Botulinum Toxin treatments

What is botulinum toxin ?
For the upper face: For a chemical brow lift , botulinum toxin , a purified protein, when used in small dilutions in a controlled fashion by a skilled physician with extensive experience of botulinum toxin injections, relaxes dynamic frown lines between the brow, on the forehead and the wrinkles around the eyes. botulinum toxin makes you look less worried, angry, or tired, and more relaxed, approachable, and confident.

For the lower face: botulinum toxin , when used in small dilutions in a controlled fashion by a skilled physician with extensive experience, can cause a chemical jowl lift and decrease a permanent mouth frown, a very undesirable effect.

What is botulinum toxin made from?
Botulinum toxin is a purified botulinum neurotoxin type A complex, produced from a culture of the A strain of bacteria called clostridium botulinum Type A. Although the clostridium bacteria cause botulism, the botulinum toxin facial extract does not.

What kind of wrinkles does botulinum toxin treat?
Botulinum toxin is for dynamic wrinkling. It is a muscle relaxing agent so it will soften the wrinkles and lines that occur from a dynamic facial movement, such as between the brows with frowning or the crow’ s feet from smiling or around the mouth from excessive pursing of the lips.

Is botulinum toxin safe?
Botulinum toxin facial injections have become an essential ingredient in facial rejuvenation, erasing frown lines and relaxing worried brows. Botulinum toxin is safe and effective and has been approved for cosmetic use by the FDA. Botulinum toxin has become the most commonly performed cosmetic procedure and has been used for more than 10 years in aesthetic practice and more than 20 years in neurology and ophthalmology. There are many publications supporting its use. It has a long and impressive safety record.

Botulinum toxin facial should be injected at a physician’s office by an experienced and trained medical doctor with an intimate knowledge and understanding of the muscular anatomy of the face as well as the aesthetic implications of proper placement . The final outcome of a botulinum toxin procedure is very dependent on the experience of the injector. In addition botulinum toxin side effects will be minimized if done by a practitioner who injects botulinum toxin cosmetic daily.

  • Botulinum toxin has been proven safe if administered by a trained medical professional.
  • Botulinum toxin has been used worldwide in millions of patients since 1989. 

What to expect after a botulinum toxin treatment?
Usually you will have a mosquito-bite looking area for 20-60 minutes which resolves without a trace. Try not to fall asleep or relax in a recumbent position for at least 4 hours after a botulinum toxin procedure as this may rarely lead to some diffusion or spreading of the botulinum toxin Facial to adjacent areas and causing problems.

Your regular skin care regimen can be resumed immediately following a treatment and makeup may be applied if desired. After having had botulinum toxin injections, exercise should be avoided for twenty four hours.

How long will it last?
Within 4 days of the treatment you should start to see an improvement in your lines and the final result only “ kicks in” 14 days later. The result can last up to 4 months but varies from patient to patient and the initial amount of botulinum toxin units given per area . Some patients have a hyperactive brow and are constantly raising their brows or frowning . In these patients a shorter effect can be expected as the botulinum toxin is quickly “ worked” out. Some practitioners charge per area for botulinum toxin and others quote per unit. The more units injected, the longer the duration of effect
 
Can all skin types be safely treated with botulinum toxin ?
Yes, all skin types can be safely treated with botulinum toxin ?

Dermal Fillers
What are dermal fillers?

Dermal fillers are injectable substances designed to 

  • erase wrinkles; 
  • augment lips;
  • to enhance volume; and
  • ​restore the youthful 3-dimensional contour of the face.  

What types of dermal fillers are there?
Dermal fillers consist of hyaluronic acids ,calcium hydroxy-appatite fillers , human fat, bovine or porcine collagen and synthetic substances. 

Hyaluronic acid fillers: The hyaluronic acid fillers are sterile, clear, dermal iller gels made of chemically modified hyaluronic acid. Hyaluronic acid is a naturally occurring substance found in the fluids surrounding cells and tissues. Hyaluronic acid is found in the human body in the skin, cartilage, joints and the eye. In skin tissue, hyaluronic acid fills the space between collagen and elastin fibers. The role of hyaluronic acid in skin is to deliver nutrients, hydrate the skin by holding in water and to act as a cushioning agent. Hyaluronic acid is hygroscopic which means that it draws water very strongly to it, yielding a larger volume effect than the material would have by itself. Made from highly purified natural hyaluronic acid, the gel is gradually absorbed by your body through natural mechanisms

Calcium hydroxy-appatite fillers are microspheres of smooth particles of calcium that, after injection, also form a scaffold that is slowly filled with human collagen. 

Newer generation fillers containing porcine collagen and poly-L-lactic acid can be used for the same indications such as hyaluronic acid dermal fillers with the exception of lip augmentation where hyaluronic acid is the preferred filler. 


What areas do the dermal fillers treat ?
The typical areas treated are

  • the nasolabial folds (lines from the end of the nose to the end of the lips);
  • perioral area (wrinkles around the lips); 
  • wrinkles of the cheeks;
  • marionette lines (lines from the corners of the mouth to the jawline, accentuating the downturn of the mouth) ;
  • lip augmentation which provides definition to lips which have become thin and wrinkled; 
  • volume replacement for “tear-trough deformity” (hollow under-eye circles), hollow cheeks, cheek-lift, brow-lift; and 
  • resculpting and strengthening the jaw line by lessening the effect of jowls and sagging.

Are dermal fillers safe?
Dermal fillers have been proven safe if administered by trained medical professionals. Hyaluronic acid dermal fillers are produced by human genes inserted into a bacterium for reproduction. Hyaluronic acid is a highly “conserved” protein, meaning that its genetic composition is almost exactly the same in 97% of animal species. This gives is an extremely low incidence of allergic reactions, hence there is no need for pre-treatment skin testing. There is little risk of a foreign-body reaction with hyaluronic acid fillers and they are completely reversible with time. 
FDA approval hyaluronic acid fillers such as Juvederm, Restylane and Perlane have been used in millions of patients for more than 10 years with a very low incidence of side effects and thus are considered very safe.

Newer generation fillers containing porcine collagen , calcium hydroxy-appatite and poly-L-lactic acid can be used for the same indications such as hyaluronic acid dermal fillers with the exception of lip augmentation where hyaluronic acid is the preferred filler. These newer generation fillers are very injector dependent and can cause lumpiness if improperly injected by inexperienced injectors. 

What to expect after a dermal filler treatment?
There is mild redness and swelling after the procedure which rapidly subsides. Try to avoid aspirin containing products or high-dosage vitamin E supplements for 10 days prior to the procedure to avoid bruising which may occur especially after treatments of the lips and cheeks. 
You may put makeup on immediately and resume whatever activities you have planned, as long as you appreciate that you may have bruising which may last for up to a ten days after the procedure. 

Can dermal fillers be combined with other treatments?
Dermal fillers are commonly performed at the same visit as botulinum toxin. Botulinum toxin helps with the upper one-third of the face whereas injectable fillers generally help with the lower two-thirds. The combination is one of the most widely used and most effective methods of achieving a significant aesthetic improvement within 1-2 weeks time.

Can all skin types be safely treated with dermal fillers?
Yes, all skin types can be safely treated with dermal fillers?