Other 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. When properly used, the injectable derivatives are both safe and effective in selectively paralyzing certain muscles of facial expression. This temporarily 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 patients.
- Physicians perform all Botox treatments.
- We routinely use a concentration of 2.5 Units/0.1 cc – a proven dose for maximum effectiveness and duration.
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 one’s 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 is a medication that weakens or paralyzes muscles. When injected into or near muscles which contribute to wrinkles, these lines may soften or disappear altogether. Wrinkles most commonly treated are crow’s feet, frown lines and forehead lines. Other lines are less commonly treated and the treatments are also less effective.
BOTOX has other uses as well. Botox is an effective treatment 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.
However, patients should consider the following:
- 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 plastic surgeon.
- 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.