Botox FAQ

·                     What is a BOTOX® Injection?

"BOTOX® injection" or "botox shot" is the term most widely used to describe the procedure of adminstering the Allergan BOTOX® Cosmetic treatement. BOTOX® injections utilize Botulinum Toxin Type A to treat wrinkles. BOTOX® Injections were originally slated to treat neurological disorders; today, BOTOX® injections are widely used to remove facial lines, especially frown lines, "crow's feet," and forehead lines.

·                     What is a BOTOX® treatment?

"BOTOX® treatments", or "BOTOX® injection treatments" are a therapeutic muscle-relaxing agent that works at motor nerve endings (nerves that lead to muscles). BOTOX®® Cosmetic is a drug used for the temporary improvement in the appearance of moderate to severe glabellar lines (frown lines). These frown lines come from muscles called corrugator and/or procerus muscles. The BOTOX® injection treatment is the name used for the process of injecting the BOTOX® Cosmetic product into the patient.

BOTOX® injection treatments were approved by the U.S. Food and Drug Administration (FDA) for cosmetic use in April 2002. (It has been approved for the treatment of several medical conditions since 1989.) BOTOX® is a trade name for botulinum toxin A. BOTOX® is related to botulism.

BOTOX® injection treatments are successfully used to treat blepharospasm and strabismus, and BOTOX® treatments are also proven useful in treating cervical dystonia -- these are all conditions that in some way involve spasms, involuntary muscle contractions. Within a few hours to a couple of days after the botulinum toxin is injected into the affected muscle(s), the spasms or contractions are reduced or eliminated altogether. The effects of BOTOX® treatments are not permanent, reportedly lasting anywhere from three to eight months. By injecting the toxin directly into a certain muscle or muscle group, the risk of the BOTOX® injection treatments spreading to other areas of the body is greatly diminished.

When BOTOX® -- botulinum toxin A -- is injected into the muscles surrounding the eyes, for instance, those muscles can not "scrunch up" for a period of time. They are paralyzed. So the wrinkles in that area, often referred to as "crow's-feet," temporarily go away.

·                     What is BOTOX® Cosmetic?

BOTOX® Cosmetic is the product name for Allergans cosmetic wrikle removing drug. BOTOX® Cosmetic is a therapeutic muscle-relaxing agent that works at motor nerve endings (nerves that lead to muscles). BOTOX® Cosmetic is a drug used for the temporary improvement in the appearance of moderate to severe glabellar lines (frown lines). These frown lines come from muscles called corrugator and/or procerus muscles. BOTOX® Cosmetic is the name used for the process of injecting the BOTOX® Cosmetic product into the patient.

In April of 2002 BOTOX® Cosmetic was first approved by the U.S. Food and Drug Administration (FDA), following previous approvale for severe medical problems as afr back as 1989. BOTOX® Cosmetic is the trade mark that Allergan decided to use to refer to their botulinum toxin A product. BOTOX® injections are related to botulism.

BOTOX® treatments are successfully used to treat blepharospasm and strabismus, and BOTOX® cosmetic are also proven useful in treating cervical dystonia -- these are all conditions that in some way involve spasms, involuntary muscle contractions. Within a few hours to a couple of days after the botulinum toxin is injected into the affected muscle(s), the spasms or contractions are reduced or eliminated altogether. The effects of BOTOX® Cosmetic are not permanent, reportedly lasting anywhere from three to eight months. By injecting the toxin directly into a certain muscle or muscle group, the risk of BOTOX® Cosmetic spreading to other areas of the body is greatly diminished.

When BOTOX® Cosmetic -- botulinum toxin A -- is injected into the muscles surrounding the eyes, for instance, those muscles can not "scrunch up" for a period of time. They are paralyzed. So the wrinkles in that area, often referred to as "crow's-feet," temporarily go away.

·                      What are the side effects of BOTOX® treatment?

Typically the amount of BOTOX® and side effects and BOTOX® danger remains low. Any BOTOX® side effects can typically only last 6 months at a maximum, because BOTOX® treatments are temporary. People with neuromuscular disorders should consult with their physician carefully before having a BOTOX® injection treatment, as cardiovascular problems may arise. Likewise, those with cardiovascular disease should also pay special attention.

