For more information on BOTOX® Cosmetic from our Chicago and Winnetka-area surgeon, also offering Restylane® and other injectable facial treatments, please contact our practice.






737 North Michigan Avenue
Suite 760
151 East Chicago Avenue (Entrance)
Chicago, Illinois 60611
312-751-2112
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118 Green Bay Road
Winnetka, Illinois 60093
847-446-7562
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BOTOX® Cosmetic, Restylane® and More - Chicago and Winnetka

BOTOX® Cosmetic is one of the most popular options at our Chicago and Winnetka centers, along with fillers like Restylane®, Perlane®, and JUVÉDERM™. Review the information below to learn more about these treatment options or contact our centers to schedule a consultation today.

BOTOX® Cosmetic

Successful BOTOX® therapy requires in-depth knowledge of the facial anatomy and precise technique. Dr. Cook has carefully studied the patterns of facial expression, and this leads to a highly individualized approach to BOTOX® Cosmetic therapy at our Chicago and Winnetka centers.. We believe that all patients benefit from our diligent attention to detail.

Over activity of the muscles in this region may have several undesirable consequences. Deep furrows or “frown lines” may develop and give the face an angry, or distressed, look. Repeated and prolonged contraction of these muscles pulls the inner brows downward and can set the facial attitude into a permanent frown. Patients with these habits report that friends and co-workers ask them why they are always “angry” or “tired.” Excess contraction of these muscles may also contribute to a sense of heaviness in the region by the end of the day. This over activity may even trigger tension or migraine headaches.

For some patients surgery may represent the best solution to this problem, but many of our patients have achieved a wonderful softening of the facial attitude with BOTOX®. This remarkable substance works by interrupting the message that tells the frown muscles to contract.

Patients are delighted by the change in their appearance after treatment with BOTOX® Cosmetic at our Chicago and Winnetka centers. A subtle but distinct elevation of the inner brows restores a calm and refreshed facial attitude. The habitual creases between the brows are softened.

Habits of expression in other facial regions may also respond well to BOTOX® therapy. These include the “crow’s feet” at the outer corners of the eyes, the horizontal creases of the forehead, and the vertical lines of the neck.

Treatment consists of precise microinjections along the path of the overactive muscles. Practically all patients are able to resume work and social interaction immediately. Most of our patients return every three to six months for additional treatments, since the BOTOX® Cosmetic loses its control of the muscle over time.

Ten Things You Should Know About BOTOX® Before You Seek Treatment

  1. BOTOX® has FDA approval for use in treating frown lines between the eyes. It also been approved by the FDA for a number of years for the treatment of medical conditions such as hyperhydrosis,  blepharospasm and extraocular muscle balance.
  2.  BOTOX® works by binding to the connection between nerves and muscles and preventing the transmission of the message for the muscle to contract. In this manner, it helps to alter habitual expressions that we often adopt subconsciously. These expressions can make us look tired or angry when we really are not feeling this way.
  3. Most patients in our practice return every three to six months for repeat injections. Usually the effect has only partially warn off, but most people prefer to seek retreatment before there is a complete return of muscle function. The reason for this is that this helps the patient to retrain his or her habits of facial expression. A smaller number of patients obtain a block, which lasts considerably longer and some last shorter. Occasionally it will not work at all.
  4. Part of the success of BOTOX® therapy comes from the retraining of facial habits. It is also our impression that the facial expression muscles treated by BOTOX® become weaker over time when a patient undergoes several injections. In our opinion, the main reason for this is that the muscles are used less so they become smaller. This is similar to the difference between the arm muscles when an individual works out regularly at a gym versus the smaller less toned muscles that occur when an individual gets out of the habit of working out.
  5. A precise understanding of the intricate anatomy of the muscles of expression is essential to success BOTOX® therapy. There is a significant variety in facial expression patterns in different people. This must be recognized and incorporated into the treatment plan if a nuanced approach to the therapy is desired.
  6. The goal is not the complete elimination of facial expression. This looks weird. The goal is to soften and retrain the patterns of facial expressions. Overdone BOTOX® looks no better than overdone facial surgery.
  7. Don’t settle for BOTOX® therapy in anything less than a medical office environment. Beauty Salons and hotel suites are not good settings for this. There are important issues of cleanliness and safety. Alcoholic beverages and BOTOX® can be a dangerous mix. Herding a group of people into a “BOTOX® party” compromises individualized and nuanced therapy.
  8. Avoid “booster” doses less than one month from the last injection. These may provoke antibodies to the BOTOX® molecule, which will weaken the effect of future treatments.
  9. Don’t settle for treatment unless the individuals in the practice are highly experienced and have a serious commitment to artistic principles of facial rejuvenation.
  10. BOTOX® may be only part of the answer. “Memory creases,” folds and creases in the skin that persist even in the absence of muscle contraction, will not be eliminated by BOTOX® alone. They do sometimes soften over time, especially after several injections. A variety of treatment options exist for the critical zones around the eyes, and the person who evaluates you should have the experience and knowledge base to be able to address all available treatment options to you. BOTOX®, helpful as it is, can be misapplied, and this will only lead to disappointment. On the other hand, the proper selection of BOTOX® from the portfolio of treatment options has provided a wonderful benefit for many patients.

