BOTOX®, Botulinum A Exotoxin

About BOTOX®

BOTOX® is a highly purified naturally occurring protein complex that has been used for over twenty years, in adults, children and even infants for the treatment of a variety of conditions caused by muscle spasm, including spasm of the vocal cords. The cosmetic use of BOTOX® is a direct outgrowth of these previous uses.

Benefits

• Treats upper facial lines, wrinkles, hyperhidrosis (excessive sweating), and some headaches
• Can be used in the lower face and neck for treatment of the "downward smile" and neck

  Before BOTOX®

  bands
• Can be used to shape the eyebrows
• One of the safest and most effective treatments for smoothing these lines and wrinkles
• Treats some thickened lower eyelids and enlarged jaw muscles
• Over time the shallower lines will frequently repair themselves

Alternatives to BOTOX®

• Fillers such as Restylane and Juvéderm

Question & Answers about BOTOX®

How does it work?

It has long been observed that when a patient has a stroke that paralyzes one-half of their face, they lose the wrinkles on that same side of their face. For the treatment of wrinkles, a very dilute solution of BOTOX® is injected just under the skin into the overactive muscles producing the wrinkles. This blocks the impulses from the nerves to those muscles and produces a temporary muscle weakening, allowing the skin to regenerate and eliminate the lines.

When the muscles are kept under the influence of BOTOX®, they become shrunken (atrophic) and the BOTOX® effect starts to become more long lasting. The first BOTOX® treatment may last two to four months, but if the next treatment is given before the BOTOX® effect has significantly worn off, the second treatment will often last three to five months. With the third treatment, if given before the effects of the previous treatment have worn off, the effect tends to become even longer lasting. We've had patients come in saying "I had BOTOX® given a year ago, somewhere else, and it didn't work." A statement like this reflects a misunderstanding of the use of BOTOX®. We tell patients that to get optimal results they need to think of BOTOX® as a series of treatments, not just a one time or short term therapy.

Frowning before BOTOX®

Frowning after BOTOX®

BOTOX® is used primarily to correct lines on the upper one-half of the face, particularly the frown lines, the forehead lines, and the crow's feet. These lines can add years to your appearance and can project a false impression of anger, concern or depression. BOTOX® can also be used to improve fine and deeper lines in the upper lip, the "downward smile" (the downward drooping of the corners of the mouth that occurs with aging), to improve the "gingival smile" (excessive gum show on smiling) and the creases and folds in the neck. BOTOX® has also been used to decrease the roll of muscle just below the lower lid margin and accentuated by smiling in some individuals. BOTOX® can also be helpful treating webbing of the neck and the transverse neck creases. Unfortunately BOTOX® cannot be used to correct lines that are not caused by muscle contraction, but in some of these instances Restylane and other fillers may be of help. At times fillers and Botox are administered at the same time.

BOTOX® acts to improve the line or crease by weakening the muscle that folds the skin. It is this repeated folding and unfolding that causes the crease. When the muscle activity stops the fold rapidly becomes less prominent because the skin tends to flatten out in the absence of muscle activity. However, the line in the skin remains initially. Fillers fill the fold, elevating it, but that does not stop the muscle activity. Sometimes BOTOX® and fillers will be used together in a single location, to produce more rapid initial improvement.

Are there people who should not use BOTOX®?

People who are pregnant, breast feeding, have rare neurological disorders, or who are allergic to albumin should not be treated with BOTOX®.

Frowning before BOTOX®

Frowning after BOTOX®

What results can you expect from BOTOX®?

Within two to fourteen days, you should begin to see decreased movement of the muscles injected. Over the next one to two weeks, you should see a further reduction and possibly a complete absence of movement of the treated muscles. We will frequently see patients back after two to three weeks to evaluate the effectiveness of the treatment. If there is still some muscle movement we may inject additional BOTOX®. As the treated facial muscles remain weakened, the skin gradually remodels itself and the lines are first reduced and then frequently eliminated. The effect of BOTOX® generally lasts about three months, although thick, strong muscles may need to be treated more frequently initially. With repeated treatments, as the muscles become weaker, the effect of BOTOX® may last longer. This depends on keeping the muscles inactive. If the effect of the BOTOX® is allowed to wear off, the muscles regain their strength, the folds and creases redevelop and the muscles do not shrink in size. The BOTOX® effect lasts on average three to six months, although on occasion it may be longer or shorter. For best long term results the BOTOX® must be re-injected as it begins to wear off. It is essential to keep the muscles in a weakened state so that the lines do not reform.

Before BOTOX®

After BOTOX®

What about safety and side effects?

Dermatologists and ophthalmologists have been using BOTOX® since 1980. It has an excellent record of efficacy and safety and was first used in infants to correct overactive eye muscles. Although there have been recent news articles about the safety of BOTOX®, problems have occurred only in children with cerebral palsey who were receiving large doses BOTOX® into their neck muscles to treat spasticity (hyperactivity of the muscles). It is our belief that BOTOX® is exceptionally safe and effective and can help prevent you from projecting emotions that you're not feeling. We had one woman patient who said that much of the communication in her marriage involved her husband repeatedly asking her "Why are you angry?" Despite her repeated denials, it took BOTOX® therapy for them to be able to move on to other topics of conversation. BOTOX® does not affect the nerves transmitting sensation, so there is no numbness associated with BOTOX® administration.

There have been no long-term side effects, allergic reactions or health hazards related to cosmetic BOTOX® use thus far. Some patients have been getting BOTOX® treatments for more than 10 years, with no problems. Side effects may include nausea, headache or mild flu like symptoms, usually with doses above those used for cosmetic purposes. If you should stop BOTOX® treatments, your appearance will gradually revert to the appearance you would have had if you had never been treated with BOTOX®.

How long will it take to recover?

One of the many advantages of BOTOX® is that there is no down time. Although occasional bruising may occur, the treatment produces no other immediately noticeable effect and you may immediately apply make-up and go about your usual activities. No local anesthetic or sedative is required, so you will be able to continue with all of your usual activities immediately after your treatment. You will even be able to drive yourself home after a treatment. BOTOX® treatments take only a few minutes.

Does it hurt?

BOTOX® treatments are short and gentle. Because of the extra care and equipment we use, every patient who has received BOTOX® elsewhere has confirmed that our California BOTOX® injections are significantly less painful than any of their previous BOTOX® treatments. A minimal amount of discomfort may be experienced when the needle is inserted and a few drops of BOTOX® are injected into the muscles which need relaxation. The discomfort lasts only a few seconds, and new patients very frequently exclaim that the pain was much less than they had anticipated.

What should I do after my BOTOX® treatment?

You should exercise the treated muscles for two hours following your BOTOX® treatment. This will allow the best possible uptake of BOTOX® by the treated muscles during normal facial movements. Do not rub or touch the areas that were treated with BOTOX® for two hours following your procedure. Rubbing and pressing the injected areas could spread BOTOX® out of the treated muscles and into non-targeted muscles. If your BOTOX® moves out of the muscles it is injected into, there could be less effect on those muscles, and unwanted temporary relaxation of nearby facial muscles. After two hours, there are no restrictions.

Who performs the treatments?

Dr. Rothfeld will personally administer your BOTOX®

How many units of BOTOX® will my treatment require?

Typical treatments are as follows:

• Glabellar lines (between and just above the eyebrows): 20-40 units
• Upper forehead lines: 15-30 units
• Crow's feet (wrinkles and squint lines radiating outwards from the outer corners of the eyes): 10-20 units
• Anterior neck (to reduce jowls, and to reduce vertical and horizontal lines on the anterior neck): 30-40 units