BoTox Therapy

Introduction

      We offer BoTox injections that will rid your face of crow's feet, forehead lines, or frown lines. BoTox is a powerful medicine used to treat facial expression lines and neck banding as well as down-turned smiles and drooping eyes. Best of all, the procedure takes just a minute. This has become our most popular cosmetic procedure because it is safe and patients love the results.  

                                     

Botulism is food poisoning produced by a bacteria. BoTox is a medicine produced by the same bacteria. BoTox is not alive but is a protein that weakens and inactivates muscles. This is another example where natural products are used for medicinal purposes: fungi produce penicillin, cowpox virus protects against smallpox, foxglove plant produces the "poison" digitalis that millions of patients take daily for heart disease. Now with bioengineering it is common for bacteria to produce the necessary medicine for a specific disease.

Safety

While BoTox is potent medicine in high concentration, it is used in very small quantities with high margins of safety. After a muscle is injected, its first effects are not seen for 24 hours and the complete effect on the muscle will not be complete for two weeks. Fifty units (one half vial) or less of BoTox per session is generally used. To have toxic effects on a patient, over 2,000 units (costing $6,000) would have to be injected at one time. BoTox effects are attracted only to muscles, and it has no effect on the central nervous system or on the body if injected accidentally into a nerve or blood vessel. BoTox is also safe because complete recovery of the muscle is possible. Recovery is due to the body's excellent ability to form new fibers that allow activation of the muscles.

 

The Cosmetic Use Of BoTox

Cosmetic BoTox injections were pioneered in 1988 by a Vancouver ophthalmologist and her husband, a dermatologist. Since that time, this team of doctors has performed over 10,000 sessions on its patients. The ophthalmologist noted that the wrinkles disappeared in her patients with eyelid spasms who were treated with BoTox. This led to further research, which confirmed the effectiveness and safety of the BoTox vaccine for improving wrinkles due to overactive muscles of the face.

In 1996 at the annual meeting of The American Academy of Dermatology in Washington, a presentation by dermatologist Dr. Nicholas Lowe showed that BoTox was useful for improving facial expression lines. Significant improvement was noted on both forehead frown lines and crow's-feet. No significant side effects were noted beyond the expected injection discomfort. For 30 patients only 1 experienced a mild drooping of the upper eyelid, which cleared spontaneously. The length of effective improvement for the forehead frown lines was approximately 18 weeks. The degree of improvement of the crow's-feet was generally less than the forehead frown lines.BoTox is not 100% effective in all patients.

BoTox For Crow's-Feet

Wrinkles radiating from the corner of the eyes caused by smiling, laughing, or squinting are especially distressing to some individuals. Previously, no reasonable medical or surgical solution improved this problem due to the strong underlying muscles. Even with the deepest chemical peels or laser resurfacing techniques, rapid recurrence of these lines around the eyes is inevitable. Now for best results, BoTox injections are used in conjunction with resurfacing procedures. It is the function of BoTox to prevent the recurrence of wrinkles by inhibiting the underlying muscles.

Nasolabial Folds

This area is not ideal for correction by the BoTox method; it also presents a challenge in facelift surgery. This area is most dynamic when talking, smiling, and eating. As one ages, both muscle and fat are lost from this area. Replacement of fat is now possible, but the real advance in this area has been the development of a permanent filling agent with a high safety and satisfaction profile--Gortex. In addition the lips can be supplemented with these techniques. In Bruising summary for the area involving the lips and around the mouth, BoTox will not help this zone and is not recommended.

What Should Be Expected After BoTox Therapy?

BoTox is a remarkably safe therapeutic agent for wrinkles. Complications have been minor and only transient. may occur where injected and a brief pain or headache may follow. Bruising may be greater in patients who are taking aspirin or any blood-thinning medicines. These products should be avoided if possible prior to the injection. Ice helps prevent bruising. Muscle weakness is first noted at 24 hours; it is not immediate.

How Long Does BoTox Last?

After the first set of injections, reinjection after two weeks allows for an accurate localization of any resistant functioning muscles. With this method, 90% or more patients do respond to BoTox. This leaves 10% who do not respond. Successful therapy is signed by muscle weakness that begins at 24 to 48 hours after injection with a peaking weakness at seven days. Paralysis after the initial injection lasts between four and seven months for most patients.

How Often Is Reinjection Needed?

Reinjection is suggested every three or four months to keep the muscles paralyzed and allow the furrows to completely smooth out. Once an area is smooth, patients are instructed to return for therapy only when they notice a return of muscle movement, which may not occur for four months to one year or even longer.

Who Should Not Use BoTox?

• Although there have been no reports of birth defects with this medicine, no pregnant patients will be treated. It is also our policy not to inject BoTox in nursing mothers.

• Patients with a history of neuromuscular disease (multiple sclerosis and myasthenia gravis) or other types of diseases involving neurotransmission should avoid this medicine.

