Botox Cosmetic

Dysport & Xeomin

Although Botox was the first FDA approved neuromodulator in the USA, we now have Dysport and Xeomin, which are very similar products and have been used in other countries for some time.  These drugs are pretty much used interchangeably although some patients prefer a certain brand.  The method of injection, action and duration are basically the same.

Who performs the injections at our office?

In many offices, nurses, interns or other staff perform Botox injections.  Dr. Niamtu personally performs 100% of all Botox treatments.

Dr. Niamtu's Experience & Qualifications

No cosmetic doctor, in any specialty, in Richmond, Virginia uses more BOTOX® than Dr. Niamtu who is the only Diamond level Botox provider in the Greater Richmond region and one of 3 in the entire state.

Thousands of Botox vials in this "office art" are testimony to the tens of thousands of Botox injections Dr. Niamtu has performed since 1996.

Dr. Niamtu is also one of the few Virginia members of the BOTOX® Cosmetic Physicians Training Network and National Training Center. As an official training center, Dr. Niamtu trains other doctors from all over the United States, has written several scientific articles on BOTOX® Cosmetic, as well as a textbook chapter and training manual.

Dr. Niamtu is also one of 4 doctors in Virginia to be a member of the Botox National Educational Faculty. This is a prestigious group of top Botox injectors from all over the USA. This group convenes twice a year to develop and enhance Botox and filler techniques.

BOTOX® Cosmetic Injection for facial wrinkles is one of the most effective treatments in the field of cosmetic surgery. Very few treatments produce such impressive results with no healing time required. BOTOX® Cosmetic is a muscle weakener that is derived from bacteria that have been purified for use in humans. BOTOX® Cosmetic is used to treat "frown lines" which are sometimes called "scowl lines" or "worry lines". These are the lines seen between the eyes and on the bridge of the nose. In addition, BOTOX® Cosmetic injections are used for "crow's feet" wrinkles and forehead wrinkles. BOTOX® Cosmetic also can be used for the bands that develop underneath the chin and extend to the neck. Botox Cosmetic is also used by Dr. Niamtu to treat migraine headaches, bruxism (tooth grinding) and some facial pain syndromes.

The injections are performed in the office with an ultra fine needle and the number of injections required varies with the degree of wrinkling. Many patients receive BOTOX® Cosmetic injections on their lunch hour and return to work. Botox is truly a lunchtime procedure. The effects of BOTOX® Cosmetic begin between 24-72 hours and the effect lasts an average of 3 months. There is some evidence that after several repeated injections, the effects last longer. We frequently have our chemical peel, brow lift and laser patients use BOTOX® Cosmetic on their wrinkles several weeks before their surgery. This causes a smoothing of the areas to be treated with the peel or laser and requires less laser tissue removal. In addition, the muscles will be inactive and make healing easier and more comfortable.

Dr. Niamtu was featured in the Richmond Times-Dispatch for his work with BOTOX® Cosmetic.

Dr. Niamtu has a personal relationship with Drs. Jean and Alistair Carruthers, the pioneers of BOTOX® Cosmetic for cosmetic use in humans. Dr. Niamtu and the Carruthers are involved in several ongoing projects. Dr. Niamtu was invited to speak at the Carruthers' international cosmetic surgery meeting in Vancouver, British Columbia in May of 2000 and has written chapters in their textbooks on two occasions.

Dr. Alastair (left), Dr. Niamtu (center) and Jean Carruthers (right), the pioneers of BOTOX® Cosmetic for cosmetic use in humans.

Dr. Bill Binder is the inventor of the "Binder Submalar Cheek Implant", one of the most commonly used facial implants in the world. On the left is Dr. Andy Blitzer who along with Dr. Binder did the world renowned research on Botox and Migraine Headaches. These colleagues of Dr. Niamtu are shown at the 2006 BOTOX® Instructors Conference (Allergan National Education Faculty) which gathers the international BOTOX® experts each year.

