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Injectables

office-new-2The cosmetic form of botulinum toxin, often referred to by its product name Botox®, is a popular injectable treatment. This purified toxin blocks the nerve impulses, temporarily paralyzing the muscles that cause wrinkles to give the skin a smoother, more refreshed appearance. Studies have also suggested that Botox is effective in relieving migraine headaches, excessive sweating and muscle spasms in the neck and eyes. Botulinum toxin can be used as a wrinkle treatment to smooth:

  • Frown lines
  • Crows feet
  • Forehead furrows
  • Skin bands on the neck

Smiling, frowning, squinting and even chewing – basically any facial movement can eventually lead to one of the most common signs of aging: wrinkles. They can make you appear tired or even angry when you are not. One of the quickest and safest remedies to remove wrinkles is an injection of botulinum toxin. Botulinum toxin can be combined with other cosmetic skin procedures such as chemical peels, dermal fillers or microdermabrasion to further improve your results. This combination of therapies can even help to prevent the formation of new lines and wrinkles.

Who Should Consider Botox?

Botox Cosmetic is indicated for the temporary correction of moderate to severe glabellar lines (frown lines) associated with corrugator and/or procerus muscle activity in patients 18 to 65 years of age. If you exhibit lines on the smooth part of your forehead above and between the brows (the glabella), you should consider treatment with Botox Cosmetic. Botox Cosmetic is contraindicated if the patient exhibits an infection at the proposed injection site(s) and or has a known hypersensitivity to any botulinum toxin preparation or to any of the components in the formulation. Do not undergo Botox if you are allergic to any of the ingredients or if you have experienced an allergic reaction to another product containing botulinum toxin. Ask your plastic surgeon about the possible side effects of Botox. Botulinum toxins won’t fix all types of skin problems. For example, while it can diminish under-eye wrinkles, it can’t repair the damage caused by the sun. Your skin thickness, type, and the degree of wrinkling all play a role in determining the effectiveness of botulinum toxin. A qualified plastic surgeon is the best person to evaluate the appropriateness of this treatment for you personally.

Special Considerations, Risks and Recovery

You may resume normal activities immediately. One note of caution: Don’t rub or massage the treated areas after the wrinkle treatment because it can cause the botulinum toxin to migrate to another area of your face. If this happens, you could have temporary facial weakness or drooping. Although generally safe, botulinum toxin side effects and complications can include:

  • Bruising and pain at the injection site
  • Redness
  • Headache
  • Flu-like symptoms
  • Nausea
  • Temporary facial weakness or drooping
  • Very rarely, the toxin can spread beyond the treatment area, which can cause botulism-like signs and symptoms such as breathing problems, trouble swallowing, muscle weakness and slurred speech.

Fillers can be permanent non autologous (Sculptra) or autologous (fat) or temporary (Restylane,  Voluma, Juvederm). Restylane is the number one selling hyaluronic acid (HA) dermal filler and the most-studied cosmetic filler in the world. Restylane, Juvederm, Belotero are FDA approved. With these injections, you can achieve natural-looking results in just one visit that deliver long-lasting results of 6 to 18 months.  The differences between fillers have to do with thickness cross linkage and longevity. In general, the thicker the filler, the better it will fill creases, but the greater the chance of possible bumps. Bumps are more likely in thinner skin such as the lower eyelids, and crow’s feet. Fillers can also be used to improve or enhance facial structures. Dr. Paul’s preference is hyaluronic acid fillers, as they are relatively safe, with immediate results and almost no downtime. These fillers are not of animal or human origin, therefore a skin test is not needed and you can have the HA treatments performed immediately. When treating wrinkles or folds, the filler is injected under the skin in tiny amounts with a very thin needle or cannula. These injections give natural volume under the wrinkle, which is lifted up and smoothed out. A typical treatment takes about 15 minutes and the results can be seen immediately.  Dissolvable fillers are used for enhancing cheek bones to make them fuller and more defined, to fill in the nasolabial fold, to enhance brow and volumize hollow upper lids and fill in hollows under the eyes (tear trough) that contribute to dark circles. These fillers are biodegradable which means that they will gradually be absorbed. As the gel breaks down, water takes its place, and when totally absorbed, the HA gel disappears unnoticed from the body. How long a HA treatment holds its effect is very individual. This depends on many factors, such as your age, skin type, lifestyle, and muscle activity, as well as on product injected. It is important to understand the difference between Botox, a muscle relaxer, and Juvederm, Restylane, Collagen, etc. which are fillers. The easiest way to visualize the difference is to think of a crease as a valley between two mountains. Botox prevents the mountains from being pushed together, and fillers fill in the valley. As we get older, our creases also age. They become deeper and deeper, even when we are not frowning, squinting, or using facial muscles. If creases are only apparent when we squint, only Botox is needed. If creases are visible at rest, and not made worse by squinting, then fillers are necessary. If creases are present at rest, and get worse with facial expressions, then Botox AND Fillers will be necessary.