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Dr. Romano’s “Exquisite Care”
Medical Spa

Injectables and Fillers

Thermage -
Radiofrequency energy
non-invasive skin tightening.

Medical Grade Skin Care
Prescription Strength Skincare Products
Wrinkles & Loose Skin
Skin Textural Irregularities
Stretch Marks
Sensitive Skin

Anti - Aging-
Reversing  external and internal
consequences of age.

Skin Maintenance
Postoperative Skin Care


This highly purified and very safe substance has the very specific and predictable mechanism of action of deactivating ANY muscle function at, or sometimes near, to where it is injected. It therefore can cure or reduce any wrinkles that are due to muscle activity. The effects are not permanent and last 3-5 months depending on the patient, muscle, and activity. It can be administered in the office in a matter of minutes and you can return to work and full activity virtually immediately. Long term use has a tendency to lessen the frequency and amount of Botox needed to obtain a given result due to several mechanisms of action. There are no bad long term side effects.

Botox only deactivates muscles and treats the wrinkles related to this. It does not fill in deep furrow lines and creases. In these cases it may be necessary to utilize combination treatment of Botox to deactivate the muscle and then an injectable to fill in the furrow or crease.

I like to think of the indication for Botox falling into two broad categories as outlined below. Functional use refers to injecting Botox into a muscle with the sole endpoint of deactivating the muscle and the wrinkles due to this. Cosmetic use refers to injecting certain muscles in certain amounts and in certain areas to provide a specific or more balanced aesthetic result. Most offices only provide the first. My office provides both.

This cosmetic usage, and understanding the balance of muscle activity and its effect on the skin and surface, is where I employ Botox beyond its usual capacity and in a very artistic way.

Functional Uses of Botox

  • Frown lines between the eyebrows. This works best if they are not deep.
  • Crow’s feet
  • Transverse lines of the forehead
  • Heavy vertical muscle bands in the neck
  • Complex irregularities of the chin
  • Smoker lines of the lips

Cosmetic Uses of Botox

  • Create symmetry in uneven eyebrows
  • Raise the tail of the eyebrows
  • Raise the inner corner of the eyebrows
  • Elevate the corners of the mouth
  • Decrease the muscle bulk at the corners of the jawline (typical in Asians)
  • Even up sagging lower eyelids
  • Even up sagging upper eyelids
  • Even up facial features from Bell’s Palsy or other facial nerve problems


Before and After Photos

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Botox , Cellulite / Fat Reduction, Injectable Fillers,
Skin Peels / Facials, Microdermabrasion, Laser Hair Removal, Laser Skin Resurfacing Laser Vein Treatment

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Dr. James Romano, M.D.
San Francisco Plastic & Reconstructive Surgery
1650 Jackson St., Suite 101, San Francisco CA 94109