Botox in San Francisco, Led by a Physician

At Ivy en Rose in West Portal, every Botox plan is created by our Medical Director, Andrew Vargas, MD. He injects patients himself and directly supervises our nurse injectors on site — so a doctor is behind every treatment, every time.

What Is Botox?

Botox is an injectable medicine that relaxes the small muscles that cause wrinkles when you make facial expressions. Here is the simplest way to think about it. Every time you frown, squint, or raise your eyebrows, a muscle under your skin pulls the skin into a crease. Do that a few hundred thousand times over the years and the crease stops bouncing back. That is a wrinkle. Botox works by briefly interrupting the signal your nerve sends to that specific muscle. The muscle relaxes. It stops pulling on the skin. The line above it softens, and over the following weeks the skin gets a chance to smooth out. It does not freeze your face, fill anything in, or change your bone structure. It quiets a handful of very small, very specific muscles — and nothing else.

The technical version, in one paragraph

Botox is the brand name for onabotulinumtoxinA, a purified protein made from a bacterium called Clostridium botulinum. In the tiny, diluted doses used cosmetically, it blocks the release of acetylcholine — the chemical messenger that tells a muscle to contract. The effect is temporary and it stays local to where it was injected. Botox has been FDA-approved for cosmetic use since 2002 and is one of the most studied aesthetic treatments in the world.

Botox vs. filler — they are not the same thing

People mix these up constantly, so it is worth being clear:

• Botox relaxes muscles. It treats lines caused by movement — frown lines, forehead lines, crow’s feet.
• Dermal filler adds volume. It treats lines and hollows caused by lost volume — sunken cheeks, deep smile lines, thin lips.

Many patients do best with a little of both. That is exactly the kind of judgment call your consultation is for.

What Botox Treats

Botox Cosmetic is FDA-approved for four areas of the face:

Area	What patients call it	Typical dose
Glabellar lines	The "11s" between the eyebrows	About 20 units
Forehead lines	Horizontal lines across the forehead	About 20 units
Lateral canthal lines	Crow’s feet at the outer eyes	About 24 units
Platysma bands	Vertical neck bands	About 26–36 units

Botox is also widely used by physicians for other concerns — a gummy smile, a lip flip, jaw slimming and clenching, chin dimpling, underarm sweating, and certain headache patterns. Some of these are FDA-approved medical uses and some are used off-label, which is common and legal in medicine. Dr. Vargas will tell you plainly which category your treatment falls into before you agree to anything.

Why Patients Choose Ivy en Rose for Botox

Ivy en Rose is a physician-led medical clinic in West Portal offering pain management, wellness, and aesthetic medicine. Botox treatment plans are set by our Medical Director, Andrew Vargas, MD. He injects patients himself, and our registered nurses and nurse practitioners inject under his on-site supervision. Product is sourced through authorized channels, stored and handled properly, and every treatment is documented in a medical chart. A two-week follow-up is included so we can check your result and make any adjustment you want.

What Happens at Your Appointment

• Consultation — about 15 minutes — You tell us what bothers you. Dr. Vargas reviews your health history and medications, examines how your face moves, and explains what Botox can and cannot do for you. You get a unit count and a written treatment plan.
• Photos — We take standardized before photos. Two weeks later you will be glad we did — memory is a terrible judge of your own face.
• Prep — about 5 minutes — We clean the area. Numbing cream or ice is available if you want it, though most patients skip it.
• Injections — 5 to 10 minutes — A series of quick injections with a very fine needle. Most people describe it as a brief pinch or a tiny pinprick. It is over before it becomes uncomfortable.
• Aftercare — about 5 minutes — We go over your instructions, hand you a printed copy, and book your follow-up. You walk out and go back to your day.
• Two-week follow-up — included — We check your result against your photos and adjust if needed.

Total time in the building is usually 30 to 45 minutes for a first visit and about 20 minutes after that. There is no downtime, no anesthesia, and nothing you need a ride home from.

Before Your Botox Appointment

Most bruising and most disappointing results trace back to something that happened before the needle ever came out. These steps take almost no effort and they matter.

One to two weeks before

• Book with time to spare. Schedule at least two to three weeks before a wedding, photo shoot, or big event. Botox needs about 14 days to settle, and you want room for a touch-up.
• Skip facials, peels, waxing, and lasers on the treatment area for about two weeks beforehand.

