Botox Cosmetic

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 National Education Faculty, Dr Joe Dr. NiamtuDr. Niamtu has been a Diamond Level Botox injector for the past decade.  This means he is in the top 3% of injectors in the USA.  He is the largest solo cosmetic injector of Botox in the state of Virginia and one of the largest in the Southeast.  He has been voted “Best Cosmetic Surgeon” or “Best Plastic Surgeon” 14 times.

The image below shows Dr. Niamtu and the 7,200 empty Botox vials he has injected since 1998

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.  All injections are performed by Dr. Niamtu. 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.

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?

While some offices offer sporadic discounts of Botox, please remember that our office has Botox for $11 per unit all day every day. In many offices, nurses, interns or other staff perform Botox injections. Dr. Niamtu personally performs 100% of all Botox treatments.

Uses For Botox

Frown Lines

Neuromodulators (Botox, Dysport, Xeomin) for Frown Lines

Forehead Wrinkles

Neuromodulators (Botox, Dysport, Xeomin)
for forehead wrinkles

Crow’s Feet Wrinkles

Neuromodulators (Botox, Dysport, Xeomin) for Crow’s Feet Wrinkles

If this picture looks familliar, it is Dr. Niamtu squinting before and  2 weeks after 30 units of Xeomin

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Vertical Lines

Botox for Vertical Lines (“smoker’s lines”)

Before and after photos, Botox injections for 'lipstick lines' around the mouth

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.

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“Bunny Lines”

Botox for “Bunny Lines”

Before and after photos, improvement of 'bunny lines' around the nose

“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”.

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The Lower Eyelid

Botox for the Lower Eyelid

Before and after photos, to improve muscle bulge in 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.

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The Jaw Muscles

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.


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Botox for TMJ/TMD disorders

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 migraine headaches, TMJ/TMD disorders, tooth grinding/clenching, and facial pain.   This video shows Dr. Niamtu injecting the temporalis muscles for a patient with facial pain from clenching and TMJ/TMD.

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Mouth Corners

Botox to Improve Downturned Mouth Corners

Botox injection on the corners of the mouth
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.

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Chin Dimples

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.

Neck Bands

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.

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Uneven Smile

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.

Gummy Smile

Botox, Dysport or Xeomin can be used to decrease the lip movement to lessen a gummy smile.  Some patients show excessive amount of teeth or gum when at rest or especially smiling.  These patients usually have an increased downward growth of their upper jaw called vertical maxillary excess.  The permanent treatment for this is to have an Oral & Maxillofacial surgeon move the upper jaw upwards to shorten the  jaw which results in less tooth and gum show.  This may not be practical for all patients and a quick and easy treatment is using neuromodulators in the smiling muscles to decrease their activity.  The patient shown below had a single injection of Botox on each side of the nostril.  She is shown before and 2 weeks after injection.  The effect lasts about 3 months.


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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.

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

Excess eyelid skin after Botox injection
This picture of Dr. Niamtu illustrates the situation described above. With the brow raised (left 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.

Read Dr. Niamtu‘s Blog entry: “Doctor: Botox made my eyelids droop”