Botox in Bedford, NH
Smooth, Refresh, and Rejuvenate
Reduce fine lines and wrinkles that form when facial expressions are made. As your skin ages these repeated expressions cause lasting static lines. Neuromodulators block the chemicals that cause muscle contraction, so these lines are softened.
Xeomin vs. Botox:
Understanding the Difference
PM Aesthetics offers both Xeomin® ($13/unit) and Botox® ($15/unit) with complete transparency about their differences.
The Science:
Both are FDA-approved botulinum toxin type A formulations that work identically, temporarily blocking acetylcholine release at the neuromuscular junction to relax dynamic wrinkles. Clinical outcomes, duration (3-4 months), and safety profiles are equivalent.
The Distinction:
Xeomin is formulated without the complexing proteins (hemagglutinin, non-hemagglutinin) present in Botox. While neutralizing antibody formation remains rare with both products, peer-reviewed research suggests Xeomin's "naked" protein structure may reduce immunogenicity risk in patients receiving repeated treatments over years.
Our Clinical Standard:
Every provider at PM Aesthetics uses Xeomin for their personal neurotoxin treatments. We default to the product we trust for ourselves, though both options remain available.
This isn't brand preference. It's pharmaceutical evidence applied to clinical practice.
Why Facial Balance Matters: Treating Botox/Xeomin as a System, Not Isolated Areas
At PM Aesthetics, we often encounter patients who want to treat just one area of their face—crow's feet, forehead, or frown lines (11s)—while leaving adjacent areas untreated.
We understand the reasoning: you have a specific concern, a budget, or you want to "start small" before committing to more comprehensive treatment.
And we'll always accommodate your preferences.
But we also have a responsibility to educate you about what results you can realistically expect—and why treating isolated areas sometimes creates outcomes you won't be happy with.
The Problem with Treating Only One Area
Your face functions as an interconnected system. The muscles that control your forehead, frown lines, and crow's feet work together to create facial expressions.
When you relax ONE set of muscles while leaving adjacent areas untreated, you can inadvertently:
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Create visual imbalance → The untreated areas become more noticeable by contrast
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Shift muscle compensation → Untreated muscles work harder, creating new lines
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Produce asymmetry → One side of your face ages differently than the other
Common examples:
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Treating crow's feet only → Forehead and 11s now stand out more because they're still moving while the crow's feet are smooth
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Treating forehead only → Can cause the brows to feel heavy or make frown lines more prominent
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Treating 11s only → Forehead muscles compensate by overworking, creating horizontal lines that weren't as noticeable before
The result: You've spent money on treatment, but you're not satisfied because the imbalance is now MORE obvious than it was before.
The Problem with Undertreating (Using Too Few Units)
Some patients request "just a little bit" of Botox or Xeomin—fewer units than clinically recommended—hoping to save money or achieve an ultra-subtle result.
Here's the issue:
Neurotoxins require a minimum effective dose to produce visible results. If we use too few units, the treatment often doesn't work at all.
What happens:
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The treated area still moves (because the dose wasn't sufficient)
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You don't see the improvement you expected
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You feel like you wasted your money
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We look ineffective (even though we warned you this might happen)
Nobody wins.
You're disappointed. We're frustrated. And the treatment didn't achieve its purpose.
Our Recommendations for Optimal Results
1. Treat the upper face as a unit.
For most patients, treating the forehead + frown lines (11s) + crow's feet together produces balanced, natural-looking results. This approach prevents compensation patterns and maintains facial harmony.
2. Use the clinically appropriate dose.
We calculate dosing based on your muscle strength, treatment goals, and facial anatomy. Using the recommended amount ensures you'll see results without looking frozen or overdone.
3. If budget is a concern, consider phasing or membership.
Phased approach: Start with the most impactful area (often the 11s or forehead), then add other areas over time as budget allows.
Membership pricing: Our membership program significantly reduces the cost per unit, making comprehensive treatment more affordable month over month.