Click on the Mona Lisa icon on this page to view before and after pictures

Botox for Vertical Lines ("smoker's lines")

BOTOX® Cosmetic can make a difference with "lipstick lines" Very small amounts of BOTOX® Cosmetic are injected in the lips and can decrease some of the wrinkling seen in this region. Although BOTOX® Cosmetic can improve these lines, alternate procedures such as Restylane injection or laser resurfacing can make a more dramatic difference.

Botox for "Bunny Lines"

"Bunny lines" describe the wrinkles that some patients have on the side of their nose when smiling. This images show patients before and after BOTOX® Cosmetic injection for "bunny lines".

Botox for the Lower Eyelid

BOTOX® Cosmetic can be used to improve muscle bulges in the lower eyelid. This patient complained of bulges on the lower eyelid when he smiles or squints. The BOTOX® Cosmetic decreased the size of these muscle budges.

Botox for the Jaw Muscles (Masseter Muscles)

BOTOX® Cosmetic to slim the face: Some patients have very active jaw muscles that give their face a very square shape. These are called the masseter muscles and are the main muscles used for chewing and biting. Injecting BOTOX® Cosmetic in these muscles can reduce their size and give a square face a much more tapered or oval appearance. In addition, many patients grind their teeth and this also can cause increase in the size of the masseter muscle as well as pain, tenderness and TMJ problems. Dr. Niamtu uses BOTOX® Cosmetic to assist in the treatment of TMJ, tooth grinding and facial pain. Weight lifters and body builders may also over develop this muscle and may seek cosmetic slimming of their face with BOTOX® Cosmetic.

Botox to Improve Downturned Mouth Corners

BOTOX® can also be injected in the muscles that turn down the corner of the mouth. By weakening these muscles it is possible to turn up the corner of the mouth. Dr. Niamtu frequently uses this technique with filler injection for lip enhancement and wrinkles.

Botox for Chin Dimples (Mentalis Muscle)

The mentalis muscle is located on the front of the chin and in some patients produces wrinkles and dimpling during talking, smiling and eating.  Several small Botox or Dysport injections are very effective in smoothing the dimples.

Botox for Neck Bands

Aging causes bands in the neck.  Although facelift and necklift is the most effective treatment, these bands can be temporarily improved with Botox or Dysport injections.

Botox for Brow Lifting

Botox or Dysport can be used to produce a small amount of brow lift.  Despite what some doctors claim, Botox will not lift the brow as dramatically as a surgical brow lift.  It can, however, produced a noticeable lifting of the brows.  By relaxing the muscles that pull the brow down, the brow lifting muscles are unopposed and produce a lifting effect.

Botox for Uneven Smile from Nerve Injury

Some patients have crooked smiles from birth or nerve injuries.  By using Botox, Dysport or Xeomin to treat the active side, the smile can be improved.  The patient below is shown before and 5 days after injection of 5 units of Botox to the right depressor anguli oris muscle.

Botox/Dysport/Xeomin, Brow Position & Apparent Eyelid Skin

This picture of Dr. Niamtu illustrates the situation described below. With the brow raised (top picture) they eyelids appear to have less skin, but with the brows totally relaxed, the skin excess is much more noticeable.  This same situation can occur in patients with excess eyelid skin that receive Botox or Dysport.

When the forehead is treated with Botox/Dysport/Xeomin it can, in some cases, affect the ability to raise the eyebrows. For some patients this is a good thing as it limits forehead wrinkles. For other patients it is a problem. Many female patients subconsciously raise their eyebrows most of their waking hours. If they have excess eyelid skin from the normal aging process, raising the brows gives the appearance of less skin. If the patient cannot raise their brows as much after a Botox/Dysport treatment, the patient may look like they have increased eyelid skin. In reality, they have no more eyelid skin than before the injections, the skin is more noticeable because the brow does not raise as much. Although this is relatively uncommon, it can occur, especially in females from the mid 40's and older. Initially, this effect may seem profound, especially when attempting to apply eye makeup but this feeling generally wears off in several weeks. If you do not understand the possibility of this occurring, please discuss it with Dr. Niamtu before your treatment.

