Facial Rejuvination – By Injection Therapy

YOUR FACIAL EXPRESSIONS ARE THE VISIBLE SIGNS OF HOW YOU FEEL. Although you may seldom think about it, many of your expressions involve contraction of facial muscles. Over time, this repeated muscle action to create certain expressions may result in wrinkles, creases and deep furrows that remain visible even when your face return to a more neutral or relaxed state. These persistent wrinkles may make you look angry or anxious when you are not, and they may be among the first visible signs of facial aging. If you are bothered by the development or presence of facial wrinkles, creases and furrows that result from repeated muscle action, facial rejuvenation by injection may be right for you. Facial rejuvenation by injection is a course of treatment to relax the muscles that create unwanted expression lines in the face, thus softening wrinkles and furrows and in many cases virtually erasing these lines. The result is a smoother facial surface and a refreshed, more youthful appearance.

What is facial rejuvenation by injection?

Facial rejuvenation by injection with botulinum toxin (commonly abbreviated as BTX or called by the product name Botox®) inhibits the action of the muscles that create certain expression lines through a process called denervation. BTX is a purified therapeutic agent used for facial rejuvenation, wrinkle reduction and softening of:

  • Frown lines, the horizontal crease or vertical wrinkles that develop between the eyebrows
  • Forehead furrows, or creases that extend horizontally across the forehead
  • Crows feet, or wrinkles that develop in the outer areas around the eyes
  • Cords in the neck, called platysmal bands

In addition, botulinum toxin has also been used to soften the folds that develop in the nasolabial area (extending from the outer corner of the nose to the corner of the mouth) and to soften marionette lines (extending from the corners of the mouth down the chin). BTX can also be used for facial shaping, for example, to soften marked eyebrow asymmetry. It can also be used to denerve muscles that create irregular movements and thus an irregular appearance.

Botulinum toxin therapy for cosmetic use is approved by the U.S. Food and Drug Administration (FDA) for treatment of moderate to severe frown lines; its use in the cosmetic treatment of other areas is common, but is considered “off-label.” This means that during the course of more than 20 years of safe and effective medical use, botulinum toxin has not been reviewed and approved by the FDA for cosmetic treatment of any specific area other than frown lines.

Facial rejuvenation by injection is generally performed on adult men and women whose facial tissue and muscles are in good condition and who have realistic goals for the temporary results of botulinum toxin therapy. While BTX can achieve a noticeable improvement in your appearance, results are not permanent. Treatment usually must be repeated within 3 to 6 months to maintain results.

Botulinum toxin therapy also has non-cosmetic uses may include treatment for:

  • Eyelid or eye spasm
  • Facial or neck muscle spasm
  • Spastic muscles that result from conditions such as cerebral palsy
  • Migraine headaches
  • Excessive perspiration

Where do I begin?
A consultation with Dr. Massiha is the first step to learn how facial rejuvenation by injection can improve the appearance of frown lines and other conditions that develop as a result of muscle contraction in the face and neck. This consultation with Dr. Massiha fully educates you in a non-pressured environment, and will include:

  • A discussion of your goals and an evaluation of your individual case
  • The options available for facial rejuvenation through injection therapy
  • The likely outcomes of botulinum toxin therapy and any potential risks or complications associated with the procedure

Dr. Massiha will recommend a specific course of treatment and will answer all your questions

Dr. Massiha will review your goals for improvement and your general health in consultation prior to any facial rejuvenation therapy. The success of your procedure, safety and overall satisfaction require that you:

  • Honestly share your expectations
  • Discuss any past wrinkle reduction therapy or other facial rejuvenation procedures
  • Fully disclose health history, current medications, the use of vitamins, herbal supplements, alcohol, tobacco and drugs
  • Commit to precisely following all of Dr. Massiha’s instructions

By making the decision to consult with Dr. Massiha and following all the instructions given, you are taking an important step in helping to assure your safety.

Dr. Massiha is certified by The American Board of Plastic Surgery®. This certification designates Dr. Massiha of having specific training in plastic surgery of the face and entire body.

My facial rejuvenation by injection
Dr. Massiha will carefully observe the muscle action that creates the conditions you wish to improve by asking you to create specific expressions. Strategic points on your face and neck may be marked as guides to the appropriate injection sites for your individual muscle anatomy. The injection sites are cleansed with an antibacterial agent, and occasionally icing or a topical numbing agent may be offered for the comfort of more sensitive patients. Injection takes only a few minutes for a course of treatment. Following injection, any markings will be cleansed and icing may be offered to alleviate any temporary, minor discomfort. Make-up may be carefully re-applied so long as care is taken not to apply pressure or massage the treatment area. This could disperse the injected botulinum toxin into other areas. An improved appearance and smoothing of creases and wrinkles will appear over the next few days or up to a week, depending on individual factors.

