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Botulinum Toxin Treatment
Wrinkles And Frown Lines
Frown lines are the result of gathering or knitting the tissue between the eyebrows into a fold. These unattractive folds and furrows are caused by the repeated action of underlying muscles associated with facial expression. Years of squinting and frowning tend to leave deep wrinkles in the skin between the eyebrows and on the bridge of the nose, across the forehead, and at the corners of the eyes. On many people, frown lines produce an angry or sad look that detracts from a pleasant facial appearance. Dermatologic surgeons can now improve these lines without surgery and without scars by a simple injection of botulinum toxin type A.
What Is Botulinum Toxin?
Botulinum toxin is a purified toxin and, when given orally in large amounts, it blocks the nerve signals from the brain to the muscle, causing a generalized paralysis called botulism. However, by injecting very tiny amounts into a specific facial muscle, only the targeted impulse of that muscle will be blocked, causing a local relaxation and weakness. In this way, botulinum toxin acts as a muscle blockade to immobilize the underlying cause of the unwanted lines and prevent "wrinkly" expressions. Botulinum toxin has been used since 1980 to treat many muscle disorders, such as lazy eye, eye ticks and uncontrolled blinking. Pioneered by dermatologic surgeons in 1987, the use of botulinum toxin for cosmetic purposes is an unapproved, or "off-label" use of a FDA-cleared drug.
Botulinum toxin is injected directly into the target muscle to treat vertical lines between the eyebrows and on the bridge of the nose, the squint lines or crows feet at the corners of the eyes, the forehead horizontal lines, and the platysmal muscle bands often visible on the neck, commonly known as turkey neck. It may also be used for eyebrow positioning. Once the muscle is weakened and relaxed, it cannot contract. Since there is no way to make the undesirable facial expression, the lines gradually smooth out from disuse, and new creases are prevented from forming. Other muscles like those needed to raise the eyebrows are not affected so a natural expression is maintained. Botulinum toxin may not be as effective on the smile lines around the mouth because the muscle action in this area is needed for expression and important functions like eating.
Botulinum Toxin Therapy
Treatment involves injection of very small amounts of botulinum toxin into the underlying muscles to immobilize them. The actual treatment is well tolerated and takes just a short time with minimal recovery. Botulinum toxin takes effect about 3 to 7 days after treatment. The improvement generally lasts about 3 to 4 months before the effect gradually fades and muscle action returns. It is anticipated that the average patient will require reinjection at various intervals. With repeated treatments, atrophy (thinning) of the muscle may occur which usually produces longer-lasting results.
Excessive sweating can be alleviated with injections of a highly diluted form of botulinum toxin directly into the underarm skin or skin on the palms and soles of the hand or foot. There it paralyzes the sweat glands of the skin which are responsible for excessive perspiration. A single treatment session can provide months of relief, and experts believe that injections can be repeated indefinitely once or twice a year to maintain dryness.
Side effects are minimal and typically relate to the local injection. Soreness or mild bruising, while uncommon, may occur around the injection site. Makeup may be worn after treatment, but care should be taken to avoid pressing or massaging the area for several hours. In rare instances, patients may develop temporary weakness of the neighboring muscles, a temporary droopy brow or eyelid, or a headache.
Chemical peeling is a technique used to improve the appearance of the skin which is typically performed on the face, neck or hands. In this treatment, a chemical solution is applied to the skin that causes it to "blister" and eventually peel off. The new, regenerated skin is usually smoother and less wrinkled than the old skin. The new skin is also temporarily more sensitive to the sun.
Dermatologic surgeons have used various peeling agents for the last 50 years and are experts in performing multiple types of chemical peels. A thorough evaluation by your dermatologic surgeon is imperative before embarking upon a chemical peel.
What Can a Chemical Peel Do?
Chemical peeling is often used to treat fine lines under the eyes and around the mouth. Wrinkles caused by sun damage, aging and hereditary factors can often be reduced or even eliminated with this procedure. However, sags, bulges, and more severe wrinkles do not respond well to peeling and may require other kinds of cosmetic surgical procedures such as a face lift, brow lift, eye lift or soft tissue filler.
Mild scarring and certain types of acne can also be treated with chemical peels. In addition, pigmentation of the skin in the form of sun spots, age spots, liver spots, freckles, splotching due to taking birth control pills, and skin that is dull in texture and color may be improved with chemical peeling.
