Dr. S. Kraft


Frown Lines and Wrinkles:


     Frowning causes the muscles in the face to pull on the tissues in and under the skin.  Over time the muscles can become too strong and cause frown lines, furrows, and wrinkles to form around the eyes and in the forehead.  Various facial expressions can also cause wrinkles to develop in other areas of the face, such as around the nose, mouth, and neck.  This can cause a person to have a discouraged or angry look, even though he or she is not upset.


Botulinum Toxin


     Botulinum toxin relaxes facial muscles.  The product form approved for use in Canada is Botox CosmeticTM, licensed by Allergan Inc.  It has been used since 1978 for relaxing muscles in several conditions where they are overactive or too tight.  It was originally approved for treating eye muscle disorders, such as crossed eyes, and for stopping uncontrolled blinking that is seen in some neurologic diseases such as blepharospasm and hemifacial spasm. 


     In recent years it has been found to be very effective in smoothing out facial wrinkles and frown lines caused by excessive facial muscle activity.  Tiny amounts of Botox CosmeticTM  are injected under the skin into the overactive muscles to relax them.  This stops them from pulling on the skin and prevents the wrinkles and furrows from forming on the surface.


Treating the Face with Botulinum Toxin


     Treatment has to planned for each patient on an individual basis.  It is important for the doctor to discuss the objectives and risks of treatment with the patient before it is given.  The drug should only be used by a doctor trained to use the drug.


     Botox CosmeticTM  begins to act 2 or 3 days after it is injected, and reaches its peak effect 7 to 10 days later.  The skin slowly responds to this relaxation by smoothing out.  The drug wears off 4 to 6 months later, after which time the wrinkles tend to recur gradually.  Thus, most patients require treatment two or three times per year to maintain the cosmetic improvement.


     It is important to note that patients do not respond in exactly the same way to the usual starting doses of the drug.  Some people need extra injections to reach their maximal response, while others never completely get rid of the furrows or wrinkles.  For this reason, it is important for the doctor to check the result 2 or 3 weeks after treatment and to be sure there have been no side effects from the treatment.  Patients who do not respond to the Botox CosmeticTM    or who are not felt to be candidates for Botox CosmeticTM  can be referred for alternative therapies such as laser resurfacing.


Side Effects


     Side effects are almost always due to local spread of the drug away from the muscles injected. These effects are very uncommon in experienced hands (far less than 1 percent of cases) and resolve within 2 to 4 weeks in almost all cases.  These include a slight droop of the upper eyelid from downward spread of the drug, or tearing from the spread to the lower eyelid.


     There can occasionally be a small bruise from the injection itself, which fades within a few days, or a discomfort ("burning sensation") at the injection sites, which wears off within 24 hours.  When the muscles are maximally relaxed there can be a feeling of "numbness" in these areas because the muscles are slower to work, a feeling which patients get used to over time.


Drug Reactions


     There are very few reports of mild allergic reactions to Botox CosmeticTM  .  The drug should not be given during pregnancy or when a woman is breast-feeding, as its effect on the fetus or infant is not known.  It should not be given to anyone with a known neuro-muscular disease such as myasthenia or muscular dystrophy.


About Dr.  Stephen Kraft


     Dr. Kraft is one of the most experienced users of Botulinum Toxin in Canada.  He was the first physician in Ontario (in 1985) and one of the first three in Canada authorized to use it.  He has used Botulinum Toxin for treatment of eye muscles and spasms of the facial muscles in hundreds of patients for over 28 years, and he has used it for cosmetic purposes for several years.  He has authored or co-authored more than a dozen publications on the use of Botulinum Toxin in several widely-read journals.  Since 1984 he has lectured on the uses of this agent to a wide variety of practitioners including ophthalmologists, family physicians, optometrists, neurologists,  and allied health personnel.


For free consultations, Dr. Kraft can be reached at:


Main Office



Health First Medical Centre, Richmond Hill



Website for Cosmetic Uses of Botulinum Toxin: