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BOTOX® Cosmetic
Overview
BOTOX® Cosmetic has received much publicity lately. It has become one of the most popular cosmetic procedures performed. BOTOX® Cosmetic along with its popularity has surfaced many misconceptions about it. The reasons for its immense popularity are numerous. First, it is easy to perform, with just a little or no downtime. It is almost painless, quite effective, cost efficient and the risks are minimal. Having said that, BOTOX® Cosmetic should not be considered without any risk at all. See the possible complications section so that you are aware of what can happen. Dr. Cruise has treated many patients who were referred to him with complications from BOTOX® Cosmetic injections.
BOTOX® Cosmetic is actually a neuromuscular toxin that inhibits the release of acetylcholine within the nerves. These nerves are located within the muscles that are injected. Without the release of acetylcholine muscles become paralyzed. This paralysis lasts 4 to 5 months. You start to notice it 2 to 3 days after injection.
Initially, BOTOX® Cosmetic was used in the early 1970s to help correct over-active eye muscles that caused a lazy eye. Like many other occurrences in medicine, some of the BOTOX® Cosmetic was inadvertently injected into the 'crow's feet' area and was found to help dramatically. After all, many of the wrinkles around the eye are caused by over-active muscles. BOTOX® Cosmetic simply controls muscular paralysis.
Ironically, the biggest disadvantage of BOTOX® Cosmetic can also be considered one of its advantages. That disadvantage is the fact that it only lasts 4 to 5 months. In the unlikely event that you are unhappy with the result, you know that it is only temporary. Most of patients, however; are so happy with their results that they return for repeated injections and often request a more permanent surgical solution.
 Dr. Cruise's philosophy regarding BOTOX® Cosmetic
 BOTOX® Cosmetic is an extremely effective tool within the armamentarium of plastic surgery. I say this because not only is it effective at improving dynamic wrinkles but for the group of patients that do not want surgery it is an excellent alternative.
I like BOTOX® Cosmetic because it is an excellent adjunct to plastic surgery procedures as well as effective alone. It is the first line of treatment for the forehead and peri-ocular wrinkles that are made worse by facial expressions. As you age, these muscles become more prominent. Thus, during normal facial aging these wrinkles become particularly noticeable.
BOTOX® Cosmetic can be used in all age groups. In fact, I believe by using BOTOX® Cosmetic in the late 20's and early 30s to treat dynamic wrinkles you can delay the onset of permanent wrinkles. By paralyzing the muscles, wrinkles are not created in the first place or at least their onset is delayed. Also, I have found that repeated injections over time creating prolonged paralysis of the incriminating muscles can actually cause those muscles to fade away. In effect, this may result in a permanent improvement.
Benefits
BOTOX® Cosmetic can dramatically improve all wrinkles that are caused by over active muscles. Most people, both men and women, over the age of 30 can benefit from BOTOX® Cosmetic, if performed correctly. This is not to say that all wrinkles can be removed with BOTOX® Cosmetic. Remember, BOTOX® Cosmetic only helps with wrinkles that are caused by over-active muscles. Static wrinkles, which are always present regardless of whether you're smiling or not, or very fine wrinkles are not removed by BOTOX® Cosmetic. These wrinkles are caused by changes within the skin itself or are due to the aging changes of the skin and underlying fat. Correcting these wrinkles requires a thorough evaluation to determine the exact cause so that the most effective treatment is performed. This could involve Chemical Peeling, Laser Skin Resurfacing, Face Lifting with or without fat resuspension, Fat or Collagen Injection, Blepharoplasty, or Brow Lifting.
How can you tell if your wrinkles are caused by over-active muscles? This is definitively determined during your consultation with your doctor. But you can be reasonably sure that BOTOX® Cosmetic will help if the wrinkles are made worse with muscular movement i.e. smiling, elevating the eyebrows, or tightening the neck, etc.
The most effective areas for BOTOX® Cosmetic include the furrows of the forehead made worse when you elevate your eyebrow, and the crow's feet area made worse during smiling. Other areas may also be helped such as neck banding, also known as turkey neck. BOTOX® Cosmetic can also be used in conjunction with other procedures.
BOTOX® Cosmetic benefits can be summarized as follows
- Very effective at reducing or eliminating dynamic wrinkles.
- Relatively painless.
- No anesthesia necessary.
- Great for crow's feet, laugh lines and forehead wrinkles.