Seven days before

• Pause anything that thins the blood, if your prescribing doctor says it is safe to stop. That includes aspirin, ibuprofen and other NSAIDs, fish oil, vitamin E, ginkgo, ginseng, St. John’s wort, and high-dose turmeric. Never stop a prescribed blood thinner on your own — tell us instead and we will work around it.
• If you bruise easily, oral arnica montana starting a few days before can help.

Twenty-four hours before

• No alcohol. It dilates blood vessels and is the single most common reason patients bruise.
• Go easy on caffeine the morning of, if you can.

The day of

• Eat something. Coming in hungry is how people get lightheaded.
• Come with a clean face or plan to have your makeup removed.
• Bring your medication list — prescriptions, supplements, everything.

Tell us before we inject if any of these apply to you:

• You are pregnant, trying to become pregnant, or breastfeeding
• You have a neuromuscular condition such as myasthenia gravis, Lambert-Eaton syndrome, or ALS
• You have had a bad reaction to any botulinum toxin product before
• You are on a blood thinner, an antibiotic, or a muscle relaxant
• You have an active skin infection, cold sore, or rash in the treatment area
• You have had facial surgery, or you have drooping eyelids or brows
• You have had any injectable treatment in the last three months, anywhere

None of these automatically rule you out. They change how we plan — which is exactly why we ask.

After Your Botox Appointment

Botox stays where it is placed as long as you give it a few hours to settle. Nearly all aftercare is about not pushing it somewhere it should not go.

The first 4 hours — the ones that count

• Stay upright. No lying flat, no naps, no face-down massage table.
• Do not rub, press, or massage the treated area. Be careful washing your face, and skip the hat or headband that sits across your forehead.
• Gently exercise the treated muscles. Frown, raise your brows, squint a few times an hour. Some patients find this helps the product take up.
• Leave makeup off for at least four hours. Applying it means rubbing.

The first 24 hours

• No strenuous exercise — no running, weights, hot yoga, or anything that gets your face flushed.
• No alcohol.
• No heat. Skip saunas, steam rooms, hot tubs, sunbathing, and very hot showers.
• Sleep on your back the first night if you can.
• Ice gently for a few minutes at a time if you have swelling — rest the pack on the skin, do not press.

The first two weeks

• No facials, massages, microdermabrasion, microneedling, chemical peels, or laser on the treated area.
• Wear sunscreen. Every day, but especially now.
• Be patient. Movement fades gradually and often unevenly at first. That is normal and it is not the final result.
• Come to your two-week follow-up. This is when adjustments get made.

What is normal in the first few days

• Small red bumps at the injection sites that fade within an hour or two
• Mild tenderness, tightness, or a heavy feeling in the forehead
• Pinpoint bruising, which is easily covered with makeup after 24 hours
• A mild headache for a day or so
• Uneven movement while the product settles

Call us at (628) 226-5605 right away if you have:

• A drooping eyelid or eyebrow, or double or blurred vision
• Trouble swallowing, speaking, or breathing
• Muscle weakness spreading away from the injection area
• Spreading redness, warmth, pus, or a fever
• Hives, swelling of the face or throat, or difficulty breathing

Serious side effects from cosmetic Botox are rare, but we want to hear from you rather than have you wait it out. If you have trouble breathing or swallowing, call 911 first.

When Will I See Results?

• Days 1–2 — Nothing much yet. Any small bumps are gone. This is normal — Botox does not work instantly.
• Days 3–5 — You start noticing that the muscle does not move the way it used to. Lines begin to soften.
• Days 7–10 — Most of your result is visible. The skin over the treated muscle is smoothing out.
• Day 14 — full effect — This is your real result, and the right time to judge it. Come in for your included follow-up.
• Months 3–4 — Movement gradually returns. Most patients rebook somewhere in this window.
• Long term — Patients who treat consistently often find they need slightly fewer units over time, because the muscle is no longer being trained into the same crease.

Is Botox Right for You?

Botox tends to work well if you

• Have lines that appear or deepen when you make an expression
• Are bothered by looking tired, stern, or angry when you feel fine
• Want a subtle, reversible change with no downtime
• Are in good general health
• Have realistic expectations about what a muscle relaxant can do

Botox may not be the right first step if you

• Have deep lines that are fully visible at complete rest — those often need filler, resurfacing, or a combination
• Are mainly bothered by loose skin or lost volume rather than movement
• Are pregnant or breastfeeding
• Have a neuromuscular disorder
• Have an infection in the area you want treated

If Botox is not what will actually get you the result you want, we will tell you that at your consultation.