• Patients taking the following medicines should not receive BoTox: aminoglycoside antibiotics (Streptomycin, Tobmamycin, and Garamycin injections), penicillamine, and calcium channel blockers (Calan, Cardizem, Dilactor, Norvasc, Procardia, Verelan).

What Are Alternatives To BoTox?

Alternatives to BoTox are filling agents including fat, Collagen, Fibril and Gortex; resurfacing procedures with acids or lasers; and lifting operations of the forehead, temporal, neck, and midface regions. If no treatment, the lines and wrinkles persist.

What Unexpected Benefits Have Come From The Use Of BoTox?

Tension headaches have disappeared for some patients. These headaches occurred in patients who were recruiting forehead and brow muscles during periods of stress and tension. When these muscles were relaxed, the headaches faded.

How Exactly Does BoTox Inactive The Muscle?

BoTox inhibits the release of acetylcholine at the joining site of the nerve to the muscle so that the muscle never gets the message to contract. Remember, muscles only have the ability to contract: An opposing muscle contracts to produce movement in the opposite direction. To rejoin the nerve to the muscle the body organizes and produces new motor endplates, which re-establishes connection.

Does The Body Make Antibodies To The BoTox Protein?

Yes, especially if enough toxin is injected often enough. The crucial amount is about 100 units (less than the usual cosmetic dosage) and booster injections placed within one month of the initial injections. Antibodies have been more of a problem for neurological disorders where larger amounts of BoTox is required. When significant amounts of antibodies are formed, the therapeutic effects of BoTox are greatly reduced.

Have There Been Any Reported Cases Of Allergic Reactions Or Hives To BoTox?

There have been no reported cases of a true allergic reaction in nearly 20,000 treatments. People who are known to be allergic to Botulism toxin or albumin should avoid BoTox.

What Happens If A Female Patient Becomes Pregnant Shortly Before Or After Treatment?

A number of neurological and ophthalmologic patients have delivered normal children after receiving their injections. For safety reasons no pregnant or nursing females will be treated.

How Painful Are The Injections?

The smallest needles are used and the medicine itself does not sting as much as the usual local anesthetic. Most patients feel it less than collagen. Pain can be minimized by the use of ice cooling the skin just prior to injections. Some patients find that two Tylenol tablets before the injections reduce the discomfort.

What Can Be Done For The Drooping Eyelid If This Occurs?

There are two opthalmological preparations that are helpful: The first is 10% phenylephrine drops and the second is lopidine. Transient drooping of one eyelid or both is the most significant complication and occurs in 1% to 2% of all injections. This drooping is a result of the local dissemination of the toxin in the injection site and can be minimized by accurate dosing, as well as proper placement, and keeping the patient in an upright position for three to four hours after injection. If drooping eyelids occur, it is usually minimal and is usually resolved within two weeks.

As A Patient, After Receiving My Injections How Can I Help BoTox Be More Effective And Avoid Side Effects?

First, do not massage the area of the injection. Second, do not lie down for a nap; keep upright. Third, use the muscle; intentionally making the muscle contract helps localize the protein to the selected muscle for ablation.

When Injecting Muscles At One Site Will This Effect Remote Muscles?

BoTox spreads along muscle fibers and does not spread to distant areas by way of the blood stream.

Can BoTox Be Used To Weaken Not Totally Paralyze A Muscle?

Yes, in fact this is done so that the face will not be left expressionless. It can also be used to balance a weak muscle on the opposite side. By injecting medicine into the subcutaneous tissue not the muscle, and by using a smaller dosage, a weakening of the muscles is more likely occur.

For The Deepest Frown Furrows What Is The Recommended Method To Get These Deep Lines To Disappear?

In one study paralysis after the initial injection lasted 4-7 months. Reinjection every 3-4 months is recommended rather than waiting for the muscle to recover. This keeps the muscle paralyzed. It takes approximately 12 months for the skin to completely smooth out. It is usually 4-12 months before a return of muscle movement occurs and additional treatments are necessary.

What Accounts For The Fact That No Treatments May Be Necessary In Some Patients After Repeated Injection Sessions?

What happens is that the patient is broken of the bad frowning habits and may not relearn them for some time in the future.

 

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                               KENNETH GOODRICH, M.D.  -  OBSTETRICIAN- GYNECOLOGIST  
     
                                           Certified by the American Board of Obstetrics and Gynecology

           Specializing in General Obstetrics and Gynecology, Minimally Invasive Gynecological Surgery- Hysterectomies
              and Uterine Fibroids, HPV treatment for Women and Men, Surgery on Obese Women,  Chronic Vaginal
              Discharges, Sexually Transmiited Diseases, Menopause, Abnormal Bleeding ,Cellulite Reduction and
                                                                                 Aesthetic Services