Botox® Cosmetic & Dysport®
All the doctors at Dermatology Associates of Atlanta offer BOTOX® Cosmetic injections that will rid your face of crow’s feet, forehead lines or frown lines. This has become our most popular cosmetic procedure because it is safe and patients love the results. BOTOX® is a powerful medicine used to treat facial expression lines and neck banding as well as down-turned smiles and drooping eyes.
Botulism is food poisoning produced by a bacterium. BOTOX® is a medicine produced by the same bacteria. BOTOX® is not alive but is a protein that weakens and inactivates muscles. This is another example where natural products are used for medicinal purposes: fungi produce penicillin, cowpox virus protects against smallpox and foxglove plant produces the “poison” digitalis that millions of patients take daily for heart disease. Now with bio-engineering, it is common for bacteria to produce the necessary medicine for a specific disease.
In 1973, BOTOX® was used as a treatment for patients with crossed eyes. By weakening the overactive eye muscles, this medicine provided an alternative to surgery. After this “breakthrough,” BOTOX® quickly gained acceptance for other ophthalmologic disorders including nystagmus and blephospasm (involuntary spasm of the eyelids). Extensive BOTOX® research repeatedly confirmed a high success rate with minimal side effects using minuscule amounts of this new-found “medicine.”
In addition to offering Botox® treatments, Dermatology Associates of Atlanta also offers Dysport®. Dysport® was approved by the FDA in June of 2009 as another botulinum-A treatment proven to reduce wrinkles and fine lines on the face. Results from Dysport® last from 4 – 6 months and it is setting out to differentiate from their competition, BOTOX® by boasting faster results, meaning even less downtime than the already minimal downtime demanded of BOTOX®.
Dysport® also demands a higher level of technical skill to administer, meaning those who offer it are going to be well-versed in the anatomy and muscles of the face and overall more skilled with cosmetic injections. At Dermatology Associates of Atlanta, our highly trained staff routinely performs thousands of cosmetic injections annually.
BOTOX® injections were pioneered in 1988 by a Vancouver ophthalmologist and her husband, a dermatologist. Since that time, this team of doctors has performed over 10,000 sessions on its patients. The ophthalmologist noted that the wrinkles disappeared in her patients with eyelid spasms who were treated with BOTOX®. This led to further research, which confirmed the effectiveness and safety of BOTOX® for improving wrinkles due to overactive muscles.
In 1996 at the annual meeting of The American Academy of Dermatology in Washington, a presentation by dermatologist Dr. Nicholas Lowe showed that BOTOX® was useful for improving facial expression lines. Significant improvement was noted on both forehead frown lines and crow’s feet. No significant side effects were noted beyond the expected injection discomfort. For 30 patients, only 1 experienced a mild drooping of the upper eyelid, which cleared spontaneously. The length of effective improvement for the forehead frown lines was approximately 18 weeks, while the degree of improvement of the crow’s feet was generally less, however, BOTOX® is not 100% effective.
While BOTOX® is a potent medicine in high concentration, it is used in very small quantities with high margins of safety. After a muscle is injected, its first effects are not seen for 24 hours and the complete effect on the muscle will not be complete for two weeks. Fifty units (one half vial) or less of BOTOX® per session is generally used. To have toxic effects on a patient, over 2,000 units would have to be injected at one time. BOTOX® has no effect on the central nervous system or on the body if injected accidentally into a nerve or blood vessel. BOTOX® is also safe because complete recovery of the muscle is possible. Recovery is due to the body’s excellent ability to form new fibers that allow activation of the muscles.
Wrinkles radiating from the corner of the eyes caused by smiling, laughing or squinting are especially distressing to some individuals. Previously, no reasonable medical or surgical solution improved this problem due to the strong underlying muscles. Even with the deepest chemical peels or laser resurfacing techniques, rapid recurrence of these lines around the eyes is inevitable. Now for best results, BOTOX® and Dysport® injections are used in conjunction with resurfacing procedures. It is the function of BOTOX® and Dysport® to prevent the recurrence of wrinkles by inhibiting the underlying muscles.
This area is not ideal for correction by the BOTOX® method; it also presents a challenge in face lift surgery. This area is most dynamic when talking, smiling, and eating. As one ages, both muscle and fat are lost from this area. Replacement of fat is now possible, but the real advance in this area has been the development of a permanent filling agent with a high safety and satisfaction profile–Gortex. In addition, the lips can be supplemented with these techniques. In summary for the area involving the lips and around the mouth, BOTOX® will not help this zone and is not recommended.
What should be expected after BOTOX® or Dysport® therapy?
BOTOX® and Dysport® are remarkably safe therapeutic agents for wrinkles. Complications have been minor and only transient. Bruising may occur where injected and a brief pain or headache may follow. Bruising may be greater in patients who are taking aspirin or any blood-thinning medicines. These products should be avoided if possible prior to the injection; however, ice helps prevent bruising. Muscle weakness is first noted at 24 hours; it is not immediate.
How long does BOTOX® last?
