Botox ^TM Wrinkle Treatment

Below is a recent interview with Joel G. Caschette, M.D., about information prospective patients need to know about Botox Cosmetic®.

	Before You Get to the Point..
	What You Need to Know about Botox®: Straight Talk about Botox® from "The Botox® M.D."

Joel Caschette, M.D. ("The Botox® M.D.") is the Director of Visage Medical Skin Care, a non-surgical Cosmetic Medicine practice based in Cape Coral and Fort Myers, Florida. (Visit the Visage Web Site at www.visagemedicalspa.com ) He shares his expertise below about what you can realistically expect when you want to eliminate wrinkles with Botox®.

Q: What is Botox®?

A: Botox Cosmetic® is a FDA approved protein naturally derived from the bacterium Clostridium Botulinum Type A. It has been used for more than 20 years to reduce unwanted muscle activity in eye and nerve diseases. Today, its best known use is for the cosmetic reduction of facial expression lines.

Q: I've heard of people getting botulism from Botox®. What do you know about that?

A: Extraordinarily small amounts of Botox Cosmetic ® are administered to treat wrinkles. These quantities are insufficient to cause botulism.

My home state of Florida has the dubious distinction of being the only state in which botulism was reported after botulism toxin was injected. Notice how I didn't say Botox®. It was not Botox® for cosmetic use that was injected. It wasn't even for human use. It was veterinary grade botulism toxin. Apparently, veterinary grade injectable botulism toxin is less expensive than Botox®. But that is no excuse for using it in humans, and I'm pretty sure the parties involved were not licensed physicians.

The take home message is this: Botox® made by Allergan, the only pharmaceutical company which makes Botox® in United States , has not caused any cases of botulism. To protect yourself, make sure you are treated by a licensed Doctor of Medicine. You can ask to see the Botox® vial prior to injection. It has purple and white labeling, and has the hologram "ALLERGAN" on the label. As an informed consumer, you maximize your chances of a good treatment result.

Q: Isn't Botox® a poison?

A: I've had patients ask this question several times. I use this example: If you have a strep throat, what might a doctor prescribe? Penicillin. What does Penicillin do? It's a poison that kills the strep bacteria. Without this particular "poison", countless lives would have been lost to infection.

As physicians, we use medications to get a desired result. Most medicine can be "poison" if improperly administered. Properly used, modern medications like Botox® get results without adverse side effects.

Q: What can you tell us about "watered-down Botox®"?

A: Sometimes patients ask: "Is your Botox® watered down?" Few patients know that Botox® is shipped at low temperatures in powdered form. ALL Botox® must have sterile saline solution added before injection- you can't inject the powder. The volume of solution used can be variable from doctor to doctor. What is important is the dosage (units) of Botox® used to treat a given area. There could be 10 units of Botox® in 1/10th cc, or only one unit per 1/10th cc of fluid. It is the amount of Botox® units used that will dictate results.

Q: Why is there so much talk about Botox®?

A: Facial wrinkles help us to convey to others our emotional state, but some unwanted facial wrinkles always seem to show fatigue or anger, even if those appearances do not represent how we are feeling. This is especially true of lines of the forehead and between the eyebrows. Other lines, such as "crow's feet", may make us appear older than our actual age. Botox ® is used to block the nerve impulses that tell those muscles to move. Botox ® is used to treat wrinkles that are found when you make facial expressions, or "wrinkles in motion".

Q: What? You mean I'll look like a wax dummy once I get Botoxed?

A: No. When I inject Botox®, I want to improve the apparent age of my patient's skin without their acquaintances being able to notice. That means reducing wrinkles while allowing for normal facial expression. In my practice, I find it crucial for the patient to be aware of the good and bad of treating facial lines with Botox®. For example, when treating forehead lines, BOTOX® can't be used to close to the eyebrows, or the brows will not move. Botox® too far to the sides of a forehead can leave female patients with a worse shape to their eyebrows. As a result, I don't inject on the edges of the forehead. After I treat a patient's forehead with Botox®, lines on the edges of the forehead will still be present on purpose. This is because the muscles causing those wrinkles allow your face to look normal and not "frozen".

Q: What is the cause of wrinkles and facial expression lines?

A: Facial expression lines develop from the action of the underlying muscles on the skin. Wrinkles develop, at least in part, from the repeated action of facial muscles under the skin over time. These are what I call "wrinkles in motion". Over time, lines get etched in and become more problematic "wrinkles at rest". Sun exposure (especially intense Florida sun) and smoking are the top two causes of premature skin aging and wrinkle formation. Botox ® is capable of improving the "wrinkles in motion". Wrinkles at rest are unlikely to improve. If they do, consider it a bonus. In my practice, however, I have seen improvement of wrinkles at rest at times, but I tell my patients NOT to expect this.

Q: How does Botox® work?

A: Botox ® acts by immobilizing the muscle at treated sites. It does this by inhibiting contraction of the targeted muscles. Only those muscles producing these undesirable lines are treated.

Q: What areas can you use Botox® for ?

A: BOTOX® can be used in many areas, but some carry more risks than others. The areas that I feel BOTOX® treats best are "frown lines" between the eyebrows, "crow's feet" and forehead wrinkles.

Q: Does the Botox® Injection hurt?

A: I always tell patients that, like any "shot", the anticipation is 10 times worse than actually getting the injection. Getting BOTOX® feels like getting a tuberculosis test- the discomfort is minimal and lasts seconds. Typically several injections are given with each treatment. I, like many experienced BOTOX® physicians, use the extremely fine needles and small amounts of injection solution to deliver the BOTOX®. When BOTOX® is injected there is a minor sting for a few seconds. Once the injection is complete, there's usually no discomfort.

Q: How does the skin appear after Botox®?

A: Immediately after treatment, the treated areas look like mosquito bites. This redness subsides with hours. However, I always warn patients that since we are poking the skin with a needle, expect bruising and swelling at the treated sites. If this does happen, these normally resolve within a few hours to days. The skin feels normal and there is no unusual sensation.

Q: How soon will a patient see results?

A: BOTOX® takes effect in three to ten days.

Q: Are there any limitations after treatment?

A: For the most part, patients return to work or other activities immediately after treatment. My main warning when patients leave the office is "Don't rub towards your eyes" . Rubbing Botox® towards your eyes can cause droopy upper eyelids, double vision, and blurry vision. It's best not to touch the treated area at all for 24 hours. I also tell patients to not lie flat for 4 hours after treatment.

Q: How long do the results of Botox® last?

A: Botox® lasts for 3 months, sometimes 4. Each patient metabolizes Botox® at different rates so the treatment may last longer or may not last as long. When the effect of Botox® wears off, the muscles that contribute to these facial expression lines again become active. If you want to keep the wrinkles away, another treatment should be scheduled.

Q: How does Botox® compare to other products such as collagen and filler materials?

A: Botox ® treats the unwanted "wrinkles in motion" that appear with facial expression at the muscle level. Filler materials, such as Restylane®, fill "wrinkles at rest". Although fillers reduce the appearance of lines when there is no facial expression, the moment the person does smile or frown, the lines may still be visible. Often, I have injected Botox® first to decrease "wrinkles in motion". If "wrinkles at rest" remain, Restylane® and other products can be used to fill etched in lines and maximize the desired results.

BOTOX® and Botox Cosmetic® are registered trademarks of Allergan, Inc. Copyright© 2007, Eastern Medical Reporting.