BOTOX® SAFETY
Neurotoxins have become one of the standard non-surgical treatment options to maintain a youthful appearance. Neurotoxin manufacturers have achieved unparalleled success with these injectible “miracle drugs” to eliminate unwanted lines and wrinkles. However, in early 2008, a few safety concerns surfaced in the media. While these concerns predominately focus on high dose therapeutic uses of neurotoxins there have also been concerns regarding neurotoxin use for cosmetic purposes.
The safety profile of injectible neurotoxins such as Botox® and Botox Cosmetic®(botulinum toxin type A) from Allergan, Inc. ( Irvine, CA) and Myobloc (botulinum toxin type B) from Solistice, Inc. (S. San Francisco, CA) have recently been called into question. Some controversial claims suggest the possibility that botulinum toxin type A may migrate to the brain. This concern relates to an animal experiment. The investigators however did not us Botox® but used a laboratory preparation of botulinum toxin. In addition, the concentration of botulinum toxin was significantly more concentrated than the heavily diluted toxin that is found in Botox cosmetics®. As neurotoxin concerns continue to capture headlines, physicians defend the safety of neurotoxins and continue using them.
To date, there have been no published or unpublished reports of death as the result of the administration of Botox® or Myobloc for cosmetic use. In early 2008, the FDA did however issue a safety concern of Botox®, Botox Cosmetic®, and Myobloc when used off label to treat spasticity in the lower limbs. A few pediatric cerebral palsy patients were reported to have died after receiving large doses of Botox®. The FDA has yet to reach any conclusions.
In defense of Botox Cosmetic, it has had an unparalleled safety record. Millions of treatments have been given over a period of two decades and if there were significant risks, they would have been apparent by now. While Dr. Sullivan is highly confident in the safety profile of neurotoxin products, he does have concerns in how, where and by whom these drugs are administered.
Quite frankly, the injection of Botox® and fillers is not technically difficult. On the other hand, it is very difficult to perform these injections and achieve consistent results and satisfactory patient outcomes. Facial Plastic Surgeons and Dermatologists spend many years in residency and after residency developing the judgment and perfecting the skills to properly perform aesthetic procedures. These are not procedures that can be learned over night by an attending a weekend course. Patients seeking Botox® or filler injections have every right to expect the best trained and qualified individual perform their procedure. It is Dr. Sullivan’s opinion that, physicians who choose to delegate these procedures either trivialize the difficulty of the procedure or underestimate the expectations of their patients.
What is BOTOX® COSMETIC and what can it do for me?
BOTOX® Cosmetic (botulinum toxin) is a solution which can be injected under the skin surface to temporarily weaken the muscles. It is safe and has proven to deliver consistent and reliable results. BOTOX® Cosmetic has a number of helpful applications in medical practice including treating muscle spasticity, tremors, and voice disorders. It is most widely known, of course, for its ability to treat wrinkles and fine lines in the face. BOTOX® Cosmetic is injected with a very fine needle under the skin in the office setting. The improvements in the wrinkles of the face begin to appear 3 days after the injection and achieve the maximal effect after 7 days.
BOTOX® Cosmetic is both a "treatment" and prevention for wrinkles that develop as a result of repetitive facial expression- especially those that have become habits. The BOTOX® Cosmetic solution will relax the muscles and smooth existing deep creases and wrinkles. It also prevents the development of permanent architectural changes in the skin structure that will eventually develop into the deep creases that are evident even when your face is completely relaxed.
What areas of the face can be treated?
The forehead (worry lines), glabellar (vertical frown lines between the brows), and the periorbital areas (crow's feet or smile lines) are the most common areas treated with BOTOX® Cosmetic. Precise placement of the medicine in the brow will produce both relaxation and smoothing of wrinkles. Many people develop a slight ptosis or "drop" of the brow line with age and BOTOX® Cosmetic can provide a gentle lift. Treatment can be also focused on the outer aspect of the brow giving a gentle, natural "arch" to the outer brow. BOTOX® Cosmetic is one of the few ways to smooth the periorbital "crow's feet" and is commonly used in this area as well.
In some cases, BOTOX® Cosmetic is injected into the areas of the upper lip or chin to treat vertical wrinkles that frequently appear in this area. Special care is required here to avoid interfering with the movement of the upper lip that patients need for everyday life. It can also be used to relax the bands or cords that appear in the neck area. If you have questions about this area, speak with your doctor.
How long does BOTOX® Cosmetic work?
The injection begins to take effect in the days immediately following placement. Patients should see the result about 5-7 days after the treatment. Although patients vary in response, most see the improvements persist for at least 3 to 6 months and in some cases longer. Results last longer in the forehead and between the eyebrows but everyone has an individual response.
Will I still have a "natural facial expression" after my treatment?
The careful placement of the BOTOX® Cosmetic injection will ensure that you achieve the smoothest skin surface but will maintain movement that is critical for a natural appearance and expression. The most experienced physician understands the location and function of the muscles and will help you achieve your desired result.
How do I know when it's time for another injection?
Patients decide when the time is right. In general, BOTOX® Cosmetic works well for 3-6 months and then the movement returns quite quickly. This is the optimal time for a re-treatment. There is no advantage in getting an injection before the muscle movement has returned. Your doctor can help you assess the return of muscular function and will guide you on your decision.
Is BOTOX® Cosmetic safe and will I develop a resistance if I have repeated injections?BOTOX® Cosmetic is very safe and has been used in the United States for years to treat a number of medical problems. Patients do not require allergic testing prior to treatment. Repeated injections are very safe and patients will not develop a resistance over time. Patients can also decide to delay treatments or stop completely at any time.
What is the injection experience and how do I care for my face after my treatment?
BOTOX® Cosmetic is injected in the office under sterile conditions. Precision placement of the solution does require multiple injection sites as well as a good understanding of your anatomy. Patients are given cool compresses, ice, or topical local cream as needed. After the treatment, patients are asked to abstain from intense physical exercise until the following day. Otherwise, your normal routine can be resumed immediately. Because the needles used are so small, cosmetics may be reapplied immediately after the injection.
Can other procedures be performed at the same time as my BOTOX®
Cosmetic treatment?
BOTOX®
Cosmetic can be placed in conjunction with most other facial plastic surgery procedures. Commonly, patients will undergo the placement of a Filler Material at the same time to achieve the optimal result. Please refer to the webpage on
Filler Materials for more information.
How should I choose my doctor?
The Sullivan Centre is a national BOTOX® Cosmetic training center and an Allergan Platinum Plus provider. This status ensures that Dr. Michael Sullivan has mastered the technique of injecting Botox, he is one of an elite group of physicians that have been asked by Allergan to train other physicians in the art of injecting Botox. There are several options now for BOTOX ® Cosmetic injections and patients need to choose an experienced physician, one who has a good understanding of the facial anatomy. Proper injection requires not only good training on technique, but also a surgical anatomical knowledge of the exact location and function of the facial muscles. Only then can you truly take advantage of the tissue sculpting potential of BOTOX® Cosmetic. Our physicians at The Sullivan Centre for Plastic and Reconstructive Surgery will perform a careful medical examination and will tailor a treatment plan that is unique to your goals. Our team is committed to providing you a truly exceptional experience.
BOTOX® Cosmetic is a registered trademark of Allergan, Inc.