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History/Background

• In 2002, FDA approved Botox® for temporary improvement of lines/wrinkles of the face (moderate to severe glabellar lines associated with corrugator and or procerus muscle activity).
• In 2005, Botox® ranked as the number one minimally invasive cosmetic procedure in the U.S.

Types/Usage

• Botox® is a manufactured injectable medication used therapeutically to reduce the strength of targeted muscle tissue.
• Botox® is a highly refined purified protein.  There are absolutely NO live bacteria in Botox®.
• Type A Clostridium Botulinum (Botox® and Dysport) and Type B Clostridium Botulinum (Myoblock) are now commercially available.

Mechanism of Action

• Botox® only works on “Dynamic Wrinkles” (wrinkles caused by contraction of muscle).
• Botox® acts by preventing the release of neurotransmitter acetylcholine from vesicles after neuromuscular junction.  In the absence of acetylcholine, muscle contraction is temporarily shut down.
• It takes 3-5 days for most patients to begin to lose muscle strength and 10-14 days to realize the full effects.
• When used to treat wrinkles/lines, a minute amount of the toxin in injected directly into the targeted muscle.  The shut down of muscle activity lasts from one-to-six months, depending on the patient.  Eventually, nerve endings recover and revert to normal acetylcholine release.  To maintain the therapeutic effect, another injection may be needed.
• Long-term regular use of the product obtains best results, and often patients will note longer duration of action, thought to be, in part, caused by mild atrophy of the hyper dynamic muscles.
• As the effect wears off, strength gradually returns (along with the wrinkles caused by movement), but wrinkles are not any worse than baseline.
  

Myths Associated with Bulinum Toxin A

• False – Botox® is new and untested.
• False – Botox® can give you botulism.
• False – I will lose sensation and will have numbness where Botox® is injected.
• False – Botox® pulls skin taunt.
• False – Botox® freezes your face and makes you lose expression.
• False – Botox® is a poison and is toxic to the body.

Areas Commonly Treated for Cosmetic Purposes

• Primary area of facial wrinkling associated with hyper-functional muscle movement include:
• Glabellar/frown lines (between the eyebrows).
• Horizontal forehead lines.
• Crows feet (outer eye areas).
• Radial lip lines (smokers lines).

Other Areas Treated With Advanced Techniques

• Gummy smile.
• Downturned oral commisures.
• Bruxism, clenching and TMJ parafunction.
• “Bunny lines” – lateral lines outside of nose.
• Tension headaches.

Safety Issues/Contraindications

• Pregnant/lactating women.
• Hypersensitivity to any ingredient including Albumin 9 Human Blood Product.
• Neurological disorders such as Amyotrophic Lateral Sclerosis (ALS), Myasthenia Gravis, or Lambert-Eaton Syndrome may be at increased risk of serious side effects.
• Flu or cold symptoms.
• Infection or dermatitis in areas being treated.

Precautions for Treatment

• Needle-related pain or anxiety.
• Special events in the new two weeks.
• Pre-existing eyelid or brow ptosis.
• Patients who have undergone surgical alterations in facial anatomy.
• Marked facial asymmetry.
• Deep dermal scarring.

Resistance

• Approximately 0.5-3% of patients develop resistance after they have used Botox® several times.
• To avoid resistance:
• Re-treatments should be spaced no more frequently than every 3 months.
• Use the lowest possible effective dose.
• Slightly alter the site of injection, if possible.
• Another type of Botox® may be used (ex: Myoblock).

Complications and Side Effects

• Transient Strabismus (“cross-eyes”, “lazy-eye”) – rare complication, but can occur; will resolve.
• Diploplia (double vision) – rate and will resolve.
• Lip Ptosis – can occur and may effect upper lip and corner of mouth; will resolve.
• Ecchymosis (bruising).
• Occasional heaviness sensation of the forehead.
• Transient headache, flu-like symptoms.
• Discomfort, swelling, redness.
• Weakness of lacrimal pump or dry-eye.
• Possible bacterial or fungal skin infection.
• Peaking of eyebrows (easily corrected with an enhancement treatment).

All side effects are temporary and resolve quickly!

See Consent Form

DERMAL FILLER TREATMENT

• Dermal fillers offer a minimally invasive treatment for static wrinkles of the face (wrinkles present at rest).

• Dermal fillers correct smile lines, downturned oral commisures, marionette lines, perioral lines, stubborn forehead lines, and scars.

• They can also add fullness to thinned lips and mid-face volume loss.

• Dermal fillers are used to refill, relax, resurface, and recontour the face.

Qualities of a Good Filler

• Look great with a pleasant cosmetic result
• Minimal complication that dissipates over time
• Technically easy to administer
• Non-migratory
• FDA approved
• Non-carcinogenic/non-toxic
• Non-animal/no skin testing

Temporary Hyaluronic Acid Fillers
Ex: Juvéderm Ultra, Juvéderm Ultra-Plus, Restylane, Perlane

• These are non-animal source stabilized hyaluronic acid.
• Hyaluronic acid exists naturally in all living organisms.
• The skin houses the vast majority (56%) of hyaluronic acid in the body.
• The primary function is to provide volume and pliability to skin and plays a crucial role in cell growth.
• Side effects are mild and transient in nature.
• Hyaluronic acid is rapidly reversible.

Contraindications

• Patients with severe allergies
• Patients with history of allergies to gram-positive bacterial proteins
• Pregnant or lactating women
• No treatment under the age of 18
• Patients who scar easily (susceptibility to keloid formation)

Complications

• Allergic reactions
• Granulomas
• Vascular occlusion

Side Effects

• Needle marks
• Ecchymosis – bruising
• Erythema
• Edema
• Acne-type eruptions

See Consent Form