For patients that may be susceptible to this situation, the Botox/Dysport is injected primarily in the center of the forehead so the patient can maintain their normal brow elevation.

Dr. Niamtu on CBS discussing bogus Botox

Dr. Niamtu has published a 1,000 page comprehensive textbook on cosmetic facial surgery which includes a large chapter on his Botox and Dysport techniques.  Few surgeons receive the honor to publish such a text with a major medical publisher like Elsevier.

Dr. Niamtu and Botox/Dysport Education

Dr. Niamtu is very involved in publishing and teaching Botox and Dysport techniques to other doctors.  The following are some of the articles Dr. Niamtu has published on Botox and other neuromodulators.

• Niamtu J: Neurotoxins (in) Cosmetic facial surgery, St. Louis, 2011, Mosby Elsevier

• Niamtu J. Injectable Fillers (in) Cosmetic facial surgery, St. Louis, 2011, Mosby Elsevier

• Niamtu, J Neurotoxin Treatment: it ain't what it used to be Cosmet Dermatol 2010;23(8):346-47

• Niamtu, J Cosmetic Surgery In: Andersson L, Kahnberg KE, Pogres MA (eds) Oral and Maxillofacial Surgery. Chichester: Wiley-Blackwell, 2010, 1149-1172

• Niamtu J. Complications in fillers and botox. In:Oral Maxillofac Surg Clin North Am. Ed Niamtu J. Philadelphia, Elsevier 2009 Feb;21(1):13-21

• Niamtu, J Minimally Invasive Options in Cosmetic Oral and Maxillofacial Surgery  AAOMS Surgical Update 2008;21:1-7

• Niamtu J. Botox injections for gummy smiles. Am J Orthod Dentofacial Orthop. 2008 Jun;133(6):782-3; author reply 783-4.

• Niamtu, J Botox and TMD Treatment  Cosmet Dermatol 2008;21(6):328

• Niamtu J. More on Botox treatment. Am J Orthod Dentofacial Orthop. 2005 Jun;127(6):645-6.

• Niamtu J. The Cosmetic Use of Botox in Maxillofacial Surgery Selected Readings in Oral and Maxillofacial Surgery 2004, Volume 12, Number 2, April. Pg1-22

• Niamtu J. Botulinum Toxin A: A review of 1,085 Oral and Maxillofacial Patient Treatments J Oral Maxillofac Surg 61:317-324, 2003

• Niamtu, J Cosmetic oral and maxillofacial surgery: the frame for cosmetic dentistry. Dent Today. 2001 Apr;20(4):88-91.

• Niamtu, J Cosmetic Oral and Maxillofacial Surgery Dentistry (United Kingdom) Vol 2 (17) September, 2001 Pg 22-26

• Niamtu, J The use of botulinum toxin in cosmetic facial surgery (In) Cosmetic Facial Surgery Oral and Maxillofacial Surgery Clinics of North America W.B. Saunders, Philadelphia 2000, Nov;12(4):596-612

• Niamtu, J Cosmetic Surgery Options in Oral and Maxillofacial J Am Dent Assoc. 2000 Jun;131(6):756-64.

• Niamtu, J Cosmetic Oral and Maxillofacial Surgery Virginia Dental Journal Volume 77, Number 2 April 2000

• Niamtu, J Aesthetic Uses of Botulinum Toxin A Oral Maxillofac Surg. 1999 Oct;57(10):1228-33

• Niamtu, J "Botox Treatment of Facial wrinkles" Part I Practical Reviews in Oral and Maxillofacial Surgery  May 1998

• Niamtu, J "Botox Treatment of Facial wrinkles" Part II Practical Reviews in Oral and Maxillofacial Surgery  June 1998

Dr. Niamtu has taught Botox/Dysport techniques in Australia, Canada, South Africa, Romania, Italy and Hawaii as well as all over the USA.