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BOTOX INJECTIONS
TREATMENT FOR SKIN WRINKLES, EXCESSIVE SWEATING & HEADACHES
What
does Botox do?
Botox
injections improve the appearance of “worry lines”, “frown lines”, “crow’s
feet”, and other so-called “dynamic” or aging wrinkles. “Dynamic” wrinkles occur when we smile,
laugh, or frown. The delicate muscles
under the skin contract, causing the skin to wrinkle. Botox is injected
into these muscles and temporarily weakens them to prevent them from
working. By weakening these tiny
muscles, the overlying skin will smooth out.
Untreated facial muscles still contract normally, allowing most facial
expressions to be unaffected. Yet, those
severe frown lines between the eyes, forehead creases, and crow’s feet around
the eyes can be smoothed out creating a more youthful appearance. Lines
that are present at rest will not be improved with Botox
injections.
Although
the use of Botox is relatively new for treatment of
wrinkles, it was approved by the FDA in 1989 and has been used safely and
effectively for over a decade for many neurologic
disorders. No irreversible clinical
effects or side effects have been reported.
Today the use of Botox has emerged as an
exciting new treatment for erasing the visible consequences of aging skin.
Other
uses for Botox:
Botox
injections may also be given into the muscles of the forehead to treat
headaches, especially tension or migraine headaches. Additionally, injections into the axilla (armpit) can be done to treat hyperhidrosis,
or excessive sweating. These Botox injections for medical
problems may be covered by your
insurance.
How
are the injections done?
Injecting
Botox is a simple and safe procedure. A small amount of diluted solution is
injected with a very fine needle into several locations of the muscles of the
face (particularly the areas of the frown creases of the forehead and the
crow’s feet lateral to the eyes).
Because the needle is so fine and only a tiny amount of liquid is used,
the pain associated with the injections is usually tolerated without
anesthesia. We try to minimize the
discomfort by applying cold compresses before each area is treated. The medicine stings during the injection and
has been compared to the sting of an insect bite, but it clears rapidly within
minutes. You will be able to drive and
engage in your normal daily activities immediately after your injections. A small number of people will have some
temporary bruising of the skin at some injection sites, which fades over
several days. Otherwise there will be no
visible signs of your treatment.
What
are the contraindications? Who should
not be treated with Botox?
Botox is
not recommended for the following:
-
Persons allergic
to human albumin or botulinum toxin
-
Pregnant or
breastfeeding women
-
Those with
neuromuscular disease such as myasthenia gravis
-
Those being treated
at the same time with tissue fillers (collagen)
-
If you are taking
aspirin, vitamin E, or other blood thinners, it would be best not to take them
a few days before being injected. Talk
to your doctor to discuss this.
-
If you are taking
a class of drugs called “calcium channel blockers”, (e.g. Norvasc,
Plendil, DynaCirc, Cardene, Adalat CC, Procardia, Cardizem, Calan, Covera HS, Verelan) the effects of Botox may
be increased so be sure your doctor knows.
Are
there any side effects?
Mild,
temporary bruising or redness may occur.
Rarely there will be a headache for a few hours. Very slight droopiness of the upper eyelid
occurs in about 2% of people who have their frown lines injected. About 5% of people who have their forehead
injected immediately above the eyebrows may notice this effect, too. A much smaller number of people will notice
slight asymmetry of the lower face after injection of the crow’s feet muscles. These effects are not usually noticeable by
others and fully recover after 3 to 5 weeks.
An extremely rare side effect – temporary double vision – has been
reported in the literature. To minimize
the possibility of such rare effects, please be sure to follow the
post-treatment instructions.
It
is important to remember that there have been no long-term adverse effects or
health hazards related to the use of Botox for any
cosmetic indications thus far. The
incidence of complications is low, the severity is usually mild, and they are
short-lived (a matter of months).
A
very small percentage of people will not notice much effect from the
treatment. A rare patient may develop
resistance to response over time.
Usually, just the opposite occurs -- they respond more to the same dose
as time goes on.
What
kind of results can I expect?
If
dynamic wrinkles (those that occur with muscle contraction) are making you look
older and more “serious”, Botox can usually smooth
these out and give you a more youthful and rested appearance. However, this treatment will not improve the
more common “static” wrinkles (those present all the time) that are unrelated
to facial muscle contraction, nor does it improve loose or sagging skin. Results from the injections are typically
seen within 2-10 days of the treatment and last for 6 weeks to 6 months
(typically 3-4 months). Occasionally,
there is a muscle that does not respond, and a “touch-up” may be needed in 2-3
weeks.
How
long do the results last?
Initially
most people require a repeat injection every 3 months to maintain the
effect. However, after three to five
injections, the effect may last longer and a repeat injection may only be
required every 6-12 months.
What
instructions should I follow after treatment?
How
much will it cost?
The
cost per treatment will vary depending on how many areas you want treated and
how many injections it will take. The
cost is $______ per unit. The average Botox injection session will take 25 units. Insurances
(including Medicaid and Medicare) do not pay for “cosmetic” medical care and
will not therefore pay for Botox therapy. You will
need to pay at the time of your visit, by cash, check or credit card.
Copyright, 2011.
John L. Pfenninger, M.D. jw02/11