It is a natural response to assume there is some BOTOX® injection danger with a prosuct derived from a toxin, but it is in fact very safe, and has been is use for some time. It is always prudent to refview the BOTOX® injection side effects and procedure so that any BOTOX® injection danger is know and understood.

Some patients have been known to experience the side effects of BOTOX® of bruisng at the site of the injection. The most common BOTOX® side effects following the use of BOTOX® Cosmetic for glabellar lines are headache (13.3%), respiratory infection (3.5%), temporary eyelid droop (3.2%), nausea (3.0%), and flu syndrome (2.0%). Blepharoptosis is consistent with the pharmacologic action of BOTOX® Cosmetic and may be technique related. In rare occurences BOTOX® cosmetic can spread into neighboring muscles and cause temporary paralysis. In less that 1% of patients, this can cause drooping of the eyelid.

Less frequently side effects of BOTOX® occurring (<3%) adverse reactions included pain in the face, erythema at the injection site, and muscle weakness. These events are thought to be associated with the injection and occurred within the first week.

·                     How does BOTOX® Cosmetic work?

In laypersons terms, BOTOX® simply keeps the muscles that cause frown lines from contracting. This causes the skin to become smoother. Normally your brain sends electrical messages to your muscles so that they can contract and move. BOTOX® keeps that message from getting to the muscle that causes the wrinkles.

Technically, BOTOX®® Cosmetic is injected directly into the corrugator and procerus muscles. It then goes on to enter the nerve endings to block the release of acetylcholine, the chemical that causes muscles to contract. BOTOX®® works to block the release of acetylcholine and, as a result, the muscle doesn't receive the message to contract. Once the muscles are at rest, the skin becomes smoother, creating a more natural and relaxed appearance.

·                     Is BOTOX® Cosmetic safe for me?

Ask your doctor if BOTOX® is the right treatment for you. BOTOX® should not be used during pregnancy, if you are nursing, or if you are taking certain medications. Only your physician can determine the best course of therapy. Botox should not be used on patients who are pregnant, breastfeeding or have a neurologic disease. The effects of BOTOX® may be increased with the use of certain antibiotics or other drugs that interfere with neuromuscular transmission. Ensure that your doctor is aware of any current medications you are taking.

·                      How effective is BOTOX®® Cosmetic?

In a clinical study with BOTOX® Cosmetic, the majority of patients (82.5%) reported an improvement in glabellar lines after a week. Results were still reported up to 4 months later.

·                     How long does the BOTOX® injection procedure take, and how long to recover?

Performed in the office, the procedure takes about 10 minutes. Since the procedure is nonsurgical, no recovery time is needed. After BOTOX® Cosmetic treatment, you can get back to work or other activities right away.

·                     How long does BOTOX® last?

This depends entirely on the patient, but a single treatment of BOTOX® will normally be sustained for approximately three months. You will notice a gradual fading of its effects. At this point you will return to your doctor for your next treatment.

Usually, BOTOX® treatment is required only three or four times a year. Symptoms may vary throughout the course of the condition, and so the degree of relief and duration of effect varies from person to person. Consult your doctor, who has special knowledge about how to achieve the best possible results with BOTOX® for your individual case.

Acceptable safety in long-term treatment has been well established. With dosing specific to treat frown lines, this same product is now marketed as BOTOX® Cosmetic. However, formal clinical evaluations of long-term treatment have not been conducted.

Chemical Peel

Chemical peels

Chemical peels

   FAQs

Chemical peels correct a variety of skin imperfections such as blemishes, wrinkles, and uneven pigmentation. They exfoliate the outer layers of dead skin, revealing a new skin layer with improved tone, texture, and color. In addition to full facial rejuvenation, certain types of skin peels can also be used for spot treatments and as a way to remove stretch marks or rejuvenate skin elsewhere on the body.

What are chemical skin peels?

In performing chemical peels, physicians apply alpha hydroxy acids (AHA), trichloroacetic acid (TCA), or phenol to the skin reduce or eliminate fine lines, acne scars, sun damage, and other skin imperfections. After a chemical peel, the outer layers of skin in the treated area slough off, revealing a new layer of skin. TCA and phenol skin peels require at-home recovery of two weeks or more. Light skin peels, however, are so mild that there is little recovery time, and improvement in the skin’s appearance is immediately visible.

