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for Eyelid and Facial Plastic Surgery

Dr. Kevin Perman


Phone (301) 571-0000
6420 Rockledge Drive, Suite 4300 | Bethesda MD 20817


Botox, Xeomin and Dysport are classified as neurotoxins. They offer temporary wrinkle relief most efficiently in the upper third of the face (forehead, eyebrows and eyelids) for upwards of 3-5 months. In the greater Washingtion D.C. Virginia, Maryland area, our practice boasts the longest clinical experience with facial botox, dating back to 1983. Dr. Perman was a member of the clinical investigation group at UCLA Medical Center when oculinum toxin was a research drug prior to its attaining FDA approval. Dr. Perman has taught numerous physicians, both in the U.S. and abroad in the techniques of neurotoxin injections. Patients seek out our expertise for treatment of facial rhytids.

Botox is one of the many trade names for the neurotoxic protein called botulinum toxin. This toxin is produced by the bacterium Clostridium botulinum. In large doses, the protein causes botulism, a rare paralytic illness often linked to food poisoning.

However, when used in cosmetic medicine to treat moderate to severe brow furrow (glabellar lines), uncontrolled blinking, lazy eye, wrinkles, and facial creases, this protein has shown many successes. These procedures use a small amount of diluted botulinum toxin that enables controlled weakening of muscles.

Botox for Bethesda, Washington D.C. and the surrounding area


Botox in Bethesda MD and Washington DC
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Botulinum toxin is sold commercially under the brand names Botox, BTXA, Dysport, Myobloc, Neurobloc, Xeomin, Botox Cosmetic, and Vistabel. Botox is widely used for non-cosmetic medical procedures in addition to cosmetic use. Botox is used to treat writer's cramp, cervical dystonia, excessive sweating, achalasia (an esophagus problem), chronic pain, neuropathy, and migraine headaches.

How does Botox work?  Botox works to relax the contraction of muscles by blocking nerve impulses. The result is muscles that can no longer contract, and so the wrinkles relax and soften. It usually takes two to four days to see cosmetic improvement and the effects tend to last from four to six months. Most patients require retreatment to remove wrinkles and lines as they begin to reappear, but after each injection the wrinkles return less severe as the muscles are trained to relax.

How is Botox administered? Botox procedures do not require anesthesia and usually take just a few minutes to perform. The protein is injected into the muscle using a fine needle in order to minimize discomfort and maximize accuracy. It is recommended that patients avoid alcohol for about a week before the procedure. In order to minimize bruising, patients should stop using aspirin and anti-inflammatory medications about two weeks before treatment. For cosmetic procedures, a study published in Dermatologic Therapy found that men need a higher dose of Botox than women.  


Is Botox better than a face-lift? According to the American Society of Plastic Surgeons, whether Botox gives better results than a facelift (surgery) depends on the age of the patient. People in their 30s who have had limited exposure to sunlight usually show signs of aging in their eyes and temple area first, with crow's feet and some bulging of the eyelid. As they have not lost much volume at this point, fillers or Botox usually smooth out the lines that people want to get rid of.  


When people enter their 40s the middle of the face starts to shift as the cheeks lose some of their fat and laugh lines set in. The cheeks become deflated towards the end of the 4th decade, and the jowls start to sag. A combination of Botox as well as minimal lifting procedures will provide the best results.