- No downtime.
- Relatively low-cost.
- Minimal risk.
- Reversible (this may be considered a disadvantage)
- Quick.
- Effectively delays the need for more invasive plastic surgery.
Possible complications
Significant complications with BOTOX® Cosmetic are rare but, of course, must be discussed. The most common complication is incomplete removal of the wrinkle. It is not realistic nor is it usually desirable to expect complete removal. Depending on location, complete removal of the wrinkle may lead to a look that is flat and without expression. The nice thing about BOTOX® Cosmetic is that with proper application in the hands of an experienced plastic surgeon it does a wonderful job of diminishing the wrinkles without creating an artificial look.
Another advantage of BOTOX® Cosmetic is that if the desired results are not achieved, a simple second injection can be performed. This is often a good way to start gradually.
Another potential complication called ptosis, which can rarely be seen when BOTOX® Cosmetic is found in the forehead region. Ptosis is a reversible problem where the eyelid droops for 4 to 6 weeks. It is caused when some of the BOTOX® Cosmetic diffuses into the muscles that elevate the eyelid. Dr. Cruise has seen several patients with this problem who have been referred to him from other physicians. Fortunately, in experienced hands this problem is extremely rare.
It should be mentioned that Dr. Cruise has used BOTOX® Cosmetic many times and it has proven itself to be extremely safe. In fact, he has it done to himself. Other problems associated with it are more of an annoyance the a complication. These include swelling, minor bruising, minor pain, and mild asymmetry.
Are you a good candidate?
As mentioned above, a good candidate is someone that has wrinkles that are caused by over-active muscles primarily of the forehead or around the eyes. Particularly good results are seen in patients who have deep furrows of the forehead giving them a mean look. These patients are often mistaken as being mad or unfriendly just because of their over-active forehead muscles.
Another group of patients that are particularly good candidates are those with wrinkles around the eyes and temporal area that worsen when smiling or when making facial gestures. When you think about it this is truly unfortunate. Here you are smiling, and feeling good about yourself when all of a sudden you look in the mirror and see someone who looks much older than you actually feel. There is no doubt that how you feel about yourself has a huge influence on how you feel in general. Fortunately, BOTOX® Cosmetic can go a long way in reducing these lines and making you look and feel younger.
Other wrinkles may be helped with BOTOX® Cosmetic as well. These include creases around the chin and mouth, excessive nasal flaring, and banding of the neck. During your consultation, Dr. Cruise will determine if your particular problem can be treated effectively with BOTOX® Cosmetic .
Prior to BOTOX® Cosmetic
BEFORE PROCEDURE
- Stop all aspirin containing products, medications that contain blood thinners (Motrin, Advil etc.) vitamin E and herbal supplements 2 weeks prior to surgery. You can take 1 multivitamin a day.
- There is no problem with eating or smoking prior to having BOTOX® Cosmetic . Many people come in on their lunch break and go right back to work afterward.
THINGS TO PURCHASE BEFORE PROCEDURE
Optional:
1. Arnica - www.alpinepharm.com (888) 746-3224 - may decrease bruising, or help it to go away faster. Patients with high blood pressure should not take this herb.
Anesthesia
No anesthesia is necessary.
After the procedure
- Immediately after the injection you may feel a little funny or you may fill nothing at all. You can leave immediately and go back to work or your daily activities.
- Do not expect immediate results. Remember, BOTOX® Cosmetic takes about 2 to 3 days to start working. When it does take effect do not be concerned if you have a slight feeling that your face is not your own as this is normal. This feeling goes away quickly. By day 3 you will notice a marked improvement in your wrinkles. In fact, you will feel as if much of tension around your eyes or forehead has gone away. Many people who suffer from chronic headaches and migraines have significant relief after having BOTOX® Cosmetic . This improvement will remain for approximately 4 to 5 months.
- Most bruising (if it happens) will fade after the second week. After the first week much of the remaining discoloration can be concealed with a cream-based cosmetic.
- You may ice the injected area for about 15 minutes to help prevent bruising. Don't put ice directly onto your skin.
Recovery time
The great thing about BOTOX® Cosmetic is that there is really no downtime. Often patients come in on their lunch break and go right back to work. Friends and co-workers will not notice any immediate changes. But do not doubt, the wrinkle improvement caused by BOTOX® Cosmetic is very dramatic by day 3.
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