What we DON'T recommend: Undertreating multiple areas just to "spread the budget." It's better to treat one area WELL than to treat three areas inadequately.
We'll Always Meet You Where You're At
If you strongly prefer to treat only one area, or if you want to start conservatively, we'll accommodate your request.
But we'll also:
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Explain what results you can realistically expect
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Discuss potential drawbacks (imbalance, compensation, asymmetry)
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Offer alternative approaches that might serve your goals better
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Document your preferences and our recommendations in your chart
Our goal is informed consent, not pressuring you into more treatment than you want.
But we also won't set you up for disappointment by agreeing to a plan we know is unlikely to produce the outcome you're hoping for.
The Bottom Line
Botox and Xeomin are medical treatments, not retail products.
Effective treatment requires:
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Proper dosing based on muscle strength and treatment area
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Balanced approach that considers how facial muscles work together
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Realistic expectations about what results are achievable
We're here to guide you toward outcomes that will make you happy—not just take your money and hope for the best.
If you're unsure what approach is right for you, schedule a complimentary consultation. We'll assess your facial anatomy, discuss your goals and budget, and create a treatment plan that's both clinically sound and financially realistic.
Neuromodulators
Recommended Units
While dosing is always personalized based on your anatomy and desired results, treatment may fall within these general ranges and could be lower or higher depending on your needs.
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Frontalis/Forehead: Typically 14–30 units are used to relax forehead muscles, reducing horizontal lines and smoothing the brow area.
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Glabella/“11’s”: Around 18–30 units can soften the frown lines between the eyebrows for a more relaxed expression.
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Crow’s Feet: Usually 12–24 units are applied around the outer eyes to diminish fine lines and wrinkles.
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Lip Flip: 4–12 units can subtly lift the upper lip for a gentle, natural smile enhancement.
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Nose / Bunny Lines: 10–24 units help soften lines on the bridge of the nose when smiling or scrunching.
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Depressor Anguli Oris (DAO): 8–14 units relax the muscles at the corners of the mouth to reduce a downward-turning expression.
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Platysmal Bands: 36–60 units target vertical neck bands for a smoother, more youthful neckline.
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Masseter/Jawline Slimming: 40–60 units are used to relax jaw muscles, improving jawline contour and reducing teeth grinding.
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Underarms/Sweat Tox: 60–100 units are used to reduce excessive underarm sweating and improve comfort and confidence.
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Hands: 60–80 units target sweat glands in the hands for relief from palmar hyperhidrosis.
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Migraines/Chronic Migraine Relief: 150–200 units are strategically injected across the head and neck to reduce the frequency and severity of chronic migraines.
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Trapezius/Shoulder & Neck Tension: 30–60 units relax the trapezius muscles to relieve tension and discomfort.
Toxin Follow-Up Policy
Every Botox and Xeomin treatment includes a complimentary 2-week follow-up to assess results and ensure precision. We do not perform touch-ups before 2 weeks to avoid over-treatment.
Complimentary touch-up units are provided only when medically appropriate, as determined by your provider. If your provider observes residual movement, asymmetry, or underdosing in treated areas and you received the provider-recommended initial dose additional units are administered at no charge.
If you declined the provider-recommended dose at your initial treatment, for any reason, including cost, and additional units are needed at your follow-up, those units are not complimentary. They will be charged at standard per-unit pricing ($13/unit Xeomin, $15/unit Botox). The complimentary touch-up applies to outcomes from a full recommended dose, not to underdosing decisions made at the time of treatment. This policy exists because we cannot clinically guarantee outcomes when the recommended protocol was not followed.
If you personally want "more units" but your provider's assessment shows no residual movement, symmetric outcomes, and no medical indication for additional product, those units are not complimentary and will be charged at $13/unit (Xeomin) or $15/unit (Botox). Your provider may decline to administer additional units if doing so would cause over-treatment or complications.
New treatment areas not included in your original plan are charged transparently at standard per-unit pricing this is not a touch-up, it's an expansion of your treatment.