Ten Questions You Should Ask Before You are Treated with BOTOX®

  1. How many patients have you treated?
    This is an important indicator of the experience of the practice. If you desire a nuanced and artistic result, it is important that the person treating you has considerable experience with proper diagnosis and treatment. There is a distinct learning curve, so the more patients that have been treated the better. Therefore, it’s best to go to a practice that has experience with at least several hundred treatments.

  2. How did you learn about the anatomy of the muscles in this area?
    Do not settle for a vague answer to this question. A precise understanding of the anatomy of the muscles in this region is essential if one is to obtain an appropriate response to the injection. BOTOX® therapy should be highly specific and precise. Injections without this knowledge can lead to over treatment or a bad result.
  3. Do you have BOTOX® parties?

    We offer private events in an informal setting to educate prospective patients on the benefits of BOTOX® and other treatments.  Groups of 15 people are welcome to inquire about the available dates and promotional pricing for these events.

  4. What is the exact setting where BOTOX® will be administered to me?
    Overall, it is unwise to settle for anything less than a physician’s office. Unfortunately, there are situations where BOTOX® is administered in many inappropriate settings, from hotel conference rooms to beauty salons. BOTOX®, although very safe, can occasionally produce reactions that must be treated appropriately. Further, if proper lighting and equipment are not available, a minor problem could turn into something quite serious.

  5. How will you balance my brow?
    If they don't understand this question, it probably means you are not speaking to someone who is serious in their understanding of BOTOX® therapy. A common mistake is to inject into forehead frown lines without understanding the competing muscle groups. This can cause an undesirable settling of the brow. The forehead creases may be softened but the downward position of the brow can give the patient an angry or downright strange expression.

  6. Will all of my wrinkles be gone?
    Admittedly this is a bit of a trick question, but it provides a good indication of the level of experience and truthfulness of the person you are speaking to. In general, it is impossible (and perhaps not even desirable), to remove every trace of an expression crease. This should be forthrightly communicated to the patient.

  7. What other treatments do you offer for this area?
    BOTOX® is indeed a wonderful treatment for patterns of overactive muscles, especially in the region between the brows and in the crow’s feet area. It is not, however, the only solution. Often the best results come from combined therapy. For example, if there has been a very strong pattern of habitual expression, there may be significant memory creases that persist even when the muscles don’t contract. These can be treated with other techniques. Sometimes the result that BOTOX® would provide would be disappointing, and a surgical procedure would be better. We believe strongly that patients’ interests are best served if they are evaluated by individuals who have an understanding of the complete range of options available. Otherwise, a very useful tool, such as BOTOX®, may be forced into a situation where it really won’t work very well. Under these circumstances, it is really not the fault of the BOTOX®, but the fault of the individual who misused it.