Facial rejuvenation and wrinkle reduction by injection does not change your skin’s surface, it only relaxes the underlying muscles that cause creases and wrinkles to appear. Additional skin resurfacing treatments such as a chemical peel or microdermabrasion can further improve the appearance of surface wrinkles. Injectable fillers can fill and reduce the appearance of deeper creases and furrows that may not fully improve following treatment with botulinum toxin, as well as enhance lost fullness in the aging face. Facial rejuvenation and wrinkle reduction by injection may be recommended as an adjunct to prolong the benefits of a brow lift or facelift. The procedure may also be recommended to fully relax underlying muscles prior to these rejuvenative surgical procedures.

Preparing for facial rejuvenation by injection
Dr. Massiha will carefully explain:

  • Your course of treatment
  • The results you can expect
  • How soon you can expect those results to appear
  • How long you might expect results to last

In addition, you will be asked to sign consent forms to assure Dr. Massiha that you fully understand the procedure and effects of facial shaping by injection, and any risks and potential complications. Reported risks associated with botulinum toxin therapy include headache, nausea or flu-like symptoms, respiratory infection and eyelid or eyebrow droop. All of these are reported to be relatively uncommon and temporary in duration. Risks will be fully discussed prior to your consent. It is important that you address any questions about facial rejuvenation and wrinkle reduction therapy with botulinum toxin directly with Dr. Massiha.

What to expect
Facial rejuvenation by injection is a procedure performed in Dr. Massiha’s office. Your initial treatment will include a complete consultation. Subsequent follow-up procedures may take only a few moments; repetition of the full process of consultation is not necessary with follow-up treatment, although consent is required at each visit.

Following treatment
Once your procedure is completed, certain physical activities may be restricted for an hour or two. This precaution is necessary in order to avoid dispersing the injected agent and diluting its action in the injected muscles. You will also be reminded about:

  • When treatment is expected to take effect
  • Specific concerns to look for at the injection site or in overall health
  • When to follow up with Dr. Massiha

Note: Occasionally, initial treatment with BTX does not produce the desired relaxation of muscles. In such cases, you may need to return to the office within 7 to 14 days for an evaluation and additional therapy. Otherwise, follow-up will be required within 3 to 6 months to maintain the results of your wrinkle reduction therapy. Over time, the treated muscles may gradually weaken and you may find maintenance treatments last somewhat longer than in the past.

Because facial rejuvenation by injection is a temporary procedure, should you decide to discontinue treatment the muscles that have been treated will eventually regain full mobility. In addition, when facial muscles resume their prior activity, the creases and wrinkles associated with these muscle actions will also return.
Results and outlook
You may find yourself surprised at how such a relatively quick and non-invasive in-office procedure can produce a marked improvement in the appearance of your face and neck. But don’t be mistaken in believing that facial rejuvenation by injection is, by any means, simple.

Effective and safe BTX use requires specialized training and a thorough understanding of facial musculature. The choice to undergo botulinum toxin therapy by a plastic surgeon is one that carries the benefits of not only training in facial shaping and wrinkle reduction by injection but in all types of non-surgical and surgical facial rejuvenation.

Dr. Massiha, your choice
Choosing to have cosmetic or reconstructive plastic surgery is an important decision; so is selecting a board-certified plastic surgeon. Consider these important guidelines:

BOARD CERTIFICATION – Not all physicians who perform plastic surgery or who use the title plastic surgeon are board certified in plastic surgery.  Dr. Massiha is a certified Plastic Surgeon by the American Board of Plastic Surgery who:

  • Graduated from an accredited medical school
  • Completed a minimum of five years of surgical training following medical school, including an accredited plastic surgery residency program
  • Passed comprehensive written and oral exams

PRIVILEGES – Your surgeon should have operating privileges at an accredited, local hospital for the same procedure you plan to have performed – even if that surgeon suggests your procedure be performed in an accredited office-based surgical facility or at an ambulatory surgery center. Dr. Massiha has these credentials—A Doctor You Can Trust.

E-mail or call us today at (504) 455-9441 to schedule your consultation.


Facial rejuvenation by injection therapy smoothes the appearance of facial wrinkles and creases in areas including the forehead, brow region, around the eyes and at the temples. Treatment is also used to soften the nasolabial folds, and banding that can occur from overactive muscles in the neck.
An evaluation of your facial structure, muscle action and expressions will determine the strategic locations for injection of botulinum toxin to inhibit the action of specific muscles. Minute amounts of botulinum toxin diluted in saline are injected directly into the muscles whose action creates the conditions you wish to improve. The number of injections necessary varies based on the area to be treated, the degree of improvement sought and individual patient anatomy.
Depending on individual factors, the effects of botulinum toxin will be apparent within a few days to a week. The procedure requires no recovery period, although certain physical activities may be restricted for an hour or two immediately following treatment. There are no visible signs of treatment other than the possibility of some slight and very temporary swelling or bruising at the injection sites. These conditions may be reduced with icing.