Is Botox(TM) safe?

Yes when FDA approved Botox(TM) made by Allergan™ is used according to approved dosage by licensed physicians who are experienced in Botox(TM) use, in my opinion.

What Is Botox(TM)?

Botox(TM) is an injectable medication that relaxes facial muscles that cause lines or wrinkles. Technically called Botulinum Toxin A, Botox(TM) is synthesized in the laboratory by Allergan™, a major pharmaceutical company.

Contrary to stories in the media Botox(TM) is not food poisoning bacteria and you cannot get food poisoning from a Botox(TM) injection. Botulinum Toxin A was discovered as a toxin created by the Clostridium Botulinum bacterium which is a cause of food poisoning which caused muscle weakness.

The synthesized, medical grade Botox(TM) used today has been safely used in medical practice for 30 years and is FDA approved. The first use of Botox(TM) was in children with spastic legs-the spasms were relaxed by this medication. Botox(TM) has also been used in Toticollis-painful spasms of the neck, and in Oculogyric spasms-tics or involuntary movements or twitches of the eyes.

How Does Botox(TM) Work on Wrinkles?

The wrinkles caused by the pull of your muscles of facial expression are called “dynamic lines” because they are dynamic or move. That is these wrinkles and lines are caused by repeated motion of muscles of facial expression-each time the muscle moves it pulls the skin into a wrinkle. After years of repeated motion, these wrinkles or lines become permanent.

Botox(TM) relaxes or quiets the muscles of facial expression. When the muscle is relaxed, the line or wrinkle caused by the muscle disappears.

Which Wrinkles Are Removed with Botox(TM)?

The lines of facial expression which are:

• Crow’s Feet-lines on the cheek around the eyes

• Frown Lines-the deep creases between your eyes at the base of your nose

• Worry Lines-the creases running across your forehead

• Bunny lines-the wrinkles at the base of your nose that wrinkle when you smile hard

• Lip Lines-the wrinkles around your mouth when you purse your lips

• Marionette Lines-the lines running from the corner of your mouth down to the jaw lie that pull the mouth down when you are angry or sad

How is Botox(TM) Given?

Tiny amounts of Botox(TM) are injected directly into the muscle that is causing the wrinkle or dynamic line. These injections are dosed in International Units (IU). Very small amounts of the solution are used.

Generally a treatment of 25 IUs 0f Botox(TM) is used to treat the crow’s feet and frown lines-5-6 IU in each side of the crow’s feet and 13-15 IUs in the frown lines. If the worry lines are also treated and additional 6.25 IU is placed into each side of the forehead for an additional 12.5 IUs.

Very small amounts of Botox(TM) are used around the mouth to avoid any interference with mouth function. Generally only 1 or 2 IUs are used on the upper lip for lip wrinkles-after treatment you may not be able to whistle or drink through a straw-but those lip wrinkles will be gone. Only 1 IU is used on each marionette line-this treatment can reduce the mouth line and help reduce the jowl.

Small amounts of Botox(TM) can also be used on the bands on the neck below the chin. 1 or 2 IUs in each band will reduce the folds or bands on the neck.

Does Botox(TM) Injection Hurt?

I use a topical numbing cream which is very effective. I also use a cold Titanium Roller to cool the skin which is very effective at numbing the skin and which also helps prevent bruising. My patients often do not even feel the injection. If the patient has had a previous Botox(TM) injection without these measures in a different office they are amazed at the difference.

What Does Botox(TM) Injection Cost?

Nationally Botox(TM) injections cost $20.00 per unit injected. If you are offered a discount or deal be sure to ask how many units you are getting. Some low priced offers are using diluted Botox(TM) which will not be as effective for removing wrinkles.

What Can Go Wrong with Botox(TM)?

Botox(TM) injections are safe when done properly by an experienced and licensed physician who is an expert in facial anti-aging therapy. However there are potential side effects which can occur-some are unavoidable-some are related to injection technique.