Chemical peeling may be combined with laser resurfacing, dermabrasion or soft tissue fillers to achieve cost-effective skin rejuvenation customized to the needs of the individual patient. Areas of sun-damaged, precancerous keratoses or scaling patches may improve after chemical peeling. Following treatment, new lesions or patches are less likely to appear. Generally, fair skinned and light haired patients are ideal candidates for chemical peels. Darker skin types may also experience good results, depending upon the type of skin problem encountered.
How Are Chemical Peels Performed?
A chemical peel can be performed in a doctor's office or in a surgery center as an out-patient procedure. At the time of treatment, the skin is thoroughly cleansed with an agent that removes excess oils, and the eyes and hair are protected. One or more chemical solutions - an alpha hydroxy acid, such as glycolic acid, salicylic acid, or lactic acid; trichloroacetic acid (TCA); or carbolic acid (phenol) - are used. Dermatologic surgeons are well qualified to select the proper peeling agent based upon the type of skin damage present. During a chemical peel, the physician applies the solution to small areas on the skin. These applications produce a controlled wound, enabling new, refreshed skin to appear. Most patients experience a warm to somewhat hot sensation which lasts about five to ten minutes, followed by a stinging sensation. A deeper peel may require pain medication during or after the procedure.
What Should Be Expected After Treatment?
Depending upon the type of peel, a reaction similar to a sunburn occurs following a chemical peel. Superficial peeling usually involves redness, followed by scaling that ends within three to seven days. Medium-depth and deep peeling may result in swelling and the presence of water blisters that may break, crust, turn brown, and peel off over a period of seven to 14 days. Some peels may require bandages to be placed on part or all of the skin that is treated. Bandages are usually removed in several days and may improve the effectiveness of the treatment.
It is important to avoid overexposure to the sun after a chemical peel since the new skin is fragile and more susceptible to complications. The dermatologic surgeon will prescribe the proper follow-up care to reduce the tendency to develop abnormal skin color after peeling.
What Are Injectable Fillers?
Injectable fillers are substances that are injected through small needles into the skin to fill or plump wrinkles, depressed scars or facial volume loss. Areas amenable to treatment with fillers include lips, wrinkles running from the nose to the corner of mouth (nasolabial folds), folds beneath the corners of the mouth (marionette lines), lines between the eyes, grooves under the eyes, fine lines on the cheeks or around the mouth, and central cheek depressions. Fillers may also be used to treat larger areas of facial volume loss seen with conditions such as HIV.
What Types Of Injectable Fillers Are Available?
For many years, bovine collagen (derived from cows) was the only available injectable filler in the U.S. Recently, many newer forms of fillers, including human collagen, have become available. The most versatile and commonly injected filler today is hyaluronic acid, which is a natural component of all living tissue. Longer-lasting fillers that are most appropriate for deeper and larger areas of volume loss may include polylactic, calcium hydroxylapetite and liquid injectable silicone. Different fillers are used depending on the condition being treated. Your dermasurgeon is the most qualified person to decide which filler is best for your particular need.
How Long Do Injectable Fillers Last?
Corrections achieved with collagen fillers last about three months, while corrections achieved with hyaluronic acids fillers, used in optimum amounts, often persist for about six months. Corrections achieved with polylactic acid calcium hydroxylapetite may persist for 1-2 years or longer. Currently, liquid silicone is the only true permanent filler available in the United States. Its use is "off label," meaning that it is specifically FDA-approved for use other than tissue augmentation, but as such may be legally used as an injectable filler for certain unique indications. Currently, investigational study with liquid silicone shows great promise for HIV facial fat loss and acne scarring.
What To Expect During And After The Treatment
Generally, your dermasurgeon will cleanse and treat the area to be injected with a topical anesthetic cream prior to injection. You may experience slight to moderate discomfort upon injection of the filler, but most patients find the treatment very tolerable. After the treatment, mild redness, swelling and tenderness may develop and persist for a few hours to 1-2 days. Occasional bruising may develop, which usually resolves after a few days. Bruising can usually be avoided by refraining from aspirin, anti-inflammatory medications (ibuprofen, naprosyn) and supplements such as vitamin E, gingko biloba, garlic, ginseng and St. John's Wort for at least one week prior to the procedure.
What Are Possible Complications?