New patients are required to attend their 2-week follow-up. Established patients are encouraged but not required.
We treat based on clinical necessity and safety, not cosmetic preference beyond medical appropriateness.
Masseter Botox/Xeomin for Jaw Slimming - What to Expect
Jawline Slimming with Masseter Neurotoxin: Realistic Timeline & Protocol
Masseter neurotoxin (Botox, Dysport, Xeomin) is one of our most requested treatments, particularly among younger patients (ages 22-38) seeking non-surgical facial contouring. We perform this treatment multiple times per week and have extensive experience with dosing protocols, muscle assessment, and outcome prediction.
That said: This is NOT a one-treatment result.
If you're booking masseter neurotoxin for aesthetic jaw slimming (not TMJ/pain relief), understanding the realistic timeline prevents disappointment and premature discontinuation.
THE CRITICAL DISTINCTION: TMJ Relief vs. Aesthetic Slimming
TMJ/Pain Relief:
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Primary goal: Reduce jaw clenching, teeth grinding, tension headaches
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Timeline: Pain relief noticeable within 1-2 weeks
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Dosing: 50-100+ units total (25-50+ per side), depending on muscle size and pain severity
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Results after 1 treatment: Often significant symptomatic improvement
Aesthetic Jaw Slimming:
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Primary goal: Reduce masseter muscle bulk for narrower, more contoured jawline
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Timeline: Visible slimming requires 2-3 treatments minimum (6-9 months)
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Dosing: 50 units total (25 per side) standard protocol for aesthetic slimming
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Results after 1 treatment: Minimal to no visible change in muscle size (muscle atrophy requires repeated treatments)
If you're booking for slimming, not pain relief, expect a multi-treatment process.
WHY MASSETER SLIMMING REQUIRES MULTIPLE TREATMENTS:
The science of muscle atrophy:
Masseter is the strongest muscle in the human body (pound for pound). When you inject neurotoxin, you're temporarily preventing muscle contraction, but the muscle itself remains the same size initially.
Muscle atrophy (shrinkage) occurs gradually over multiple treatment cycles:
Treatment 1 (Month 0):
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Neurotoxin prevents muscle contraction for 3-4 months
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Muscle activity decreases, but muscle size remains largely unchanged
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Visible slimming: Minimal to none (5-10% reduction at most)
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Functional benefit: Reduced clenching if present, but not the primary goal for aesthetic patients
Treatment 2 (Month 3):
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Second round of neurotoxin maintains muscle inactivity for another 3-4 months
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Prolonged disuse begins muscle atrophy (shrinkage)
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Visible slimming: Moderate (15-25% reduction from baseline)
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This is when most patients start noticing jawline narrowing
Treatment 3 (Month 6):
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Third round continues muscle atrophy process
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Cumulative disuse produces maximum muscle size reduction
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Visible slimming: Significant (25-40% reduction from baseline)
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This is when friends/family start commenting on jawline change
Maintenance (Month 9+):
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Repeat treatment every 4-6 months to sustain muscle atrophy
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Without maintenance, muscle rebuilds within 6-9 months (regaining original size)
THE DOSING REALITY: Why We Use 50 Units for Aesthetic Slimming
Standard aesthetic protocol: 50 units total (25 units per masseter)
Why not higher doses initially?
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Muscle size variability: Some patients have naturally smaller masseters. Starting conservatively (50 units) allows us to assess response and increase at Treatment 2 if needed.
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Functional preservation: Masseter is essential for chewing. Over-dosing (70-100 units) in patients with smaller muscles can cause difficulty chewing tough foods, asymmetric smile, or excessive weakness.
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Cost accessibility: 50 units at our in-app pricing ($550) makes the multi-treatment protocol financially sustainable for younger patients. Higher initial dosing (70-100 units = $770-1,100) prices out the primary demographic.
