The Original Neuromodulator
What Botox Is
Botox is the brand name of onabotulinumtoxinA, a purified botulinum toxin type A that blocks acetylcholine release so the treated muscle contracts less and the line it creases softens; it was the first neuromodulator FDA-approved for an aesthetic use, with approvals now covering frown lines, crow’s feet, forehead lines, and platysma bands. At Aesthetica by Ashley Howarth MD it takes effect in 3 to 5 days and lasts 3 to 4 months, and it is injected by Dr. Howarth or by an advanced aesthetic nurse injector under her direction.
Botox is the brand name of onabotulinumtoxinA, a purified botulinum toxin type A made by Allergan Aesthetics, an AbbVie company. Injected in small doses into a specific muscle, it blocks the release of acetylcholine at the nerve ending so the muscle contracts less, and the line that muscle creases into the skin softens. Botox Cosmetic was the first neuromodulator the FDA approved for an aesthetic use, for glabellar frown lines in 2002, followed by crow’s feet in 2013, forehead lines in 2017, and vertical platysma bands of the neck in October 2024. It is also used off-label, with a patient’s informed consent, for the masseter, a lip flip, chin dimpling, bunny lines, and a modest brow lift. At Aesthetica by Ashley Howarth MD, the med spa of Howarth Plastic Surgery in Scottsdale, Botox takes effect in 3 to 5 days, reaches full effect at 10 to 14 days, and lasts 3 to 4 months, so most patients return three to four times a year. It is one of three neuromodulators the practice offers alongside Dysport and Daxxify, and the assessment decides which one fits.
What separates one Botox treatment from another is not the vial but the plan. The label dose for the glabella is 20 units across five points in the corrugator and procerus muscles, yet the right dose for a given brow depends on muscle bulk, brow position, asymmetry, and how much movement the patient wants to keep. A heavy brow treated with a full forehead dose drops; a thin frontalis treated lightly holds. The practice therefore doses by anatomy and by the previous visit’s photographs, not by a template, and revisits the plan at a two-week check. Botox treats expression lines. It does not fill volume loss, lift skin that has lost its elasticity, or resurface sun damage; those belong to dermal fillers, facial surgery, and physician-performed laser skin resurfacing, and the injectables overview explains how they are combined.
Why Patients Ask for Botox
What Patients Who Choose Botox Notice
Most people who ask Aesthetica by Ashley Howarth MD about Botox describe an expression rather than a wrinkle. They look angry in a meeting when they are only concentrating, tired in a photograph taken at noon, or older than they feel in the rearview mirror at a stoplight. The lines they point to are the ones their muscles make hundreds of times a day. These are the findings the team hears most.
- Two vertical lines between the brows that stay after the frown is gone
- Horizontal forehead lines that deepen every time the brows lift
- Fan-shaped creases at the outer eyes when smiling
- A jaw that aches from clenching, with widening at the angle
- Vertical bands in the neck that show when speaking or straining
- A gummy smile or a chin that dimples like an orange peel
Dynamic lines, the ones that appear with movement and fade at rest, are the problem Botox solves best. Lines that have etched into the skin at rest respond partly, and the remainder is a job for resurfacing or filler. The honest assessment separates the two before anyone is treated.
Surgeon-Directed Care
More Tools in the Toolbox: Why a Plastic Surgeon Directs Botox
Aesthetica by Ashley Howarth MD is the medical aesthetics practice of Ashley Howarth, MD, FACS, a board-certified plastic surgeon and instructor in plastic surgery at Mayo Clinic. The judgment a plastic surgeon adds to Botox begins with anatomy she operates on. The frontalis is the only muscle that lifts the brow; the corrugators, procerus, and orbicularis pull it down; and the balance between them decides whether a forehead treatment leaves a patient looking rested or heavy-lidded. A surgeon who performs brow lifts and blepharoplasty reads that balance on sight, knows which patient has a low brow being held up by a working frontalis, and doses accordingly. She also knows the levator that lifts the eyelid and how far a glabellar injection must stay from it. At Aesthetica by Ashley Howarth MD, Botox is injected by Dr. Howarth or by an advanced aesthetic nurse injector under her direction and protocols, with every dose and point recorded and a two-week check built into the plan.