Generally there is about a 2% incidence of side effects in my current experience although initial studies years ago were higher. The more common potential side effects of Botox(TM) are:
• Headache
• Flu like illness
• Nausea
• Temporary eyelid droop

Eyelid droop is caused if the agent is injected too low in the forehead near the eyelid, and does not occur with the typical forehead injection.

Where Should I Go to Learn about Botox(TM)?

See an expert in non-surgical facial rejuvenation and anti-aging skin care therapy. In my opinion experts are board certified dermatologists and plastic surgeons that specialize in facial rejuvenation procedures.

Study your doctors website and ask questions-especially ask how many Botox(TM) injections they have done and how many they do each week. Experience is very important in getting the best result and avoiding complications.

Don’t go to Botox(TM) parties-I have seen some unhappy results on patients who have had Botulinum Toxin A injections in a non medical setting.

My opinion is that you want an expert who is board certified in dermatology or plastic surgery who is an expert at what causes facial aging and wrinkles, knows all of the various techniques for correcting facial aging, and knows which treatment is best for your unique face. Some doctors are now handing Botox(TM) injections over to nurses or PA’s because they dont want to be bothered by doing an injection. I am a board certified plastic surgeon with 26 years of experience. I do every Botox(TM) injection in my praqctice. I believe I can do the injection better, my patients prefer that I do the injection and I believe patients deserve my expertise. attention and care when they are paying for this service.

Botox(TM) is one of the most revolutionary advances in anti-aging skin care in the past 10 years. Regular use can actually prevent permanent wrinkles from occurring on your face. In terms of facial aging, prevention is the best cure.

To leaqrn more about Botox(TM) call 978-369-4499 or email me. Read our free newsletter for updates on non-surgical facial rejuvenation. Read Save Your Face to learn how to prevent facial aging.

Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts

Botox® is the most revolutionary and effective facial anti-aging treatment since the advent of laser resurfacing. Unlike laser resurfacing, there is no down time with the procedure, which, along with the effectiveness of Botox® accounts for its incredible popularity. Yes, the name Botox® is short for botulinum toxin, a toxin produced by the bacteria Clostridium botulinum. It was discovered in 1895 and purified as botulinum toxin A (the type we use today) in 1946. It was first used in the late 1970’s to treat torticollis and other severe forms of muscle spasm and was found to be very safe and effective.

In the 1980’s, doctors Jean and Alastair Carruthers noticed that when they used Botox® to treat patients with ocular spasm (spasm of the eyelid) the wrinkles or crow’s feet around the treated eye disappeared (4). These results encouraged doctors to use Botox® to treat the lines of facial expression, frown lines, worry lines, and crow’s feet. The cosmetic use of Botox® was approved by the FDA in April 2002.

Before (left) and 3 weeks (right) after Botox injection for “crows feet” (patient is actively smiling in both photographs.)

Botox® works by weakening the muscles of facial expression. When you contract or tighten one of the muscles of facial expression, the nerve which connects with the muscle releases a chemical called acetylcholine. The acetylcholine then stimulates the muscle to contract or tighten. Botox® works by blocking the effect of acetylcholine on the muscle, and causes the muscle to relax and quit pulling on the skin. When the muscle stops pulling on the skin, the wrinkle caused by the muscle pull goes away. Importantly, the muscles of facial expression function to produce an expression on your face.

The muscles of facial expression are not involved in chewing or other important functional tasks. If they were, we would not use Botox® on them. Botox® also works well on the bunny lines, those little lines at the base of your nose when you squint or wrinkle your nose. The part of your eyelid muscle that is important for eye closure is not treated with Botox®, we treat only the outer part of that muscle which causes the crow’s feet. [Figure 7].

Botox injections are quick and relatively painless, especially when the area to be injected is iced first and a small 32 gauge needle is used.

Doctors who are expert at the use of Botox® can also use Botox® to lessen lipstick lines and some of the deep furrows below the lip on the chin. Only small amounts, two or three IU’s (International Units ) are used in these areas.

