OVERVIEW: Botox™ Cosmetic (Botulinum A) is a bacterial product which temporarily paralyses the muscle. Since much of your facial wrinkles (lines) are caused by overworked muscles, weakening these muscles will usually eliminate or reduce these lines. Botox injection works especially well at the frown lines, forehead lines and Crow’s feet. It has also been used to lift or even up the brow line, reduce the nasal scrunch and facial asymmetry as well as the neck lines (platysmal bands). We also use Botox™ to relieve migraine headaches for the most difficult patients in this office. We have also been used to control excessive sweating under the arm and on the hands and feet. Currently we offer Botox for both medical and cosmetic purposes.
How fast and how long? You will start to note improvement in about 4 days with the maximum effect between 14-21 days. However you will likely require re-injection in about 3 months depending on how large and how strong your facial muscles have become. It has been observed that its effects tend to get better and last longer with each successive injection and that male usually require more frequent injections. Some patients may require a much higher dose to achieve the desired cosmetic effect and thus it is essential that we get a chance to look at the result after about 24 days and give a booster dose if necessary. Expect that with repeated injections, you will probably need re-injection every 6 months in the following years.
Is it painful? Since the needle used in Botox injection is a very fine one (30 gauge), most people will not experience much discomfort from the injections. However for some unusually pain-sensitive individuals, applying an ice pack or topical anesthetic prior to the injections may be necessary.
What about side effects? The dose of Botox used for cosmetic purpose has not been linked to any significant side effect due to the relative low doses involved. The most common side effect is a transient drooping of the upper eyelid usually from having the Botox injected too close to the eye. This effect is transient and can be partly counteracted by using a prescription eye drop called Iopidine 0.5% (apraclonidine hydrochloride). Ironically even though Botox™ is being studied as a treatment for migraine headaches, headaches have been reported on rare occasions after Botox™ injections. . As with any injections, transient bruising may happen but this usually subside in less than a week and may be reduced by applying an ice pack to the site immediately after the injection.
Any contraindications? We do not give injections to pregnant women or people suffering from a systemic neuromuscular disease such as myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis.
Alternatives: Myobloc™ (botulinum B) may be an alternative for the rare individuals who have become resistant to Botox™ (botulinum A) but its effects only last half as long as Botox™ even though it acts much faster ( 1-2 days versus 4 days for Botox™). Due to the need to use a much higher dose, resistance to Myobloc™ is also more likely to develop. Dysport™ is yet another form of botolinum A which is awaiting FDA approval. Neither is routinely used in our practice.
Medical BOTOX™: MIGRAINE BOTOX ™ has been found to be effective in the treatment of chronic daily headaches. After first identifying the cause of the headache, BOTOX ™ injections are used to block the muscle spasms for 6 weeks to 6 months. Usually 50 IU of BOTOX will be effective. The program is enhanced by other migraine treatments.
Medical BOTOX™: EXCESSIVE SWEATING BOTOX ™ has been found to be effective in the treatment of chronic excessive sweating called hyperhidrosis. Using 100 IU of BOTOX™, the excessive sweating can be controlled for months. In time, the amount of sweating diminishes eliminating the twice a years treatments.
Effective duration: Botox™ injections last from 4 weeks to 6 months depending on the individual and frequency of previous injections. Botox™’s effectiveness tends to lengthen with successive injections.
Costs: BOTOX™ costs are $12.50 per IU when diluted in 2cc of bacterio-static water. Optimal results are found at the higher concentration Dr. Lichten uses, 1.5cc per 100 iu of BOTOX™. Expect to pay $250 for the glabella or crowsfeet and $350.00 for the forehead or brow at the 2cc dilution.