The second judgment is the honest one about when Botox is the wrong tool. Etched lines at rest are a job for physician-performed laser skin resurfacing. Hollow temples and flattened cheeks are a job for filler or fat transfer. A heavy brow with hooded upper lids, jowls, or a loose neck is a job for a brow lift, blepharoplasty, facelift, or neck lift, and no amount of neuromodulator substitutes for it. Because the same physician evaluates all of these, the plan is not limited to the vial in the room. The practice offers Dysport and Daxxify alongside Botox, chooses between them for onset and duration, and manages any complication on site. More tools in the toolbox, and an honest answer about which one you need.
SCOTTSDALE · MODERN OFFICE SETTING
Where to Start
Who Botox Is For, and What Happens First
Botox at Aesthetica by Ashley Howarth MD is for adults with lines of expression on the upper face, a clenched or widened jaw, or platysma bands of the neck who want a softer, rested version of their own face rather than a still one. It suits first-time patients in their late twenties and thirties who want to slow the etching of lines, and patients in their forties to seventies who want expression lines managed alongside volume replacement or surgery. The assessment is the first step. The injector watches you frown, raise your brows, squint, smile, and clench, photographs each expression, notes asymmetry, brow position, and eyelid heaviness, and checks for a history of neuromuscular disease, pregnancy, breastfeeding, and prior reactions to any botulinum toxin. Sun-weathered Arizona skin with lines etched at rest is told plainly what Botox will and will not do, and where resurfacing or a brow lift or blepharoplasty is the better answer. Patients who want the fastest onset are offered Dysport; patients who want the longest interval between visits are offered Daxxify.
Dr. Ashley Howarth, MD, FACS is a board-certified plastic surgeon and an instructor in plastic surgery at Mayo Clinic. Aesthetica by Ashley Howarth MD is the medical aesthetics brand of her practice, Howarth Plastic Surgery, at 7373 N. Scottsdale Road, Suite C150, Scottsdale, Arizona 85253.
One Molecule, Many Muscles
How Botox Is Used in Scottsdale
Frown Lines, Forehead Lines, and Crow's Feet
The three on-label upper-face areas, glabellar frown lines, forehead lines, and crow’s feet, use label doses around 20 units for the glabella and forehead and about 12 units per side for crow’s feet, adjusted to each patient’s muscle bulk and brow height.
The three on-label upper-face areas are where most Botox is used. For glabellar frown lines the label dose is 20 units across five points in the corrugator and procerus muscles; the 2002 pivotal trial in the Journal of the American Academy of Dermatology found that dose reduced line severity at every follow-up visit through day 120. Forehead lines are treated with about 20 units across the frontalis, always together with the glabella so the brow does not drop, and crow’s feet with about 12 units per side in the orbicularis oculi. The practice adjusts each of these to muscle bulk, brow height, and the amount of movement the patient wants to keep, and photographs at maximum expression before and at two weeks.
Platysma Bands and the Lower Face
Since October 2024 Botox is FDA-approved for vertical platysma bands in the neck, and off-label it is also used for jaw slimming at the masseter, a lip flip, and a dimpled chin.
In October 2024 the FDA approved Botox Cosmetic for moderate to severe vertical platysma bands, the cords that stand out in the neck when speaking or straining. In the phase 3 trial, 26 to 36 units placed superficially along the bands improved band severity and jawline appearance at day 14 with no reports of swallowing difficulty. Botox in the lower face is also used off-label with informed consent: 20 to 30 units per masseter for clenching and jaw slimming, with the contour change arriving over 4 to 8 weeks; 4 to 6 units at the lip border for a lip flip; and 4 to 8 units in the mentalis for a dimpled chin. When neck bands are accompanied by loose skin and fat under the chin, the assessment discusses a neck lift instead.