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Cumulative effect: Even at 50 units, repeated treatments every 3-4 months produce significant cumulative atrophy. Higher doses don't necessarily accelerate the timeline, they just increase cost and side effect risk.
When we increase dosing:
If muscle is very large (palpably hypertrophied, visible bulging when clenching) AND patient reports no difficulty chewing after Treatment 1, we may increase to 60-70 units at Treatment 2.
If patient presents primarily for TMJ/pain relief (not aesthetic slimming), we may start at 60-100 units depending on symptom severity and muscle size.
This is medical decision-making based on individual anatomy, not one-size-fits-all protocols.
REALISTIC EXPECTATIONS BY TREATMENT NUMBER:
After Treatment 1 (Month 0-3):
What you WILL notice:
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Reduced jaw tension and clenching (if present)
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Less teeth grinding during sleep (if applicable)
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Softer, less "pumped" feeling when touching masseter
What you will NOT notice:
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Visible narrowing of jawline (muscle size unchanged)
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Comments from others about face shape
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Immediate before/after photo difference
After Treatment 2 (Month 3-6):
What you WILL notice:
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Moderate jawline narrowing (15-25% reduction)
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Slightly more tapered appearance when looking straight-on
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Reduced muscle bulk when palpating (masseter feels smaller/softer)
What photos show:
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Subtle but measurable difference in lower face width
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More defined jawline angle
After Treatment 3 (Month 6-9):
What you WILL notice:
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Significant jawline narrowing (25-40% reduction from baseline)
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Visibly more contoured, tapered lower face
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Friends/family commenting on face looking "slimmer" or "more feminine"
What photos show:
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Dramatic before/after difference
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Clear reduction in lower face width
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Enhanced jawline definition
THE FINANCIAL REALITY: Why We Offer In-App Pricing
Standard pricing: Masseter neurotoxin (50 units) = $700-800 at most practices
Our in-app exclusive pricing: $550 (for patients using our rewards/loyalty app)
Why we offer this:
The multi-treatment requirement (2-3 sessions minimum = $1,650-2,200 over 6-9 months) can be financially prohibitive at standard pricing.
In-app pricing reduces barrier to completing the full protocol:
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$550 × 3 treatments = $1,650 total (vs. $2,100-2,400 at standard pricing)
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Makes multi-treatment commitment more accessible
This is reward pricing for loyalty app patients who actively engage with our practice through the app, not a general discount available to the public or in clinic.
REALISTIC CANDIDACY ASSESSMENT:
Ideal candidates for masseter neurotoxin (aesthetic slimming):
✓ Visibly square or wide jawline caused by masseter hypertrophy (enlarged muscle), not bone structure
✓ Palpable masseter bulk when clenching (muscle visibly bulges outward)
✓ Willing to commit to 2-3 treatments over 6-9 months before judging efficacy
✓ Realistic expectations about gradual timeline (not instant results)
✓ Financial capacity to complete multi-treatment protocol ($1,650-2,200 over 6-9 months)
✓ Ages 22-45 (younger patients have more robust muscle response; older patients may have less muscle bulk to reduce)
NOT ideal candidates:
✗ Square jawline caused by bone structure (wide mandible angle), not muscle bulk → Neurotoxin won't change bone
✗ Expecting visible results after single treatment → Will be disappointed and discontinue prematurely
✗ Unable or unwilling to commit to multi-treatment protocol → Won't achieve desired outcome
✗ Very small/thin masseter muscles → Limited room for further reduction, higher risk of functional impairment
WHAT TO EXPECT DURING TREATMENT:
Consultation & Assessment:
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Provider palpates masseter bilaterally while you clench to assess muscle size
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Discussion of primary goal (aesthetic slimming vs. TMJ relief vs. both)
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Dosing recommendation based on muscle size and goals
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Realistic timeline expectations set (2-3 treatments for visible slimming)
Treatment (10-15 minutes):
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3-5 injection points per masseter (total 6-10 injections for both sides)
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Minimal discomfort (brief pinch sensation)
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No numbing required (highly tolerable)
Post-Treatment:
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Avoid massaging or applying pressure to masseter for 4-6 hours
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Avoid intense exercise for 24 hours
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Avoid lying flat for 4 hours (prevents migration)
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Normal chewing, talking, daily activities immediately
OUR COMMITMENT TO REALISTIC EXPECTATIONS:
What we will tell you:
✓ Masseter slimming requires 2-3 treatments (6-9 months) for visible results
✓ Treatment 1 produces minimal visible change (5-10% reduction)
✓ Treatment 2 produces moderate slimming (15-25% reduction)
✓ Treatment 3 produces significant slimming (25-40% reduction)
✓ Maintenance required every 4-6 months to sustain results
✓ Not all patients are good candidates (bone structure vs. muscle bulk)
What we will NOT tell you:
✗ "You'll see dramatic results after one treatment"
✗ "This is a permanent fix"
✗ "Everyone responds the same way"
✗ Overpromise outcomes to secure the booking
If you're not willing to commit to 2-3 treatments over 6-9 months, masseter neurotoxin for aesthetic slimming is not the right treatment for you.