Correction of the lines of facial expression is not permanent, so Botox® injections must be repeated. The initial injection last three to six months, but the second injection often lasts six to nine months. The effect of Botox on the muscle seems to be cumulative in my experience, raising the possibility that after two to three years of use, the muscles will have atrophied and will be weak enough that repeat injections may not be necessary. At the present time, however, you should assume that you will continue to need Botox® injections every 6 to 9 months for as long as you want the lines to be gone.

It is essential that the physician who injects Botox® be experienced in the injection techniques for this drug. Botox® must be accurately placed within the muscle for it to work. The muscular anatomy of the face is very complex and injections can easily be placed too deep (below the muscle), or too superficially (in the dermis.) In either case, the injection will not work as well and you will be unhappy with the result. This is not something that a nurse or anyone other than a physician should be doing. It looks so simple, but technique is very important.

If Botox® is placed into the wrong muscle, your eyelid can droop or your smile can become crooked. Ask the right questions when you seek this treatment. Adverse reactions that have been reported are headaches (13%), nausea (3%), and flu-like syndrome (2%), but whether they are related to the Botox® is unknown. Three percent of patients in initial studies had temporary eyelid droop lasting three to six weeks, but in my opinion, eyelid droop can be avoided by proper injection technique.

Botox® injections sting, but the discomfort can be significantly reduced by icing the area prior to injection and diluting the Botox® with a preservative containing saline. Botox® is expensive. Botox® comes from the manufacturer as a powder which must be refrigerated. It must be mixed and diluted with saline (salt water) prior to injection and after it is diluted, it must be kept refrigerated. The company that makes Botox® recommends that the diluted, refrigerated Botox® be used within two weeks, or it loses much of its effectiveness.

Treatments are charged by the unit of Botox®, usually around $20 per unit. A typical initial treatment uses 25 units, which costs $500. Fifty units is usually the maximum treatment recommended for one session. In my practice, 50 units could easily treat frown lines, worry lines, crow’s feet and bunny lines. Very small amounts (1-3 units) are used around the mouth for lipstick lines, carefully placed to avoid the corner of the mouth where smile muscles and the muscles used for chewing are present.

We still don’t know the long term effects of Botox® treatment on the muscles, but it has been in clinical use since 1978 and no adverse long-term effects have been reported in the past 26 years. Recent widely-publicized stories of complications in Florida were misleading. The individuals involved did not use Botox but rather an unapproved solution, ordered from a lab which was unsafe. Please re-read the first section of this chapter and Chapter 10 about the importance of finding a board-certified, ethical doctor for your facial rejuvenation treatments.

For more information on Botox and other facial rejuvenation techniques read Save Your Face or contact me. Be sure to sign up for our free email newsletter.

Dr Seckel

978-369-4499

Concord, Massachusetts

Boston, Massachusetts

Botox® is the most revolutionary and effective facial anti-aging treatment since the advent of laser resurfacing. Unlike laser resurfacing, there is no down time with the procedure, which, along with the effectiveness of Botox® accounts for its incredible popularity. Yes, the name Botox® is short for botulinum toxin, a toxin produced by the bacteria Clostridium botulinum. It was discovered in 1895 and purified as botulinum toxin A (the type we use today) in 1946. It was first used in the late 1970’s to treat torticollis and other severe forms of muscle spasm and was found to be very safe and effective.

In the 1980’s, doctors Jean and Alastair Carruthers noticed that when they used Botox® to treat patients with ocular spasm (spasm of the eyelid) the wrinkles or crow’s feet around the treated eye disappeared (4). These results encouraged doctors to use Botox® to treat the lines of facial expression, frown lines, worry lines, and crow’s feet. The cosmetic use of Botox® was approved by the FDA in April 2002.