Preventive Botox and Long-Term Planning
Starting Botox early can be worthwhile because lines etch where a muscle folds the skin repeatedly, so the practice treats patients in their late twenties and thirties conservatively, with lower doses and longer intervals.
Younger patients ask whether starting early prevents lines. Lines etch where a muscle folds the skin thousands of times, so reducing the fold reduces the etching; the practice treats patients in their late twenties and thirties conservatively, with lower doses and longer intervals, and only where a line is beginning to hold at rest. Regular treatment every 3 to 4 months keeps the result continuous, and many long-term patients find they need fewer units over time as the muscle stays quieter. Sun protection matters as much as the injection in Arizona: the Skin in Arizona guide explains why, and HydraFacial and SkinPen address the texture that Botox does not.
When Dysport or Daxxify Is the Better Choice
Dysport works faster and spreads more for broad areas, Daxxify lasts a median of 24 weeks for patients who want fewer visits, and Botox offers the longest safety record and the most approved areas.
Aesthetica by Ashley Howarth MD offers all three FDA-approved aesthetic neuromodulators that differ from one another in a way a patient can feel. Dysport (abobotulinumtoxinA) has an onset most patients notice in 2 to 3 days with full effect around day 7, uses a different unit scale of roughly 2.5 to 3 units per Botox unit, and spreads slightly more, which suits broad areas such as the forehead. Daxxify (daxibotulinumtoxinA-lanm) is stabilized with a peptide instead of human serum albumin and lasted a median of 24 weeks in its phase 3 glabellar trials, so it suits patients who want two visits a year rather than four. Botox has the longest safety record, four aesthetic approvals, and the most predictable dosing across the most areas. The assessment, not the brand, decides.
At a Glance
Botox at a Glance
Areas treated with Botox at Aesthetica by Ashley Howarth MD, what each treatment softens, typical units, onset and duration, and whether the use is on the FDA label; individual doses are set at the assessment.
| Area | What it softens | Typical units | Onset and duration | On-label |
|---|---|---|---|---|
| Glabella (frown lines) | Vertical lines between the brows from the corrugator and procerus | 20 (label dose), adjusted to muscle bulk | 3 to 5 days; full at 10 to 14 days; 3 to 4 months | Yes, since 2002 |
| Forehead lines | Horizontal lines from the frontalis, treated with the glabella | About 20, reduced for a low brow | 3 to 5 days; full at 10 to 14 days; 3 to 4 months | Yes, since 2017 |
| Crow's feet | Fan-shaped lines at the outer eyes from the orbicularis oculi | About 12 per side | 3 to 5 days; full at 10 to 14 days; 3 to 4 months | Yes, since 2013 |
| Platysma bands | Vertical neck cords that show with speech or strain | 26 to 36 total, placed superficially along the bands | About 2 weeks; 3 to 4 months | Yes, since October 2024 |
| Masseter | Clenching, grinding, and a widened lower face | 20 to 30 per side | Clenching eases in about 2 weeks; slimming over 4 to 8 weeks; 4 to 6 months | No, off-label with consent |
| Lip flip and chin | A tucked upper lip or a dimpled chin | 4 to 6 lip; 4 to 8 chin | 3 to 5 days; 2 to 3 months for the lip | No, off-label with consent |
Three Neuromodulators
Botox vs Dysport vs Daxxify
How the three neuromodulators offered at Aesthetica by Ashley Howarth MD compare, using FDA labels and published trials; the Dysport and Daxxify pages cover each in full.
