What is Botox® Cosmetic?
Botox® Cosmetic  is the trade name for Botulinum Toxin type A, a purified toxin derived from the bacterium Clostridium Botulimum. The toxin blocks the nerve impulses to muscles and sweat glands. It has been used since 1980 for the treatment of strabismus (lazy eye) and blepharospasm (uncontrolled eye blinking). The use of Botox® Cosmetic for wrinkles was pioneered in 1989 by Dr. Carruthers of Vancouver. Botox® Cosmetic has now been used in thousands of people for the treatment of facial wrinkles.

Who may benefit from Botox® Cosmetic?
Botox® Cosmetic improves the appearance of wrinkles that are caused by contraction of the underlying muscles. It does not help wrinkles associated with sundamage or age related sagging of the skin.

How soon will I see results?
The actual treatment takes only a few minutes, and the Botox® Cosmetic begins to take effect in 3-5 days. Maximal weakness occurs in 1-2 weeks.

How long will it last?
Over about 3-6 months the Botox® Cosmetic effect will fade, and the muscle action will return.Botox® Cosmetic causes a temporary, not permanent, muscle weakness.

How can I achieve the best results?
The best results are achieved when treatments are given every 3-4 months for the first year, so that the muscles will not return to their full strength between treatments. After the muscles have withered over the first year, treatments may be spaced further apart, possibly every 6 months, based on the return of muscle strength/ movement.

How often can I be treated?
Closely spaced treatments increase the possibility of developing neutralizing antibodies. For this reason, repeat treatments should be performed no earlier than 3 months after the previous treatment.

Can a benefit be guaranteed?
No. Some patients do not get the desired effect from Botox® Cosmetic. A lack of benefit may occur when wrinkles are due to “sleep creases”, sun damage, or other factors unrelated to muscle movement. If patients develop neutralizing antibodies to Botox® Cosmetic, subsequent treatments are not as effective. There are rare patients in whom Botox® Cosmetic simply fails to “take”.

What happens if it doesn’t work?
Some patients require more Botox® Cosmetic than the usual amount. A “touch-up” may be required 2 weeks after the initial treatment. This is not covered in the cost of the initial treatment.

Who should not receive Botox® Cosmetic?
Botox® Cosmetic should not be used in patients with muscular or neurological diseases, pregnant women, breastfeeding women, patients taking aminoglycoside antibiotics (gentamycin, tobramcyin, amikacin, netilmycin) or drugs that interfere with neuromuscular transmission, or patients with a known hypersensitivity to human albumin.

Are their side effects?
There will be a slight discomfort when the needle enters the skin, and a small chance of a bruise at the site of the injection, especially if patients are on aspirin, ibuprofen, Aleve, vitamin E, ginkgo, ginger, Vioxx, Celebrex, or any other medications that increase bleeding. Approximately 2-3% of patients may develop ptosis (slight lowering) of one eyelid. This side effect is temporary, may not even be noticeable, and may be improved with a medicated eye drop.

Is Botox® Cosmetic FDA-approved?
Botox® Cosmetic was FDA-approved for the treatment of strabismus (lazy eye) and blepharospasm (uncontrolled eye blinking) in 1989, and for the treatment of frown line wrinkles in 2002. Treatment of other areas is considered “off label”.

What other areas can be treated frequently?
The cosmetic uses for Botox® Cosmetic are constantly expanding. The most common, and most effective, areas treated include: Forehead lines, glabella (frown lines between the eyes) and the crows feet around the eyes.

Who should administer my Botox® Cosmetic?
The physician always personally evaluates and injects Botox® Cosmetic for his patients. Make sure whoever treats you is at least Board Certified in their given specialty (this is a good rule of thumb for any physician you may see.)

How much does Botox® Cosmetic cost?
Each patient, each treatment and each area requires an individualized approach. The amount of Botox® Cosmetic will vary depending on many factors that your dermatologist will evaluate at every treatment. Be wary of physicians who offer “1 price fits all” or “cookbook” approaches- often you may not get the maximal benefit from your Botox® Cosmetic injections. The easiest way for a physician to beat other doctor’s prices is to give you less Botox® Cosmetic. Our goal is to maximize and individualize your response with each treatment, so treatment cost will vary.

Botox® Cosmetic: POST CARE INSTRUCTIONS
1. Remain upright for the next 6 hours. You may apply ice for 5 minutes every 1/2 hour if there is any pain or swelling.
2. Move the facial muscles (frown, smile) that have been treated throughout the rest of the day. This will help the muscles absorb the Botox® Cosmetic.
3. If bruising occurs during treatment, it will resolve on its own.
4. No vigorous exercise for 24 hours. When bending or stooping over, do so from the knees.
5. Do not rub or massage the areas treated for 24 hours.
6. Do not take aspirin containing products, Ibuprofen, or vitamin E for the next 24 hours. (Tylenol is acceptable)
7. The onset of muscle relaxation usually begins in 3-5 days, but optimal results may take up to 2 weeks.
8. Results may vary. If there is partial improvement of a treated site, and re-treatment is desired, a second treatment may be performed at 2-4 weeks.
9. Please contact our office should there be any side effects or questions regarding your treatment