·                     What are the different types of chemical skin peels?

There are several types of chemical peels, each indicated for different types and degrees of skin problems.

    Light (glycolic acid or salicylic acid) chemical peels can improve rough, dry skin, as well as uneven pigmentation. They can also improve the texture of sun-damaged skin and help control acne. Because a light chemical peel is the mildest type of peel and penetrates the skin the least, multiple treatments may be necessary to achieve the desired results.

    Medium (TCA) chemical peels are best for people who want to smooth out fine wrinkles, remove superficial blemishes, and even out skin pigmentation. Medium skin peels can be used on any part of the body, and the peel depth can be adjusted to best suit the needs of the individual patient.

    Deep (phenol) chemical peels can remove major blotching, such as that caused by aging, sun exposure, or birth control pills. Deep peels can also be used to smooth deeper wrinkles. Deep skin peels are only used on the face.

    Acne chemical peels help to control acne and smooth acne scars. A mild, medium, or deep chemical peel may be used, depending on the patient’s skin condition. As with cosmetic chemical skin peels, an acne chemical peel can also reduce or eliminate wrinkles and improve skin pigmentation.

·                     Which type of chemical peel is right for me?

Only a qualified cosmetic dermatologist or plastic surgeon can determine which type of skin peel is appropriate for you. In deciding who is a good candidate for a chemical peel, a physician must consider several factors, including the patient’s medical history, pigmentation, the skin condition to be treated (especially the extent of sun damage), and desired results.

·                     How are chemical skin peels actually performed?

Some aspects of the chemical peel procedure differ according to the type of peel (light, medium, or deep) being administered. However, all skin peel procedures follow the same basic protocols:

    The chemical peel is administered in a doctor’s office, surgery center, or hospital by a certified and trained cosmetic dermatologist or plastic surgeon.

    If a deep chemical peel is being administered, or if the patient requests it, the patient is given a sedative to aid relaxation.

    The doctor cleanses the patient’s skin and, if necessary, applies a topical anesthetic to the treatment area.

    The doctor then applies the chemical peel solution. This solution is formulated according to each patient's specific needs and goals. It is common for the patient to feel a tingling or stinging sensation as the

    chemical peel is applied.

    After the skin peel solution has been on the skin for the prescribed amount of time, it is washed off with water. A soothing ointment is then applied; a thick coating of petroleum jelly is often used after deep

    chemical peels.

    The doctor then instructs the patient on aftercare, and the doctor may also prescribe a mild pain reliever for discomfort after the procedure, especially if a deep chemical peel was administered.

    Depending on the patient’s skin condition and the depth of the chemical peel, multiple treatments may be necessary to achieve the desired results.

·                     Can chemical peels be performed on areas other than the face?

Though deep (phenol) peels are only appropriate for the face, the skin on any part of the body can be treated with a special mix of the chemicals used in mild and medium skin peels.

The chemical solution for body chemical peels is typically comprised of a combination of trichloroacetic acid (the main ingredient in a medium-depth skin peel) and glycolic acid (the main ingredient of a mild peel). The solution for body chemical peels is typically formulated to be slightly stronger than the chemical solution used for light or medium facial skin peels, though it is milder than the phenol solution used for deep skin peels.

As with facial chemical peels, body peels address the effects of sun damage, even out skin pigmentation, and improve skin texture. Chemical peels can also be used on the body to minimize stretch marks. Read more about treating stretch marks with chemical peels.

·                     Will I be sedated during a chemical peel?

A local anesthetic in combination with mild or full sedation is typically used for deep chemical peels. For light and medium skin peels, no anesthetic or sedation is necessary, though patients may request a local anesthetic or mild sedation to alleviate discomfort.

·                     Are chemical peels painful?

In general, patients only feel a mild stinging sensation during light or medium chemical peels. After the procedure, the physician may prescribe a mild pain reliever to relieve any discomfort.

·                     Will my skin literally "peel"?

Chemical peels remove the outer layers of skin to reduce or eliminate the appearance of a number of skin imperfections and conditions. After a patient undergoes a skin peel, the treated layers of skin gradually flake away, revealing a fresh new layer of skin.

·                     How long is the recovery period after a skin peel?