| Botox | Dysport | Daxxify | |
|---|---|---|---|
| Molecule | OnabotulinumtoxinA (Allergan Aesthetics, AbbVie) | AbobotulinumtoxinA (Galderma) | DaxibotulinumtoxinA-lanm (Revance), peptide-stabilized |
| FDA cosmetic approvals | Glabellar lines 2002, crow's feet 2013, forehead lines 2017, platysma bands 2024 | Glabellar lines 2009 | Glabellar lines 2022 |
| Onset | 3 to 5 days; full at 10 to 14 days | Often 2 to 3 days; full around day 7 | As early as day 1 and typically within 2 days per Revance; full at about 2 weeks |
| Duration | 3 to 4 months | 3 to 4 months, up to 5 on the label | Median 24 weeks in the SAKURA trials; varies by patient |
| Unit scale | Reference scale; 20 units for the glabella | Roughly 2.5 to 3 units per Botox unit; 50 units for the glabella | Its own scale; 40 units for the glabella |
| Best used when | Most areas, the longest record, predictable dosing in small or bulky muscles | A fast onset before an event or a broad area such as the forehead | A patient wants two visits a year and accepts a newer product with less long-term data |
A Visit Built Around Your Expressions
What to Expect at a Botox Visit at Aesthetica by Ashley Howarth MD
A Botox visit at Aesthetica by Ashley Howarth MD has three parts: an examination of how your face moves, the injections themselves, and a written plan for the next two weeks and the next four months. First visits take about 30 to 45 minutes; maintenance visits about 15 to 20.
Your expressions photographed and your muscles mapped
The injector watches you frown, lift, squint, smile, and clench, photographs each expression, marks the injection points, and records asymmetry, brow position, eyelid heaviness, medical history, and prior neuromodulator response. The dose per area is set from this map and from your previous visit, never from a template.
Small injections with a fine needle, about ten minutes
The skin is cleansed and cooled. Botox is injected with an insulin-gauge needle into each marked point, a quick pinch at each one, in about ten minutes for the upper face. No numbing is needed. Small bumps at each site settle within 20 to 30 minutes, and you can drive yourself home.
Aftercare in writing and a two-week check
You leave with instructions to stay upright for 4 hours, avoid rubbing the areas and strenuous exercise or heat for 24 hours, and expect softening at 3 to 5 days and the full result at 10 to 14 days. A two-week check is offered for any asymmetry, and the next visit is set about 3 to 4 months out.
Clear Information. Informed Choices.
Safety and Limitations of Botox
Botox has more than twenty years of aesthetic use and a well-defined side effect profile. Most effects are local and brief. The one patients worry about most, a heavy or drooping eyelid, occurred in about 5 percent of treated patients in the original 2002 glabellar trial, mostly mild, and is far less common with careful placement away from the levator muscle; when it happens it resolves over weeks. The one that matters most is dose and placement in the wrong hands: a forehead treated without the glabella drops the brow, and an over-treated lower face changes the smile. Botox carries the same boxed warning as every botulinum toxin product about distant spread of toxin effect, which has not been reported at the doses used for facial lines. At Aesthetica by Ashley Howarth MD, injections follow a surgeon’s protocols, the practice keeps a record of every dose and point, and patients with neuromuscular disorders, pregnancy, or prior reactions are not treated.
Possible Side Effects Include
- Small bumps, pinpoint bleeding, or a bruise at an injection site
- Headache in the first day or two
- Heaviness of the brow or, less often, an eyelid droop that resolves over weeks
- Temporary asymmetry corrected at the two-week check
- Rarely, flu-like symptoms, dry eye, or an altered smile after lower-face treatment
What Treatment Cannot Guarantee
- Removal of lines already etched into the skin at rest
- Any change to volume loss, jowls, or loose skin
- A result that lasts beyond about 3 to 4 months
- Identical results in a patient who has developed a weaker response
- A substitute for a brow lift, blepharoplasty, or facelift
What Happens After Botox
Recovery After Botox
Recovery from Botox is measured in hours, and the result is measured in days. There is no wound and no downtime: patients return to work from the visit, and the only real restrictions are the first four hours upright and the first day without rubbing, heavy exercise, or heat. What patients wait for is the onset, which for Botox begins at about day 3 to 5 and is complete at day 10 to 14. When filler is planned as well, the practice usually schedules it at the same visit or the following one; when SkinPen or a laser is planned, that treatment is separated by about two weeks.
Each injection point shows a small raised bump that flattens in 20 to 30 minutes. Stay upright for 4 hours, leave the areas alone, and skip the gym, hot yoga, and the sauna until tomorrow. Makeup can go on after the bumps settle. A bruise, if one forms, is small and covers easily. There is no change to your expressions yet.
