Injectables & Fillers

Botox® Cosmetic refers to Botulinum Toxin, Type A. Botulinum is a toxin produced by the bacteria Clostridium Botulinum, found in soil and marine environments throughout the world. Large doses of the toxin from oral ingestion, wound contamination and spore ingestion cause mild to life threatening illness. The toxin affects the nerve muscle junction, preventing transmission of the nerve impulse that causes muscle contraction. Two FDA approved companies produce a very diluted frozen suspension of the toxin that becomes available for injection when mixed with a small amount of saline. The doses used to paralyze the upper facial muscles are miniscule. The toxin attaches to the muscle- nerve junction, paralyzing muscles, softening facial appearance. The toxin remains there for 3-4 months where upon it is metabolized and harmlessly excreted. It does not spread to affect other parts of the body. It is used primarily to eliminate wrinkles between the eyebrows, the forehead and crow’s feet lateral to the eye. Experienced practitioners, using advanced techniques also use it around the mouth, in eyelids and neck for spasm conditions, and palms, soles, and underarms for excessive sweating conditions.

Specific areas are injected to prevent temporary weakening of other muscles. We use cautious doses at first and have clients return in one week for a touch up if needed. This reduces the cost of the procedure. The Botox® Cosmetic is very expensive and has a short shelf life when mixed with saline. To quote directly from Harrison’s Principles of Internal Medicine, “Botulinum Toxin is being used as therapy for strabismus blepharospasm and dystonias and appears safe and effective.”

Fillers are substances that remain in the skin after injection, plumping up wrinkles so they disappear or are less noticeable. This fills out the space where your own collagen has evaporated with age, restoring a more youthful appearance. The first fillers were from bovine or chicken collagen and required a skin test to check for allergy. Never the less some disfiguring allergic reactions occurred, causing a search for a safer product. Q-Med, a Swedish company, synthesized a non-animal biodegradable product called Restylane and Perlane. This is pure hyaluronic acid, a substance found naturally in the spaces between cells in your body. This substance helps support the cellular structure of the skin and body. The slightly viscous clear gel is injected under and around wrinkles in small amounts, drawing fluid into the specific area, raising and flattening the depressed line. It can also be used to plump up lips. The only complication is mild bruising. The cosmetic effect last 6-8 months.

Both with Botox® Cosmetic and Filler, it is recommended that aspirin, Ibuprofen, Vitamin E and Ginkgo be stopped one week before treatment to minimize bruising. It is also recommended that exercise and facial massage be stopped for 3 days after treatment to decrease unnecessary dispersion of the products. These products are easy to administer safe and effective and will see more frequent use in the years ahead.