The recovery time after a chemical peel depends on the type of peel administered, because each type of peel affects the skin to a different degree.

    Light chemical peels: These mild peels require virtually no recovery time. Though the skin may be mildly irritated after the peel, patients can return to their daily activities immediately after treatment.

    Medium chemical peels: The new layer of skin appears three to seven days after treatment. About two weeks after treatment, the skin will be fully healed.

    Deep chemical peels: The new layer of skin begins to appear seven to ten days after treatment, though complete healing can take two months or longer. Patients typically take a week off from work after undergoing 

    a deep chemical peel.

Dermal Filler Aplication

Dermal fillers FAQ

·                    

 What are injectable dermal fillers?

Injectable dermal fillers are injectable gels made from naturally-occurring substances, including collagen and hyaluronic acid. Dermal fillers are injected just under the skin in order to add volume to aging skin, lips and to fill and lift wrinkles and folds. Dermal fillers add volume for a more natural youthful appearance.

The majority of dermal fillers contain hyaluronic acid as their main active ingredient. Hyaluronic acid based dermal fillers include Restylane and Juvederm. Hyaluronic acid is a natural component of the skin.

Injectable dermal fillers are used to fill wrinkles, lines, folds, and scars (eg. acne scars). Dermal fillers are also commonly used to give a fuller appearance to the lips.

The most common areas treated with injectable dermal fillers are the smile lines around the nose and mouth, fine lines above the mouth, frown lines between the eyes, and acne scars.

·                     What are other names for injectable dermal fillers?

Injectable dermal fillers are also known as cosmetic fillers, injectable cosmetic fillers, dermal fillers, facial fillers, injectable facial fillers, tissue fillers, injectable tissue fillers soft tissue fillers, injectable soft tissue fillers, injectable hyaluronic acid, injectable collagen and just plain and simple injectable fillers.

·                     What are some examples of dermal fillers?

Some examples of dermal fillers include:

Restylane

Juvederm

Radiesse

Sculptra

Hylaform

Artefill

CosmoDerm

CosmoPlast

Cymetra

ZyDerm

ZyPlast

Hydrafill

Bio-Alcamid

Laresse

DermaLive

DermaDeep

·                     How do injectable dermal fillers work?

The skin is made of two layers, an outer layer called the epidermis and an inner layer called the dermis. The area between these two layers contains a jelly-like substance called hyaluronic acid. When we are young, our skin contains plenty of hyaluronic acid. However, when we age the hyaluronic acid between the layers of our skin diminishes. This decrease in hyaluronic acid causes the skin to lose its natural volume and fullness and creates wrinkles or folds. Dermal fillers replace the natural hyaluronic acid and add volume and firmness to the skin.

·                     How are Dermal Filler Treatments Performed?

A skin test needs to be performed before the injectable filler procedure if a collagen based dermal filler is being used. The skin test is required because approximately 3% of people are allergic to the collagen in these dermal fillers.

A skin test is not necessary if a hyaluronic acid based dermal filler is being used.

Before the procedure begins, some clinics and most patients prefer to numb the face with a topical anesthetic cream. If the procedure if for lip augmentation, anesthetic injections can be used.

During the dermal filler procedure, the dermal filler gel is applied under the skin in tiny amounts using a very fine needle. The procedure can be mildly uncomfortable.

The dermal filler treatment procedure can take up to an hour to complete. However, most treatments only take 5 to 10 minutes.

If the procedure is on a smaller area many people can resume their regular daily activities right away. If larger areas are treated longer recovery times may be required, up to a couple of days. The gel produces volume under the wrinkle, which is lifted up and smoothed out. When enhancing lips or facial contours, Fillers add volume and shape to the treated area.

·                     How Long Does It Take To Have A Dermal Filler Treatment Done?

Cosmetic procedures involving dermal filler treatments are usually very quick and easy. Most dermal filler treatments take from 5 to 30 minutes. The time to complete the procedure differs somewhat, depending on the type and extent of the correction that you wish to have performed.

·                     Do Injectable Dermal Filler Treatments Hurt?

This answer to this question depends on the person. Some people have much more sensitive pain responses compared to other people. Most people do not find that the injections hurt.

The level of discomfort also depends on the areas being treated. Treatments around the lips and nose tend to cause the most discomfort.