The treated muscles begin to feel slower. The frown is harder to make, the forehead lines fade with movement, and crow’s feet soften on smiling. A mild headache in the first day or two is the most common side effect and responds to acetaminophen. Onset can be a day or two faster in a small muscle and slower in a bulky masseter.
Botox reaches its full effect by about two weeks. This is when photographs are compared with the pre-treatment set and when any asymmetry, a brow that lifts more on one side or a line that still shows, is adjusted at a brief follow-up. Masseter and platysma results continue to build for several more weeks as the muscle softens.
Movement returns gradually from about month three, and the line returns more slowly than the movement does. Most patients rebook at 3 to 4 months, before the full frown is back, which keeps the result continuous and often reduces the dose needed over time. Daily mineral sunscreen protects the skin between visits; the Skin in Arizona guide explains why that matters more here than elsewhere.
Before & After
Botox, Before and After Treatment
Botox results are best judged in photographs taken at maximum expression before treatment and again at two weeks, when the full effect is in. Aesthetica by Ashley Howarth MD maintains before-and-after galleries for Botox, Dysport, Daxxify, and dermal fillers, and during your visit the team can show you cases that match your concern, whether it is frown and forehead lines, a clenched jaw, or neck bands, and your age.
Patient Case Summaries
Selected Botox Case Summaries
These deidentified case summaries illustrate how Dr. Howarth and the injectors working under her direction at Aesthetica by Ashley Howarth MD plan Botox treatment in Scottsdale. They include a first-time patient, a long-term maintenance patient, a man treated for jaw clenching, a patient moved to a different neuromodulator, a patient who arrived with a drooping eyelid from treatment elsewhere, and a patient for whom Botox was the wrong answer. Each summary connects the patient’s concern and assessment with the treatment performed or the recommendation made.
Case 01
First-time patient
A first Botox treatment planned conservatively around a low-set brow
Patient presentation
A woman in her thirties, new to neuromodulators, asked for Botox to the forehead because the horizontal lines showed in every photograph, and mentioned she did not want to look surprised or frozen.
Skin assessment
At rest her brows sat low with slight hooding of the upper lids, and her frontalis was working hard to hold them up. Her glabellar lines were moderate at maximum frown. A full forehead dose alone would have dropped the brow onto the lids.
Procedure performed
Botox 20 units to the glabella and a reduced dose of 8 units in the upper frontalis only, sparing the lower forehead, with photographs at maximum expression and a two-week check.
Clinical rationale
In a patient whose frontalis is compensating for a low brow, treating the depressors fully and the lifter lightly softens the lines without lowering the brow; the two-week check confirms the balance before any more is added.
Follow-up
At two weeks the forehead lines were softer and the brow position unchanged; she returns every four months and has kept the same conservative dose.
Case 02
Maintenance patient
Ten years of Botox with a shrinking dose and a plan that added resurfacing
Patient presentation
A woman in her fifties who had received Botox every three to four months for a decade asked whether her lines were becoming resistant, since the vertical glabellar lines were now visible at rest.
Skin assessment
Her muscles responded fully at maximum frown, so there was no loss of response; the lines at rest were etched creases in sun-weathered Fitzpatrick II skin after decades in Arizona, which no neuromodulator addresses.
Recommendation
Continue Botox at a slightly lower dose, since the muscles had quieted over the years, and add physician-performed laser skin resurfacing of the glabella and forehead during laser season to smooth the etched component.
Clinical rationale
Botox controls the movement that makes a line; it cannot erase a crease already etched into the dermis. Separating the two components gives an honest answer and the right tool for each.
Follow-up
Resurfacing was performed in November; at four months the resting lines were markedly softer and she continues maintenance Botox at the reduced dose.
Case 03
Masseter clenching
A man with jaw pain and a widened jawline treated off-label in the masseters
Patient presentation
A man in his forties reported morning jaw aching, a night guard he rarely wore, and a jawline that had grown wider and squarer over several years.