  8. What is your goal in treating this area?
    In almost every field of human activity, the person who can clearly articulate his or her goals will get a better result than someone who cannot. I would suggest that if someone is not able to explain what they are trying to accomplish with the BOTOX®, then perhaps you might seek someone with a greater level of knowledge and finesse.

  9. What do you think looks good? What is your artistic concept?
    This is perhaps the key question that should be asked by anyone considering either skin care treatment or plastic surgery of any sort. The concept of beauty is very subjective for each individual. Perhaps the person who is about to treat you has a concept of beauty that is very different from your own. It is better to define these issues in advance, so that you can avoid the disappointment that comes from miscommunication.

  10. Are you truly interested in me as a patient or merely as a source of revenue?
    This is, of course, a question that you should not ask directly. The answer to this question will be revealed to you by the manner in which you are treated. I would strongly suggest that if you find yourself in a facility where these individuals do not pay attention to your medical history and general health, that you do not seek treatment. If you are not asked questions about medications, medical allergies, your general level of health, and your goals for the treatment, then you are subjecting yourself to the care of individuals who do not care much about your well being.

Restylane®

In addition to BOTOX® Cosmetic, our Winnetka and Chicago centers offer Restylane® treatments to provide comprehensive facial rejuvenation options to our patients. Restylane® is safe, versatile, and effective treatment for filling fine lines and smoothing the appearance of the skin for a more youthful look. It can also be successfully utilized to achieve natural-looking lip augmentation.

Review Dr. Cook's informative article on Restylane® and other hyaluronic injectables to learn more about these popular treatment options. You may also wish to contact our Winnetka and Chicago centers to schedule a consultation to determine if Restylane® or other facial rejuvenation options are right for you.

An Article by Dr. John Q. Cook

FDA approval of Restylane® and other hyaluronic injectables opens a new era for facial soft tissue augmentation in the United States. These versatile fillers have significant advantages over materials previously available for this purpose. The purpose of this overview is to provide you with an understanding of the nature of hyalurionic injectables, the range of medical applications to date, their characteristic advantages and disadvantages, and the qualities you should look for in the clinician who will treat you.

WHAT IS HYALURONIC ACID?
Hyaluronic acid (HA) is a natural material that is found throughout the human body. It has a simple chemical structure that is known as a glycoprotein; in other words it is simply made of a sugar molecule that is hooked to a small protein molecule.

The physical properties of various commercial forms of hyaluronic acid are determined by the degree of cross-linking between chains of these molecules hooked together. In general, the greater the degree of cross-linking, the thicker the material. This variation provides us with a useful range of materials, each suited for a different purpose. The thicker, more cross-linked forms are placed deeper, while the thinner, less cross-linked forms are placed closer to the surface of the skin.

Although HA is found in many tissues in the body, we will concern ourselves predominantly with the HA that is found in the skin. The skin can be viewed as having two main layers, an outer cellular layer (the epidermis) that protects us from the external environment and a deeper structural layer (the dermis) that provides resiliency, tone and support. The dermis is made up of bundles of collagen and elastic fibers that run through a squishy pudding of HA.

With each decade of aging, our skin loses about 10 percent of its hyaluronic acid content. This is one of the main reasons that aging skin deteriorates in quality. The skin actually becomes thinner and less resilient. It also becomes drier. This is largely due to the decreased HA content. Biochemists like to say that HA is remarkably hydrophilic; this means that it naturally draws water molecules to itself, in a ratio approaching 100 to 1. As we lose HA with the aging process, our skin becomes progressively dehydrated. The appeal of restoring the HA content to the skin and surrounding areas should be readily apparent.