The use of topical anesthetic creams or ice packs before the procedure can greatly reduce the level of discomfort.

·                     How Quickly Do You See Results After The Injectable Dermal Filler Procedure?

The results of a dermal filler procedure can be seen right away. The result do tend to improve for a few hours after treatment.

·                     How Long do Injectable Dermal Filler treatments last?

The Results obtained with dermal fillers typically last 6 to 9 months. The results may last up to a year in some people. How long results last varies from person to person. Dermal fillers are gradually broken down and absorbed by the body, so the lines, wrinkles or lips will ultimately return to their previous appearance without follow up treatments.

USUALLY A FOLLOW-UP APPOINTMENT IS RECOMMENDED 2 WEEKS AFTER THE ORIGINAL PROCEDURE IN THE EVENT A TOUCH-UP IS REQUIRED. FOLLOW-UP APPOINTMENTS SHOULD ALSO BE SCHEDULED FOR 4 TO 6 MONTHS AFTER THE PROCEDURE.

·                     What Are The Common Dermal Filler Side Effects?

There are actually very few dermal filler side effects.

Some side effects of dermal fillers include:

    Bruising

    Mild swelling and redness

    Itching

    Discoloration

    Tenderness

    Rarely, redness, tenderness, and swelling develops a few weeks after treatment

    Also rarely granulomas can form. (Granulomas are inflammatory lumps under the skin that can last for months.)

·                     What Types Of Dermal Fillers Are Available?

Collagen: Originally, dermal fillers were all made of collagen derived from cows. This is referred to as bovine collagen.

Collagen is nature’s most abundant protein polymer. Collagen acts as a scaffolding for our bodies. It controls cell shape and cell differentiation. Collagen is the fibrous protein constituent of skin, cartilage, bone, and other connective tissue. It is the substance that fills the spaces between the cells of the body.

Collagen dermal fillers are not used as often now because of its potential to cause allergic reactions. Skin tests are preformed before treatment with bovine collagen dermal fillers to check for allergic sensitivity.

Today, collagen dermal fillers use human collagen. Cosmoderm, Cosmoplast, Zyderm and Zyplast are examples of human collagen-based dermal fillers still in use today.

Hyaluronic acid: (Restylane, Perlane, Juvederm, Juvederm Plus, Revanesse) The synthetic hyaluronic acid dermal fillers are the most common fillers in use today. If you see the term NASHA, this stands for Non-Animal Stabilized Hyaluronic Acid. The first hyaluronic acid products were made from rooster comb extracts. In fact, one product Hylaform is still made from rooster combs. The hyaluronic acid products used today are made by genetically copying human hyaluronic acid.

Poly-L-lactic Acid: (Sculptra) Sculptra is derived from fruit acids. It is a biocompatible and biodegradable injectable material known as poly-L-lactic acid that naturally stimulates the body to produce its own collagen.

Calcium Hydroxylapatite: (Radiesse) this product contains calcium hyroxylapatite (CaHA) microspheres. Calcium hydroxylapatite is one of the primary mineral substances of bone. No allergy testing is required. Over a period of weeks following injection your body encapsulates the microspheres with collagen, giving a filling effect. Because the calcium hydroxylapatite microspheres persist for 2-3 years, collagen production is continuous. This product provides the longest duration of all the temporary fillers, averaging about 18 months.

·                     What Problems Can Be Treated With Injectable Dermal Fillers?

Fillers can be used for smoothing out folds and wrinkles, lip enhancements and shaping facial contours. Commonly treated areas are the nasolabial folds (from the root of the nose to the angle of the mouth), the glabellar lines (between the eyebrows), the droopy mouth corners, and thinning lips, although other sites can also be treated.

·                     What Will I Look Like Immediately After The Dermal Filler Procedure?

You should expect to see some redness and swelling. This is quite normal with dermal filler treatments. If you are having a lip augmentation treatment done with dermal fillers your lips may be swollen for a few days afterwards.

·                     What properties does the ideal injectable dermal filler have?

The ideal injectable dermal filler has the following properties:

    non-permanent but long-lasting

    have minimal side-effects

    not require allergy testing

    be easy to use/inject

    be cost-effective both to the physician and patient.