one is hyperhidrosis or excessive sweating of the armpits. But Off-Label uses for sweating can be palms of hands, soles of feet, and scalps. Treatment of Migraines is an On-Label therapeutic use but an interesting side effect of Botox Cosmetic to the glabella (frown area between the eyebrows) is that fewer people get headaches.

There are so many fascinating ways to use Botox but also it can easily make you look relaxed, less aged and happier on your Zoom, Facetime or Google meeting. Call our office at 503-905-9255, or email to [email protected] for this simple treatment that can be done in an artful and well-trained manner. Check out our specials page on our website, www.BurgessPlasticSurgery.com, to see how to Bank Your Botox in September!

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16865 Boones Ferry Rd, Suite 101
Lake Oswego, OR 97035

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