After the first set of injections, re-injection after two weeks allows for an accurate localization of any resistant functioning muscles. With this method, 90% or more patients do respond to BOTOX®, leaving 10% who do not respond. Successful therapy is signed by muscle weakness that begins at 24 to 48 hours after injection with a peaking weakness at seven days. Paralysis after the initial injection lasts between four and seven months for most patients.
How often is re-injection needed?
Reinjection is suggested every three or four months to keep the muscles paralyzed and allow the furrows to completely smooth out. Once an area is smooth, patients are instructed to return for therapy only when they notice a return of muscle movement, which may not occur for four months to one year or even longer.
Who should not use BOTOX®?
- • Although there have been no reports of birth defects with this medicine, no pregnant patients will be treated. It is also our policy not to inject BOTOX® in nursing mothers.
- • Patients with a history of neuromuscular disease (multiple sclerosis and myasthenia gravis) or other types of diseases involving neurotransmission should avoid this medicine.
- • Patients taking the following medicines should not receive BOTOX®: aminoglycoside antibiotics (Streptomycin, Tobmamycin and Garamycin injections), penicillamine and calcium channel blockers (Calan, Cardizem, Dilactor, Norvasc, Procardia, Verelan).
What are alternatives to BOTOX®?
Alternatives to BOTOX® are filling agents including fat, collagen, fibril and Gortex; resurfacing procedures with acids or lasers; and lifting operations of the forehead, temporal, neck, and mid-face regions. Without treatment, the lines and wrinkles persist.
What unexpected benefits have come from the use of BOTOX®?
Tension headaches have disappeared for some patients. These headaches occurred in patients who were recruiting forehead and brow muscles during periods of stress and tension. When these muscles were relaxed, the headaches faded.
How exactly does BOTOX® cosmetic inactive the muscle?
BOTOX® inhibits the release of acetylcholine at the joining site of the nerve to the muscle so that the muscle never gets the message to contract. Remember, muscles only have the ability to contract. An opposing muscle contracts to produce movement in the opposite direction. To rejoin the nerve to the muscle the body organizes and produces new motor endplates, which re-establishes connection.
Does the body make antibodies to the BOTOX® cosmetic protein?
Yes, especially if enough toxin is injected often enough. The crucial amount is about 100 units (less than the usual cosmetic dosage) and booster injections placed within one month of the initial injections. Antibodies have been more of a problem for neurological disorders where larger amounts of BOTOX® is required. When significant amounts of antibodies are formed, the therapeutic effects of Botox® Cosmetic are greatly reduced.
Have there been any reported cases of allergic reactions or hives to BOTOX®?
There have been no reported cases of a true allergic reaction in nearly 20,000 treatments. People who are known to be allergic to Botulism toxin or albumin should avoid BOTOX®.
What happens if a female patient becomes pregnant shortly before or after treatment?
A number of neurological and ophthalmologic patients have delivered normal children after receiving their injections. For safety reasons no pregnant or nursing females will be treated.
How painful are the injections?
The smallest needles are used and the medicine itself does not sting as much as the usual local anesthetic. Most patients feel it less than collagen. Pain can be minimized by the use of ice cooling the skin just prior to injections. Some patients find that two Tylenol tablets before the injections reduce the discomfort.
What can be done for the drooping eyelid if this occurs?
There are two opthalmological preparations that are helpful. The first is 10% phenylephrine drops and the second is lopidine. Transient drooping of one eyelid or both is the most significant complication and occurs in 1% to 2% of all injections. This drooping is a result of the local dissemination of the toxin in the injection site and can be minimized by accurate dosing, as well as proper placement, and keeping the patient in an upright position for three to four hours after injection. If drooping eyelids occur, it is usually minimal and is usually resolved within two weeks.
After receiving my injections, how can I help BOTOX® be more effective and avoid side effects?
First, do not massage the area of the injection. Second, do not lie down for a nap; keep upright. Third, use the muscle; intentionally making the muscle contract helps localize the protein to the selected muscle for ablation.
When injecting muscles at one site will this affect remote muscles?
BOTOX® spreads along muscle fibers and does not spread to distant areas by way of the blood stream.
Can BOTOX® cosmetic be used to weaken not totally paralyze a muscle?
Yes, in fact this is done so that the face will not be left expressionless. It can also be used to balance a weak muscle on the opposite side. By injecting medicine into the subcutaneous tissue not the muscle, and by using a smaller dosage, a weakening of the muscles is more likely occur.
For the deepest frown furrows what is the recommended method to get these deep lines to disappear?
In one study paralysis after the initial injection lasted four to seven months. Re-injection every three to four months is recommended rather than waiting for the muscle to recover. This keeps the muscle paralyzed. It takes approximately 12 months for the skin to completely smooth out. It is usually 4-12 months before a return of muscle movement occurs and additional treatments are necessary.
What accounts for the fact that no treatments may be necessary in some patients after repeated injection sessions?
What happens is that the patient is broken of the bad frowning habits and may not relearn them for some time in the future.