When Results Appear—And How Long They Last
The Neurotoxin Timeline ("Bell Curve"):
Botox, Dysport, and Xeomin don't work instantly. Results follow a predictable timeline:
Days 3-5: Onset of muscle relaxation (early visible improvement)
Days 10-14: Peak effect (maximum muscle relaxation and smoothing)
Months 3-4: Gradual tapering (muscle activity slowly returns)
Months 4-5: Full wear-off (return to baseline movement)
Why we schedule 2-week follow-up assessments: Peak effect occurs at 14 days. If additional units are needed for optimal result, we add them at this appointment while product is still active.
Typical duration: 3-4 months for most patients in forehead, frown lines, and crow's feet.
Lip Flip exception: 8-12 weeks maximum (2-3 months). The orbicularis oris muscle (upper lip) is used constantly for speaking, eating, and expression, causing faster metabolism of neurotoxin compared to less-active facial muscles.
Individual Variables Affecting Duration:
Gender:
Men typically metabolize neurotoxin 20-30% faster than women due to higher muscle mass and metabolic rate. Male patients often need higher doses (40-64 units for "Botox 3" areas vs. 30-50 units in women) and may experience shorter duration (3 months vs. 4 months).
Age:
Younger patients (20s-30s) with stronger, more active muscles may metabolize faster than older patients (50s-60s) with reduced muscle tone.
Exercise habits:
High-intensity athletes and frequent exercisers (5+ days/week cardio or strength training) often report 3-3.5 month duration vs. 4+ months in sedentary patients. Increased circulation and metabolic rate accelerate neurotoxin breakdown.
Dosing:
Higher doses typically last longer. Underdosing (attempting to "stretch" product) often results in shorter duration and suboptimal results.
Treatment frequency:
Some patients report longer duration with consistent treatment over time (potentially due to muscle atrophy from repeated relaxation), though clinical evidence is mixed.
Recommended Rebooking Timeline:
Standard areas (forehead, frown, crow's feet): Every 3-4 months
Lip flip: Every 8-12 weeks (2.5-3 months maximum)
Masseter (jaw slimming/TMJ): Every 3-4 months
Optimal approach: Rebook before complete wear-off (around month 3-3.5) to maintain consistent results rather than waiting for full return of movement.
Why We Only Use Merz and Allergan Injectables
At PM Aesthetics, we don’t cut corners or chase trends. We exclusively use Merz and Allergan injectable products, the two gold-standard manufacturers in medical aesthetics. These are the brands backed by decades of clinical data, global safety studies, and proven, consistent results.
We don’t gamble with off-brand or gray-market products just to save a few dollars. Our patients trust us for outcomes that are safe, natural, and precise, and that means using the best science available, not the cheapest option.
Better ingredients. Better data. Better results. That’s why we only inject Merz and Allergan.
