Botox Cosmetic

The use of Botox® brand Botulinum Toxin has been recently approved by the FDA for treating wrinkles in the glabellar area. This therapy involves injecting small amounts of the toxin into the facial muscles responsible for movement associated with lines and wrinkles. This injection weakens or paralyzes the muscle, thus reducing the associated lines and wrinkles. The most common areas that this therapy is used are the lines between the eyes, forehead wrinkles, crow’s feet, necklines, and on occasion around the mouth. This therapy is temporary meaning it has to be repeated on a regular basis to maintain the results. The weakening effect gradually begins over 3-5 days, and is not complete for 2 weeks. Therefore, optimal results are not seen for at least 2 weeks, and sometimes longer. During this period, you may notice asymmetry, or unevenness, within the treated areas. This asymmetry will usually correct itself as the toxin takes effect.

For maximum results it is recommended that you maintain an upright posture for at least 4 hours immediately following treatment. During this time it is also recommended that the treated area not be rubbed vigorously or massaged. You may wish to actively flex and relax the treated areas during this time, as this may help to increase the response of the targeted muscles.

There are no known permanent side effects of Botulinum for wrinkles. There are, however, several well-documented side effects that are temporary. These include the following:

Muscle weakness: a flu-like syndrome or the development of antibodies to Botox®. Serious or long lasting effects are very rare.

Bruising: May occur at or near the injection site. This effect clears within 7-10 days. No treatment is necessary.

Headache: Related to the actual injections, is usually mild and transient, lasting less than 24 hours. May be relieved with Tylenol.

Asymmetry: As described above, may be noticed within the first two weeks of therapy. May be corrected with “touch up” injections, if necessary. There is a fee for touch up injections.

Numbness: Actually a change in sensation noticed by some patients in the treated areas, better described as a “dullness”, it is usually only noticeable for a few days after the procedure and resolves without treatment.

Eyebrow or eyelid ptosis (drooping) or diplopia (double vision): Seen in 1-2% of patients receiving this therapy. It is temporary but may last weeks, is usually mild and may be treated with prescription eye drops.

PRE – TREATMENT INSTRUCTIONS

In an ideal situation it is prudent to follow some simple guidelines before treatment that can make all the difference between a fair result or great result, by reducing some possible side effects associated with the injections.  We realize this is not always possible; however, minimizing these risks is always desirable.

• Avoid Alcoholic beverages at least 24 hours prior to treatment (Alcohol may thin the blood increasing risk of bruising.

• Avoid Anti-inflammatory / Blood Thinning medications ideally, for a period of two (2) weeks before treatment.  Medications and supplements such as Aspirin, Vitamin E, Gingo Biloba, St. John’s Wort, Ibuprofen, Motrin, Advil, Aleve, Vioxx, and other NSAIDS are all blood thinning and can increase the risk of bruising/swelling after injections.

• Schedule Botox® appointment at least 2 weeks prior to a special event which may be occurring, i.e., wedding, vacation, etc. etc.  It is not desirable to have a very special event occurring and be bruised from an injection which could have been avoided.

BOTOX® POST – TREATMENT INSTRUCTIONS

The guidelines to follow post treatment have been followed for years, and are still employed today to prevent the possible side effect of ptosis.  These measures should minimize the possibility of ptosis almost 98%.

• No straining, heavy lifting, vigorous exercise for 3-4 hours following treatment. It is now known that it takes the toxin approximately 2 hours to bind itself to the nerve to start its work, and because we do not want to increase circulation to that area to wash away the Botox® from where it was injected.  This waiting period continues to be recommended by most practitioners.
• Avoid Manipulation of area for 3-4 hours following treatment. (For the same reasons listed above.) This includes not doing a facial, peel, or micro-dermabrasion after treatment with Botox®.  A facial, peel, or micro-dermabrasion can be done in same appointment only if they are done before the Botox®.
• Facial Exercises in the injected areas is recommended for 1-hour following treatment, to stimulate the binding of the toxin only to this localized area.
• Do not lie down or bend over for 3-4 hours following treatment. (This instruction has been employed for years by some practitioners, although, we have not been able to find out the main reason for this since many practitioners inject while the patient is in a lying position. Many practitioners do not adhere to this anymore.
• It can take 2-10 days to take full effect. It is recommended that the patient contact office no later than 2 weeks after treatment if desired effect was not achieved and no sooner to give toxin time to work.

Makeup may be applied before leaving the office. Some practitioners recommend avoiding Retin-A, Glycolic acid, Vitamin C, and Kinerase for 24 hrs to the treated areas.