Rarely, bruising, overcorrection, persistent lumpiness or inflammation around the injection site may develop and persist for weeks after a procedure. If such a reaction should occur with hyaluronic acid, hyaluronidase may be injected to dissolve the filler and alleviate the problem. Allergic reactions to the older bovine collagen were common (about three percent). With the newer forms of fillers, allergic reactions are very rare (one in 5000 for hyaluronic acid). Rarely, injection of fillers may compromise blood flow to the skin, causing scab formation and possible development of a scar. This problem is very rare with the newer injectable fillers.
Can Fillers Be Used Safely With Botox And Lasers?
Yes, these modalities often compliment one another and recent studies support the safety and effectiveness of a combined approach to facial rejuvenation.
What Are Spider (Telangiectatic) And Varicose Veins?
Spider veins are formed by the dilation of a small group of blood vessels located close to the surface of the skin. Although they can appear anywhere on the body, spider veins are most commonly found on the face and legs. They usually pose no health hazard, but may produce a dull aching in the legs after prolonged standing and indicate more severe venous disease.
Spider (Telangiectatic) And Varicose Veins
Varicose veins are abnormally swollen or enlarged blood vessels caused by a weakening in the vein's wall. They can be harmful to a patient's health because they may be associated with the development of one or more of the following conditions: phlebitis or inflamed, tender vein; thrombosis or a clot in the vein; and venous stasis ulcers or open sores from inadequate tissue oxygen and fluid retention.
Who Develops Spider And Varicose Veins?
The exact cause of spider and varicose veins is unknown, although heredity, pregnancy and hormonal influences are believed to be primary factors contributing to both conditions. More than 40 percent of women have some form of varicose conditions, with an increasing incidence of venous disease as one gets older, so that up to 80% of women have some form of venous disease by age 80. Slightly more women than men have varicose and telangiectatic leg veins.
What Is Sclerotherapy?
Sclerotherapy is considered the gold standard treatment for removing spider and some varicose leg veins. It is a very cost-effective procedure that seldom leaves a scar or produces adverse effects. It is typically performed on an outpatient basis by a dermasurgeon. A concentrated saline or specially developed chemical solution is injected with a very small needle into the spider or varicose vein. The solution causes the vein to close up or collapse and become scar tissue that is eventually absorbed by the body. The work of carrying the blood is shifted to other healthy blood vessels nearby.
Sclerotherapy generally requires multiple treatment sessions. One to three injections are usually required to effectively treat any vein. The same area should not be retreated for four to six weeks to allow for complete healing, although other areas may undergo treatment during this time. Many dermasurgeons have found that treating all abnormal veins in one session gives the best results.
Post-treatment therapy includes wearing bandages and support hose for two days to three weeks (most commonly one week) following treatment. Walking and moderate exercise also helps speed recovery. Although sclerotherapy works for existing spider and varicose veins, it does not prevent new ones from developing, but may decrease this risk.
Are There Side Effects Or Complications?
Most patients report few, if any minor side effects, which usually disappear in time. Temporary reactions can include a slight swelling of the leg or foot, minor bruising, pigmentation, the temporary appearance of new blood vessels, redness and mild soreness.
What Are Other Treatments For Vein Conditions?
Laser and intense pulsed light (IPL) therapy may be effective for certain leg veins and facial blood vessels. The heat from the high-intensity laser or IPL beam selectively destroys the abnormal veins.
The veins are sealed off with the application of electrical current. The treatment may leave scars.
Surgical Ligation, And Stripping And Intravascular Laser Or Radiofrequency Ablation
Certain varicose veins may require an in-hospital procedure, usually performed by a vascular surgeon, which involves making an incision in the skin and either tying off or removing the damaged blood vessel. This procedure has been mostly replaced by intravascular laser or radiofrequency ablation of varicose veins. Intravascular laser or radiofrequency ablation, pioneered by dermasurgeons, is performed entirely under local anesthesia. A laser fiber or radiofrequency catheter is inserted into the abnormal vein which is then sealed closed by thermal energy. Patients are awake during the procedure and can resume almost all normal activities immediately after the procedure.
Removal of undesired veins through a series of tiny incisions along the path of an enlarged vein. This procedure, pioneered by dermasurgeons is performed entirely under local anesthesia with patients being able to resume nearly all normal activities immediately after the procedure.
Your dermasurgeon may utilize a combination of techniques and technologies to provide an optimal treatment program for your individual condition and lifestyle.