Dr. Lisa Cassileth is a Beverly Hills plastic surgeon. Her website can be found at www.drcassileth.com. Eagerly awaiting the next newsletter? It's finally here! This is the first one in a series of three on the exciting world of injectables. An injectable is, technically, anything that can be injected into your body, in this case for the sake of beauty. So many are available, even a plastic surgeon can become completely overwhelmed. They can paralyze, de-wrinkle, and plump up lips and folds. Can they even remove fat? Don't get carried away...
| This first Injectables newsletter is all about BOTOX®. BOTOX® works, and it is here to stay. Over 1,000,000 patients – the number of women injected in 2002 – can't be wrong. BOTOX® erases wrinkles by paralyzing the muscle that makes the wrinkle, so it only works on dynamic wrinkles. Dynamic wrinkles are the ones that are created by the motion of your muscles. It is safe, effective, and with little or no downtime.
If you must know...
BOTOX® is short for botulinum toxin. It is a substance produced from bacteria, and then, yes, injected into your face. There are no bacteria in the injection. It works by blocking the reception of a neurotransmitter called acetylcholine at the neuromuscular junction (where your nerves activate your muscles), effectively paralyzing your muscle.
Ouch? The pain...
After their first time with the injections, patients often say, "that was it?" If you are very pain-phobic (and who isn't?) try icing your forehead 10 minutes before the procedure, or ask the doctor for some EMLA cream to numb the skin. The needle normally used for these injections is so tiny; it is only a little thicker than a human hair!
Avoid the bruise
Don't take aspirin, Motrin, Advil, or any other ibuprofen-containing products for one week before the injections. If you tend to bruise easily, you may want to take arnica one day ahead and on the day of injection.
Side effects
Minor bruising is the most common. It is also possible to get something called eyelid ptosis. One eyelid droops when BOTOX® is injected too low in the central eyebrow area. This happens in less than 3% of injections, and I have a few tricks I do to avoid it, but I believe it is by far the worst complication that I have seen with BOTOX®. If you get eyelid ptosis, even with special eye drops, it takes at least two to three weeks to go away, and sometimes as many as six weeks. If your doctor asks you not to lie down or move your eyebrows after the injection, this is what she or he is trying to avoid. In my experience, however, it is good injection technique that makes the difference. Also, tell your doctor if you have had any eye or eyebrow surgery, as that changes the anatomy in that area. Finally, I truly believe that BOTOX® injections do not have long term side effects. And the FDA agrees!
BOTOX® "alternatives"
Other products are now promising that they deliver the effectiveness of BOTOX® in a cream form. Wouldn't that be great? Unfortunately, although some products can improve lines (see our Fall 2003 Newsletter), nothing can paralyze the muscles when applied from the skin. But here are some of the pretenders to the de-wrinkling throne:
BOTOX® Cream No way. For starters, real BOTOX® goes bad after a few hours left out of the refrigerator, and even after a few days when properly cooled. For finishers, you can't absorb BOTOX® through your skin anyway. StriVectin Sound paralyzing? It's not. About as effective as retinol (see our previous newsletter). Firma-Taux, Vitox, Serutox, etc. Who knew the word "toxin" would ever boost sales? Faux-tox would be a more accurate name for these ineffective products.
Tricks of the trade
Now, as you longtime BOTOX® users know, the results depend on the technique: there is good BOTOX® and bad BOTOX®, and it all depends on how it is administered. Here's the low down on injection locations for those who really want to know.
Forehead creases: 4-20 units Frontal area (frontalis muscle) Frown lines: 20 units Glabellar area (corrugator muscle) This area requires the full 20 units, or it will likely not work. Crow's feet: 5-10 units per side (Lateral orbicularis oculi muscle) Paralyzing these may emphasize the parallel wrinkles under your eyes. Bunny lines: 5 units (Procerus muscle) Cute little transverse lines. |  | DON'T inject here! The brow can droop and make you look old. DO inject here. Tiny muscles pull the brow down. Lip lines: Overdoing it here can make your mouth look weird and can make you drool.
Coming soon...
Part two in this series covers Fillers, including collagen, Restylane, and more. Coming soon to your email inbox.
BOTOX is a registered trademark of Allergan, Inc. Copyright © 2004 Lisa B. Cassileth, MD, Inc. All rights reserved. Privacy Policy & Disclaimer Click here to unsubscribe from Dr. Cassileth's newsletter.