What Our Clients Say
Very professional staff. Wonderful people made me feel very comfortable great value. Dr Keady spent the time to consult with me about all the options. I went with the Botox and I look 10 years younger already. My wife can't keep her hands off me. Very highly recommended.
Steve
October 2025
PRE-TREATMENT INSTRUCTIONS
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Remove all jewelry from the treatment area.
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If possible, remove all makeup in the treatment area.
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Avoid excessive sun exposure (or tanning beds) 1 week prior to treatment.
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Avoid non-steroidal anti-inflammatories (NSAIDS) such as ibuprofen, Advil, aspirin, Aleve (unless taking these medications for a medical condition).
POST-TREATMENT INSTRUCTIONS
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Sit up straight for the next 4-6 hours.
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Avoid intense exercise for 24 hours post injection.
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Avoid direct sunlight, saunas, & hot tubs for 48 hours.
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Avoid alcohol consumption for 24 hours.
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Avoid wearing hats for 24 hours.
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Do not touch or massage the treatment area.
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Avoid all blood thinners before & after.
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Avoid retinol for 48 hours.
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You may gently apply ice and use arnica cream for bruising.
Before & After: The PM Aesthetics Difference
Our Providers’ Right to Say No
At PM Aesthetics, your safety and long-term results come before sales. Our medical providers have both the authority and the ethical duty to decline treatments that aren’t in your best interest—whether it’s unsafe, unnecessary, or likely to produce an unnatural result.
We’re not here to say “yes” to everything; we’re here to practice medicine responsibly and help you achieve outcomes you’ll still love a year from now.
FREQUENTLY ASKED QUESTIONS
Botox is a purified protein injected into specific muscles to temporarily relax them, reducing the appearance of fine lines and wrinkles.
It works by blocking nerve signals in the targeted muscles, preventing them from contracting and causing wrinkles.
Most sessions take about 10–30 minutes, depending on the number of areas being treated.
Most clients report minimal discomfort. Tiny needles are used, and some practitioners may apply a topical numbing cream if needed.
Results typically appear within 3–7 days, with full results visible around 2 weeks.
Results usually last 3–4 months, but this can vary depending on individual metabolism and treatment area.
Most clients return every 3–4 months to maintain results.
Both Xeomin and Botox are FDA-approved neuromodulators that reduce wrinkles by relaxing targeted muscles. The main difference is that Xeomin is “naked,” meaning it contains only the active ingredient without any additives, while Botox contains small accessory proteins. This can make Xeomin slightly less likely to trigger resistance over time, though both products are very safe and effective. Results and duration are similar for most people.
Clinical Standards You Can Trust
At PM Aesthetics, every neurotoxin treatment is performed under our comprehensive Clinical Standards framework. Our providers are never commissioned, our products are always pharmaceutical-grade (Merz & Allergan only), and our recommendations are based solely on medical appropriateness—not sales quotas. We also reserve the right to refuse treatment if it's not in your best interest.
ToxBooster Add-On
Elevate your Botox results with the ToxBooster treatment, which pairs a medical-grade VI Peel with your Xeomin® or Botox® injections in one visit. This powerful combination refines skin texture and tone while softening lines—delivering a brighter, smoother, more youthful look in about a week.
Lift and Define with the Lip Flip
Get a naturally lifted, more defined smile with our $69 Lip Flip. This quick, non-invasive treatment uses Botox to gently relax the muscles around the upper lip, creating a subtle lift without adding extra volume. Perfect for patients seeking a youthful, balanced look, the Lip Flip is an easy, affordable way to refine your results or complement lip filler treatments.
Join Us on Your Aesthetic Journey
Every PM Aesthetics consultation begins with lifestyle assessment, not treatment sales. We evaluate sun protection, nutrition, sleep, stress, exercise, and other factors that determine 70-80% of aging outcomes. If your lifestyle foundation needs attention, we'll tell you, even if it means less treatment revenue for us. Medicine first, always.