WHAT MAKES HYALURONIC ACID SO USEFUL?

The clinician has quite a few choices available for soft tissue augmentation in the United States and an even greater range of options in other countries. This is one of the reasons I have spent significant time in recent years traveling to medical conferences and visiting clinicians in European countries. In Europe, an almost Darwinian struggle goes on between all of the possible materials that compete for a doctor’s limited attention. In many ways this is quite good; the beneficial and useful materials tend to gain market share, while the ones with problems or disadvantages tend to fade away. Since medical materials and drugs come to market much quicker in Europe than in the United States, an American physician such as myself, who can speak some French or German, can monitor the Europeans and predict future developments in the United States. It’s hard for me to say which knowledge has been of greater benefit to my patients: knowing what will probably turn out to be useful or knowing what to avoid at all costs. I’ve certainly seen plenty of examples of both. What was readily apparent to me was that European doctors en masse were abandoning other injectables and moving to HA products.

As I learned from my European colleagues and began to develop my own approach to injection technique, I was struck by certain advantages inherent in the hyaluronic products.

First of all, they are soft. There is less of a problem with lumpiness or palpability than in many of the other injectables. A pair of lips may look beautiful, but if you feel a firm ridge when you kiss them, they lose much of their appeal.

A second advantage that springs from this softness is the remarkable versatility of HA injectables. With many of the other materials the clinician is limited to a small number of sites where he can inject safely: lip borders, nasolabial creases, and other facial grooves and furrows. With HA injectables, the highly experienced clinician can actually build up three-dimensional structures in certain facial zones, especially around the lips. This allows for more of a sculptural approach.

A third advantage is durability. HA injectables persist for months longer than many other forms of soft tissue fillers. To the patient this means fewer trips to the doctor for restoration.

The fourth advantage, non-permanence, may at first seem paradoxical; why wouldn’t it be better just to inject something that will persist for years? After all, there are products out there that supposedly will do just that. There are two powerful reasons why non-permanence is a desirable characteristic. First of all, if the patient doesn’t care for the result, it will eventually melt away. To achieve their true potential HA injectables require a highly skilled and visually sophisticated clinician on the other end of the syringe. If a patient is treated by someone who lacks these characteristics, at least there is no permanent problem.

An even more important advantage to non-durability came to me during a visit to one of the European medical congresses. I noticed that physicians with a high level of experience and skill who had used so-called permanent injectables in the past were warning others not to do so in their lectures. In each case, the reason was the same: delayed granulomas. No matter what the material, the message was remarkably similar: at first the doctors loved using a type of injectable, but after several years they began to notice that in a certain percentage of patients changes began to appear in the skin above the area of injection. These changes consist of granulomas: itchy, raised, red bumps that do not go away. As I looked into the record of these injectable materials, I was struck by the similarity of the pattern. Stage I: the physician thought he or she had found a permanent injectable that didn’t cause long-term problems. Stage II: aggressive marketing on the part of the company that manufactures the injectable material and uncritical acceptance on the part of certain physicians. Stage III: several years later the physicians discovered delayed granulomas.

These problems shouldn’t happen in my practice, as we follow a simple principle: only use materials for facial soft tissue augmentation that nature put there in the first place. That means we use the patient’s own fat for deep volume restoration and collagen or hyaluronic products closer to the surface of the skin. These are the very things that thin out with the aging process, so why not simply put them back?

WHAT IS THE WORLD WIDE EXPERIENCE WITH HYALURONIC INJECTABLES?
When it comes to facial injectables, there truly is safety in numbers. The more patients who have been treated with a given material and the longer the treatment experience, the more intelligently one can talk about safety. If I were considering treatment with a facial filler, the first question I would ask is, “How many people have been treated with this material?” If the clinician who will be treating you cannot answer this question, I would think twice about their commitment to patient care.

It is reassuring that over one million facial soft tissue augmentations have been carried out with HA injectables.

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