Botox® works by weakening the muscles of facial expression. When you contract or tighten one of the muscles of facial expression, the nerve which connects with the muscle releases a chemical called acetylcholine. The acetylcholine then stimulates the muscle to contract or tighten. Botox® works by blocking the effect of acetylcholine on the muscle, and causes the muscle to relax and quit pulling on the skin. When the muscle stops pulling on the skin, the wrinkle caused by the muscle pull goes away. Importantly, the muscles of facial expression function to produce an expression on your face.

The muscles of facial expression are not involved in chewing or other important functional tasks. If they were, we would not use Botox® on them. Botox® also works well on the bunny lines, those little lines at the base of your nose when you squint or wrinkle your nose. The part of your eyelid muscle that is important for eye closure is not treated with Botox®, we treat only the outer part of that muscle which causes the crow’s feet. [Figure 7].

Botox injections are quick and relatively painless, especially when the area to be injected is iced first and a small 32 gauge needle is used.

Figure 7. Before (left) and 3 weeks (right) after Botox injection for “crows feet” (patient is actively smiling in both photographs.)

Doctors who are expert at the use of Botox® can also use Botox® to lessen lipstick lines and some of the deep furrows below the lip on the chin. Only small amounts, two or three IU’s (International Units ) are used in these areas.

Correction of the lines of facial expression is not permanent, so Botox® injections must be repeated. The initial injection last three to six months, but the second injection often lasts six to nine months. The effect of Botox on the muscle seems to be cumulative in my experience, raising the possibility that after two to three years of use, the muscles will have atrophied and will be weak enough that repeat injections may not be necessary. At the present time, however, you should assume that you will continue to need Botox® injections every 6 to 9 months for as long as you want the lines to be gone.

It is essential that the physician who injects Botox® be experienced in the injection techniques for this drug. Botox® must be accurately placed within the muscle for it to work. The muscular anatomy of the face is very complex and injections can easily be placed too deep (below the muscle), or too superficially (in the dermis.) In either case, the injection will not work as well and you will be unhappy with the result. This is not something that a nurse or anyone other than a physician should be doing. It looks so simple, but technique is very important.

If Botox® is placed into the wrong muscle, your eyelid can droop or your smile can become crooked. Ask the right questions when you seek this treatment. Adverse reactions that have been reported are headaches (13%), nausea (3%), and flu-like syndrome (2%), but whether they are related to the Botox® is unknown. Three percent of patients in initial studies had temporary eyelid droop lasting three to six weeks, but in my opinion, eyelid droop can be avoided by proper injection technique.

Botox® injections sting, but the discomfort can be significantly reduced by icing the area prior to injection and diluting the Botox® with a preservative containing saline. Botox® is expensive. Botox® comes from the manufacturer as a powder which must be refrigerated. It must be mixed and diluted with saline (salt water) prior to injection and after it is diluted, it must be kept refrigerated. The company that makes Botox® recommends that the diluted, refrigerated Botox® be used within two weeks, or it loses much of its effectiveness.

Treatments are charged by the unit of Botox®, usually around $20 per unit. A typical initial treatment uses 25 units, which costs $500. Fifty units is usually the maximum treatment recommended for one session. In my practice, 50 units could easily treat frown lines, worry lines, crow’s feet and bunny lines. Very small amounts (1-3 units) are used around the mouth for lipstick lines, carefully placed to avoid the corner of the mouth where smile muscles and the muscles used for chewing are present.

We still don’t know the long term effects of Botox® treatment on the muscles, but it has been in clinical use since 1978 and no adverse long-term effects have been reported in the past 26 years. Recent widely-publicized stories of complications in Florida were misleading. The individuals involved did not use Botox but rather an unapproved solution, ordered from a lab which was unsafe. Please re-read the first section of this chapter and Chapter 10 about the importance of finding a board-certified, ethical doctor for your facial rejuvenation treatments.

For more information on Botox, soft tissue fillers and other non surgical facial rejuvenation options read Save Your Face or contact me.

 Be sure to sign up for my free email newsletter.

 Dr Seckel

Boston, Massachusetts

Concord, Massachusetts