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Botox Injections for residents of California

Botox is the #1 cosmetic procedure performed in this country. The reason for this is simple… it is the only treatment available in its class and it works. Botox works by blocking the release of neurotransmitter (molecules that transmit signals between nerves and muscles) at the junction between the nerve and muscle. When this process is blocked by Botox, the muscle cannot contract as a result of the nerve signal. Therefore, the muscle activity is minimized.

So what does this all mean and what does this have to do with looking younger? The answer is as follows. Wrinkles around the eyes and forehead result from muscle activity.

As the muscle under the skin contracts, the skin folds into a crease. Try it.. raise your eyebrows. The lines running across your forehead are forming because you are using your forehead muscle to lift your eyebrows. When we are young, the skin bounces back as if nothing happened. As we age, the elasticity of the skin diminishes and after years of continuous muscle activity, the lines start to remain present even after you stop contracting the muscle (i.e. raising your eyebrows). This is the point when a dynamic (with movement) wrinkle moves into the realm of a static (is there even when you are not animating) wrinkle or crease. For BOTOX injections in California by facial plastic surgeon Dr. Amir Karam contact us today at 858.259.3223.


Botox has 2 basic roles in anti-aging and cosmetic surgery.


1) It treats the wrinkle by relaxing the muscle. This is the most common reason people use it. If you don’t like the lines between the eyebrows for example, then Botox will soften them. We also use it as purely as a cosmetic treatment. We can elevate the eyebrows (brow lift); elevate the corners of mouth etc.


2) To prevent line from forming in the first place. If you are a little more pro-active with your anti-aging program, you would use our La Jolla Botox treatment to prevent wrinkle formation. Think about it… if you can’t move the muscle, you can form a skin crease, and you won't form a wrinkle.

To me this is the most important benefit. Aging of the upper face, forehead, glabella (region between the eyes and eyebrows) and crows feet (laugh lines around the sides of the eyes), is the most difficult to treat once the wrinkles transition from dynamic to static. Therefore, it’s best to prevent the lines from forming in the first place.

I tell my patients, even if they did it 2x/ year, you are effectively decreasing the factors that lead to facial aging by over 50%. Because, 50% of the year, the muscles are not leading to wrinkle formation.

In fact, a study using identical twins showed this anti-aging benefit after 13 years of treatment in one twin and no treatment in the other.

Adverse Effects

largely related to misplacement. This results in an asymmetry, potential sagging eyebrow or eyelid. These potential side effects are significantly avoided when an experienced person is performing the injections. Also,


Now this brings me to the issue of duration. How long does Botox last? Typically, each treatment lasts 3-4 months. Many people wish it lasted longer. However, in my opinion, a shorter acting process is a good thing if for some reason you didn’t get a good result! If you don’t like the result… you don’t have to wait long before it goes away on its own.


This brings us to the issue of injection quality. The fact is Botox injections are not totally trivial. Believe me, though it seems straight forward in concept.. it requires a real understanding of what makes a face look attractive and better (an aesthetic sense) in addition to a sound understanding of the muscular anatomy. There is a lot of interplay between the different facial muscles and understanding how to manipulate the dosages in each patient is important to get a customized and natural result. So you must do your investigation. Price either high or low is not an indicator of a good injector either. However, at the very least good training and consistent results should be sought after.


Botox is measured by units, not cc’s or by area. The active component of Botox is what you are paying for. So when you get 25 Units of Botox injected, the dilution of the Botox is not important. Each injector uses different amounts during their standard treatment.

As a general consideration, the more you put, in the more frozen the muscles are and the longer the effects last. Many, of my patients don’t like the “frozen” look. I don’t either. So in my practice, I inject the least amount I can to get the desired effect. Remember, if you charge by the Unit, you get what you pay for. I want my patients to pay the least and get the most out of it. If you get flooded with Botox, not only will you not know what is the least amount it takes to get the desired effect, but you end up paying more than you should. My definition of the ideal amount is slight movement.. so it looks natural, but not so much movement that it causes wrinkles. This takes art and experience to strike this balance.

There are different components that you can treat in the upper face.

1. The 11’s (glabella) these are the vertical wrinkles between the eyes.

2. The crow's feet (laugh lines on the corners of the eyes)

3. The Forehead

4. The Eye Brows- An eyebrow lift is a more advanced treatment.

On average to effectively treat the entire upper face (Components 1-4) approximately 50 units of Botox is required.

Remember, Botox is not for everyone, but for those interested in treatment of wrinkles of the upper face and prevention, it is the best treatment currently available.

Dr. Karam, who is board certified by the American Board of Facial Plastic and Reconstructive Surgery and American Board of Otolaryngology, offers services in San Diego County including San Diego, Del Mar, Carlsbad, Carmel Valley, Encinitas, Rancho Bernardo and La Jolla in Southern California.

If you are ready to schedule an appointment with Dr. Karam, contact us today.

(858) 259-3223 Contact Us

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