Therapeutic Botox from a fellowship-trained neuromuscular specialist.
For movement disorders, dystonia, spasticity, hyperhidrosis, and TMD — by a neurologist who treats the underlying condition, not just the injection.
OnabotulinumtoxinA (Botox) has well-established uses across neurology beyond cosmetics. Dr. Warner performs therapeutic Botox personally in the Midtown East office, with EMG guidance available for selected dystonia and spasticity cases.
At a glance
Re-treatment cycle
Typically every 12 weeks; effect builds over the first 2–4 weeks.
Insurance coordination
Prior authorization handled in-office for covered indications.
Non-covered & cosmetic pricing
$15 / unit, with no hidden fees. See Fees for full transparency.
Complication management
Neuromuscular training to recognize and manage botulism, weakness from prior injections, and adverse spread.
Conditions treated with therapeutic Botox
Each condition has its own injection pattern, dosing range, and re-treatment cadence. Initial visits include a focused neurologic exam, discussion of prior treatments, and a customized treatment plan.
Cervical dystonia
Involuntary neck muscle contractions causing the head to twist, tilt, or shift (torticollis, laterocollis, anterocollis, retrocollis). Often painful. Botox is the first-line treatment, with injection patterns tailored to the muscles actually pulling — not a one-size-fits-all template.
Blepharospasm
Involuntary eyelid closure or forced blinking that interferes with vision and daily function. Targeted injections to the orbicularis oculi and surrounding muscles can dramatically reduce symptoms.
Hemifacial spasm
Involuntary twitching on one side of the face, often starting around the eye and spreading. Botox is highly effective and remains the mainstay of treatment for most patients.
Meige syndrome
Combined blepharospasm and oromandibular dystonia (jaw/face/tongue). Treatment requires careful targeting to balance symptom relief with preservation of speech and swallowing.
Spasticity
Muscle stiffness and involuntary contractions following stroke, brain injury, multiple sclerosis, or spinal cord injury. EMG-guided targeting helps reach deep muscles and improves outcomes.
Severe primary axillary hyperhidrosis
Excessive underarm sweating that doesn't respond to prescription antiperspirants. Botox blocks the nerve signals to sweat glands; a single treatment typically lasts 4–6 months.
Temporomandibular disorder (TMD/TMJ)
Jaw pain, clenching, bruxism, and tension headaches related to overactive masseter and temporalis muscles. Targeted injections can reduce muscle activity, pain, and grinding.
Chronic migraine
FDA-approved for chronic migraine using the PREEMPT protocol (31 sites). See the migraine page for qualification criteria and what to expect.
Why a neuromuscular specialist matters for Botox
Targeting
Knowing which muscles to inject — and which to leave alone — comes from understanding the underlying movement disorder. Fellowship training in neuromuscular medicine includes the anatomy and physiology of these conditions, not just the injection technique.
Dosing
Doses are individualized based on the muscle, the condition, prior response, and side-effect profile. Generic dosing protocols underdose some patients and overdose others.
Complication management
Neuromuscular training is what's required to recognize and manage adverse events — botulism, distant weakness from spread, antibody resistance, and the rare patient who needs a different toxin formulation.
What to expect at your visit
First visit
- Focused history of the condition and prior treatments
- Targeted neurologic exam, including evaluation of muscle activity at rest and with movement
- Discussion of treatment goals and realistic expectations
- Insurance coordination and prior authorization where applicable
- Initial injection at the same visit when appropriate
The injection itself
- Small-gauge needles, typically without numbing
- EMG guidance available for selected dystonia and spasticity cases
- Most appointments take 15–30 minutes
- Resume normal activities the same day
- Effect usually onsets within 3–14 days, peaks at 4–6 weeks
Follow-up & re-treatment
Most patients return every 12 weeks. Follow-up visits include a brief assessment of response and side effects, dose adjustments where needed, and re-injection. Between visits, message the office through the patient portal if symptoms return early or new questions come up.
Pricing & insurance
Insurance-covered indications
For FDA-approved indications (chronic migraine, cervical dystonia, blepharospasm, spasticity, hyperhidrosis), most insurance plans cover Botox when criteria are met. The office handles prior authorization paperwork.
Out-of-network billing applies for the office visit; superbills are provided so you can submit for reimbursement from your insurer.
Non-covered & cosmetic Botox
$15 per unit, with no hidden fees and no upcharges. Typical doses by area:
- Glabellar lines: ~20 units
- Forehead: ~10–20 units
- Crow's feet: ~12–24 units
- Masseter (TMD/jaw slimming): ~25–50 units per side
Final dose is determined at the visit based on muscle activity. See the Fees page for full pricing transparency.
Book a Botox consultation
Whether this is your first time considering Botox or you're switching providers because the previous results weren't quite right — schedule a visit to discuss the right approach for your condition.