Skin assessment
Both masseters were bulky and firm on clenching, the widening was muscular rather than bony, and his dentist had documented bruxism. He had no neuromuscular history. Masseter treatment is an off-label use, which he understood and consented to.
Procedure performed
Botox 25 units into each masseter at three points, with a plan to reassess at six weeks and repeat at about four months.
Clinical rationale
Reducing masseter contraction relieves clenching within about two weeks and slims the muscle over 4 to 8 weeks; Botox was chosen over Dysport for the predictable dosing in a bulky muscle where diffusion toward the smile muscles is undesirable.
Follow-up
His morning aching resolved within three weeks and the jawline narrowed by six weeks; he now repeats every five months and wears his night guard.
Case 04
Switched for duration
A patient who wanted fewer visits and was moved from Botox to Daxxify
Patient presentation
A woman in her forties who traveled for work and often missed her four-month Botox visit asked whether anything lasted longer, because her frown lines were back for weeks before she could get in.
Skin assessment
Her glabellar lines responded well to Botox 20 units each cycle, and the problem was scheduling rather than response. She had no prior reaction to any botulinum toxin product.
Procedure performed
Daxxify 40 units to the glabella in place of Botox, with the forehead and crow’s feet left on Botox at the same visit and a two-week check.
Clinical rationale
Daxxify lasted a median of 24 weeks in its phase 3 glabellar trials, roughly six months against Botox’s three to four, so for a patient whose difficulty is the interval it offers two glabellar visits a year; the other areas stayed on the product with the longest record.
Follow-up
Her frown lines held for about five and a half months; she now has Daxxify to the glabella twice a year and Botox to the rest of the upper face when her schedule allows.
Case 05
Complication elsewhere
A drooping eyelid after treatment at another clinic, managed and then re-planned
Patient presentation
A woman in her thirties arrived ten days after a glabellar treatment elsewhere with a heavy right upper eyelid that narrowed her eye, and asked whether it could be fixed and whether she should ever have Botox again.
Skin assessment
The assessment found ptosis of the right upper lid consistent with spread of toxin to the levator muscle, with a normal pupil and full eye movement. She had been treated with an unrecorded dose at points low over the orbital rim.
Recommendation
Apraclonidine eye drops to lift the lid in the interim, reassurance that the droop would resolve as the toxin wore off over several weeks, and a future glabellar plan with points kept above the orbital rim and away from the levator, with every dose and point recorded.
Clinical rationale
Eyelid ptosis is a placement complication, not an allergy; a physician-led practice can diagnose it, treat it, and correct the technique rather than abandon a treatment that works.
Follow-up
Her lid recovered fully by week six; she returned for a conservative glabellar treatment three months later with no recurrence.
Case 06
Not this treatment
Neck bands with loose skin, and why the honest answer was a neck lift
Patient presentation
A woman in her sixties asked for Botox to the platysma bands after reading about the 2024 approval, hoping to sharpen a jawline that had softened over the past decade.
Skin assessment
She had prominent vertical bands, but also loose skin under the chin, descended fat, and early jowls. Platysma Botox reduces the bands; it does not remove skin or fat, and in a neck like hers the result would have been a small change for a recurring cost in units.
Recommendation
A surgical consultation with Dr. Howarth for a neck lift, with Botox to the glabella and crow’s feet continued, and platysma Botox offered only as a maintenance option after surgery if bands recurred.
Clinical rationale
The right tool for skin and fat is surgery; a plastic surgeon’s practice can say so and perform it, rather than treating the only part of the problem a neuromodulator reaches.
Follow-up
She underwent a neck lift the following spring and continues upper-face Botox; at one year she has not needed platysma treatment.
From First Visit to a Plan You Can Keep
Booking, Planning, and Follow-Up at Aesthetica by Ashley Howarth MD
Aesthetica by Ashley Howarth MD is a medical practice with a spa’s convenience. Established patients book online. New patients can book online or request a consultation, and the team responds usually the same day.
