Injectables: Botox, Dysport, Etc.
These products are derivatives of Botulinus
Endotoxin, which is toxin that when ingested can kill
an individual by paralyzing breathing muscle. Properly
used the injectable derivatives are both safe and effective
in selectively paralyzing certain muscles of facial expression
which minimizes or eliminates facial wrinkling.
BOTOX: OUR APPROACH
All patients are evaluated by a board
certified plastic surgeon prior to treatment.
The physician provides a thorough
discussion of options and limitations. Adequate
time for questions is made available.
Topical anesthetic is offered to all
Physicians perform all Botox treatments.
We routinely use a concentration of
2.5 Units/0.1 cc – a proven dose for maximum effectiveness
Botox is a purified form of Botulism Toxin (Botulinum Toxin
A). This toxin blocks the transmission of nerve impulses
to a muscle leaving it weakened or paralyzed. Dysport
is a similar Botulism toxin derivative from another manufacture,
which mainly adds competition to Botox, which hopefully
will reduce cost of both products.
Movement of the "muscles of facial expression" can
produce lines in ones face as skin thins with aging. These
expression lines or dynamic wrinkles can be effectively
treated with Botox. Lines unrelated to muscle movement
are not effected by Botox. The toxin is injected directly
into or very near the muscle with a tiny needle. The effects
begin to be seen in 4-5 days but the full effects are not
seen for 10-14 days. Duration of action varies, but may
last up to 4 months.
Recent surveys have shown that many people are looking
for the least invasive and least expensive treatments
for aging. Botox offers a very effective treatment for
early signs of aging, but only for wrinkles related to
muscle movement. It is not a magic bullet and it has
limitations. It does not work for lines not related to
muscle activity or drooping tissue. This is why a thorough
evaluation by an appropriately trained physician is so
vital to a good result. You must understand the effects
and the limitations of the drug and your needs.
The FDA has recently approved the cosmetic
use of Botox for the treatment of frown lines around the
eyes. Other “off-label” areas commonly treated are forehead
lines and crows-feet. These areas have a long history of
treatment and have been shown to be safe and effective
as well. Other uses of Botox include the treatment of sweating
and migraine headaches.
The risks are few and tend to be minor and
temporary. The most common side effect is bruising of the
area treated. Rashes can occur but are very rare. Inadequate
response can occur, but patients should wait 14 days before
the area is re-treated. Drooping of an eyelid from weakening
of the eyelid retractor muscles is a very rare complication.
This is treated with the use of prescription eye-drops
and the drooping is temporary.
The procedure takes approximately a few minutes
to perform. The muscles to be treated will be marked and
the area cleaned. The individual muscles are then injected
with a tiny needle. There is only a minor amount of discomfort
associated with the injection.
After the treatment you may notice some redness
and swelling of the area injected. This will resolve over
the next few hours. One should not rub this area for several
hours after injection as this may cause the toxin to move
away from the muscle to be treated. One should try to limit
physical activities and apply an ice pack to the treated
area for a period after treatment.
All of these will encourage the best and longest
lasting effect. Alcohol should be avoided around the treatment
time as it causes vasodilatation (flushing), which can
wash the toxin away. This is why Botox parties where alcohol
is served are not such a good idea.
Botox: Smoothing Out the Wrinkles
Cosmetic Surgery: Promises and Pitfalls™
is a medication that weakens or paralyzes muscles.
When injected into or near which contribute to wrinkles,
these lines may soften or disappear all together.
Wrinkles most commonly treated are crows feet, frown
lines and forehead lines. Other lines are less commonly
treated and their effects are also less well accepted.
Botox has other effects as well. Botox
is very effective for excessive sweating (hyperhidrosis)
of the armpits, hands and feet. Botox is also thought
to be effective for certain types of migraine headaches.
This is actively being researched and becoming a more
accepted treatment for migraines.
- Choosing Inappropriate Wrinkles:
Botox only effects wrinkles that are present with muscle
movement and disappear when the muscle is relaxed. Inappropriately
treating a line that is present without muscle movement
will lead to disappointment. An evaluation by a knowledgeable
physician will help you.
- Effect is not permanent: The
effects of Botox on facial wrinkles lasts 3-4 months
under the best circumstances. Certain conditions may
shorten the effective period. Permanent surgical options
may be available and they can be discussed with your
- Dilutional Tricks (Why some Botox
treatments are much cheaper than others): Botox
comes as a dry powder that must be reconstituted with
injectable saline. The vial comes with 100 units of
toxin. It is typically diluted with 2.5-4 cc of saline
(4-2.5 units per 0.1 cc - a typical injected volume).
Some physicians are selling very inexpensive Botox
treatments. Often these are very dilute formulations
of the product. It typically will work but for a much
shorter period of time. There is nothing wrong with
this as long as you know what you are getting.
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