Book Your Botox Consultation

Ivy en Rose

323 W Portal Ave, San Francisco, CA 94127 (628) 226-5605 [[HOURS — e.g. Mon–Fri 10am–6pm, Sat 10am–4pm]] Serving West Portal, Forest Hill, St. Francis Wood, Noe Valley, the Sunset, and the greater San Francisco Bay Area.

Frequently Asked Questions

Does Botox hurt?

Very little. We use an extremely fine needle and most patients describe a quick pinch, similar to a tiny pinprick, that lasts a second or two per injection. The whole set of injections takes about five minutes. Numbing cream or ice is available if you would like it, though most people find they do not need it.

Who will actually inject me — a doctor or a nurse?

Andrew Vargas, MD, our Medical Director, sets every treatment plan and injects patients himself. Our registered nurses and nurse practitioners also inject, and they do so under his direct, on-site supervision. If you would like Dr. Vargas to perform your injections personally, just say so when you book and we will schedule you with him.

How long does Botox last?

Typically three to four months. Some patients get a little more, some a little less. Strong muscles, high metabolism, and heavy exercise tend to shorten it. Most patients settle into treating three times a year.

How soon will I see results?

You will usually notice the first change on day three to five, most of your result by day seven to ten, and the full effect at about two weeks. Do not judge your result before day fourteen.

Will I look frozen or fake?

Not if it is dosed and placed well. A frozen look comes from too much product in the wrong muscles. We start conservatively and can add more at your two-week follow-up if you want a stronger result.

How many units will I need?

It depends on your muscle strength and anatomy, not on your age. Common ranges are 18 to 25 units for frown lines, 10 to 20 for the forehead, and 18 to 24 for crow’s feet. Men often need more because the muscles are stronger. You will get an exact number at your consultation.

Is Botox safe?

Botox has been FDA-approved for cosmetic use since 2002 and is one of the most extensively studied aesthetic treatments available. The most common side effects are minor and temporary: injection site tenderness, small bruises, and occasionally a mild headache. Serious side effects are rare.

What is Botox made of?

Botox is a purified protein called onabotulinumtoxinA. It is produced from a bacterium and then purified and diluted to an extremely small, controlled dose. It works only on the muscles it is injected into and its effect wears off on its own.

Can I exercise after Botox?

Wait 24 hours before any strenuous exercise. Increased blood flow and flushing in the first day can raise your chance of bruising and, in theory, of the product moving. A gentle walk on the day of treatment is fine.

Can I get Botox before a wedding or big event?

Yes, and it is a great idea if you plan ahead. Book your treatment two to three weeks beforehand so the result has settled and there is time for a touch-up. If this is your very first time, aim for four to six weeks out so you know how you respond.

What is the difference between Botox and filler?

Botox relaxes muscles and treats lines caused by movement, such as frown lines and crow’s feet. Filler adds volume and treats hollows and folds caused by lost volume, such as flat cheeks or deep smile lines. They solve different problems and are often used together.

What happens if I stop getting Botox?

Nothing bad. Muscle movement gradually returns over three to four months and your lines go back to the way they were. Botox does not make wrinkles worse and there is no rebound effect.

Am I too young — or too old — for Botox?

Botox Cosmetic is approved for adults. Patients in their late twenties and thirties often start preventively, when lines are only visible during expression. Patients in their fifties and beyond can still get excellent softening, though deeper set lines usually respond best when Botox is combined with something that treats skin quality or volume. What matters is your face, not your birth year.

What if I do not like my results?

Come to your two-week follow-up and tell us. If the result is too subtle, we can add units. If something looks uneven, we can usually balance it. Botox is temporary either way, so nothing about your result is permanent.

Do you offer Dysport?

Yes. We offer both Botox and Dysport. Dysport is another botulinum toxin that works the same way. It tends to start working a day or so sooner and spreads a little more from each injection point, which some patients prefer for larger areas like the forehead. Units are measured differently between the two, so a Dysport dose is not the same number as a Botox dose. Dr. Vargas will go over which one fits your goals at your consultation. Ivy en Rose is a physician-led medical clinic in West Portal, San Francisco, under Medical Director Andrew Vargas, MD. This page is general information about Botox and is not medical advice or a promise of a specific result. Individual results vary. Botox Cosmetic is a registered trademark of Allergan Aesthetics, an AbbVie company; Ivy en Rose is not affiliated with or endorsed by Allergan. A consultation is required to determine whether treatment is appropriate for you.