Online booking or a consultation request
Book a Botox assessment directly online, or request a consultation and describe the lines or the clenching you notice and whether you have had a neuromodulator before. Either path starts with the same examination of how your face moves.
A dose map, not a menu
Maintenance every 3 to 4 months, year-round
Botox is not seasonal, so most Scottsdale patients settle into three or four visits a year with a two-week check after any change in plan. Patients who use Allē rewards can track their treatments there. A-List members have the next visit scheduled before they leave the last one.
Your Questions, Answered
Botox Frequently Asked Questions
Botox is onabotulinumtoxinA, a purified botulinum toxin type A. Injected into a specific muscle, it blocks the release of acetylcholine at the nerve ending, so the muscle contracts less and the line it folds into the skin softens. The effect is local to the injected muscle and temporary: nerve endings recover over about 3 to 4 months and movement returns. It does not affect sensation or fill volume.
Not when the dose matches the muscle. A frozen look comes from treating the frontalis fully in a patient who needs it to hold the brow up, or from treating every area at a maximum dose. At Aesthetica by Ashley Howarth MD the injector maps your expressions first, doses each muscle for softening rather than stillness, and adjusts at a two-week check. Most patients look rested and still fully expressive.
Botox begins to work in about 3 to 5 days, when the treated muscles feel slower and the lines soften with movement, and reaches its full effect at 10 to 14 days. Photographs are compared at two weeks, which is also when any asymmetry is corrected. Masseter and platysma results keep building for several weeks after that. Dysport tends to start a day or two sooner.
Botox lasts about 3 to 4 months in the upper face for most patients, sometimes longer in a small muscle and shorter in a large or very active one such as the masseter. Movement returns gradually from about month three and the line returns more slowly than the movement. Regular treatment before the full frown is back keeps results continuous, and many long-term patients need fewer units over time.
Yes. Botox injected into the masseter muscles, an off-label use, reduces clenching and grinding within about two weeks and slims a widened jawline over 4 to 8 weeks as the muscle softens. Typical dosing at Aesthetica by Ashley Howarth MD is 20 to 30 units per side, repeated about every 4 to 6 months. It complements a night guard rather than replacing dental care for bruxism.
Botox Cosmetic is FDA-approved for glabellar frown lines, crow’s feet, forehead lines, and vertical platysma bands of the neck. It is also used off-label, with informed consent, for the masseter, a lip flip, chin dimpling, bunny lines, a gummy smile, and a modest brow lift. It does not treat volume loss, loose skin, or lines etched at rest, which belong to fillers, surgery, or resurfacing.
No. Small bumps at each injection point flatten within 20 to 30 minutes, and most patients return to work from the visit. The only restrictions are staying upright for 4 hours and avoiding rubbing, strenuous exercise, and heat for 24 hours. A small bruise is possible and covers with makeup. There is nothing to see in the treated areas by the next morning.
Botox at Aesthetica by Ashley Howarth MD is injected by Dr. Ashley Howarth, MD, FACS, a board-certified plastic surgeon and instructor in plastic surgery at Mayo Clinic, or by an advanced aesthetic nurse injector working under her direction and protocols. Every dose and injection point is recorded, a two-week check is built into the plan, and any complication is managed on site by a physician.
All three are botulinum toxin type A products that relax muscles the same way. Botox has four aesthetic FDA approvals, onset in 3 to 5 days, and lasts 3 to 4 months. Dysport starts in about 2 to 3 days, uses roughly 2.5 to 3 units per Botox unit, and spreads slightly more. Daxxify is peptide-stabilized and lasted a median of 24 weeks in its trials. Aesthetica by Ashley Howarth MD offers all three.
Sun does not shorten the muscle effect of Botox, which depends on nerve recovery over 3 to 4 months. What Arizona sun does is etch lines faster in the skin between treatments, so a patient with about 300 days of sun a year who skips sunscreen will see resting lines return sooner than the movement does. Daily mineral SPF 30 or higher and a hat protect the result; the Skin in Arizona guide explains why.
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