July « 2010 « Cosmetic, Facial & Eye Plastic Surgery Blog

July 20, 2010

Do Asian doctors make the best Asian eyelid surgeons?

Filed under: asian eyelid surgery,best cosmetic surgeons,blepharoplasty,Cosmetic Surgery,double fold surgery,Eyelid Surgery — Tags: asian blepharoplasty, asian eyelid surgery in los angeles, Cosmetic Surgery, eyelid surgery for Asian eyes, los angeles cosmetic surgeon — admin @ 9:23 am

If you are seeking Asian eyelid surgery, seek treatment with the best. This seems like a no-brainer that is of course true of most any medical procedure, and yet some people still seek specialized treatments from nonspecialists. The key to obtaining definitive, optimized results is to do your homework and consult with the most experienced, respected, and qualified specialists. Be completely honest about your needs, goals, and medical history, and ask as many questions as you need in order to feel good about your decision and confident in your doctor’s abilities. When you seek Asian eyelid surgery in Los Angeles or elsewhere, we recommend you consult with a cosmetic surgeon who has a specialized strength in this area.

Asian Eyelid Surgery Before and After

Finding the Best Asian Eyelid Surgeon

Many wonder if Asian doctors make the best Asian eyelid surgeons. This seems like a natural question to ask, even if it is not the most logical upon closer examination. A surgeon is as good as his or her training, skill, experience, ethical values, education, leadership, medical understanding, and a myriad of other dynamic factors that come together to make a capable and reputable physician. Every physician has particular areas of strength and specialization, so of course you will not choose the same surgeon to operate on your heart, brain, or eyelid. You of course will choose the specialist. So, in short, the best Asian eyelid surgeon is a specialist. There are many Asian doctors who are excellent at performing procedures like Asian blepharoplasty and double fold surgery, and this is because they have studied and specialized in Asian eyelid surgery.

Nobody is born with an innate knowledge of medicine. Yes, becoming the best oculoplastic surgeon does require developed talent and artistic vision, while it also requires years of study, focus, training, and experience. These factors depend on the individual surgeon. It is therefore wise to evaluate potential surgeons not based on their own photo or ethnicity, but on their credentials, expertise, and clinical experience.

A Unique Approach

Asian eyelid surgery should not be approached in a cookie-cutter fashion, but then again, neither should any eyelid surgery. While it is important that your doctor has experience and training in treating the distinctive features of Asian eyelids, it’s also important that both you and your doctor understand that there is no one standard approach to Asian eyelid surgery. When everyone has unique eyes and distinctive features, how could there be one method that works for everyone? There is a wide range of characteristics among Asian eyelids that vary based on the individual. The approach should therefore emphasize results that enhance the natural features, rather than aiming to “westernize” the eye. This common misconception is rarely the goal of Asian eyelid surgery.

The most qualified Asian eyelid or blepharoplasty surgeons for giving you natural results will be someone who specializes in oculoplastic surgery for Asian features and has treated a variety of eyelid shapes and concerns by custom-tailoring each procedure to the individual.

Consult with an Expert

To find the doctor best suited for your needs, seek someone with extensive oculofacial cosmetic surgery experience and training who has also demonstrated an exceptional ability to treat a variety of eyelid concerns. This should include a solid understanding of how to maintain the natural beauty of Asian eyelids and a recognition that every eyelid is different and cannot be improved by simply following assembly line instructions.

We invite you to consult with Dr. Steinsapir, a specialist of Asian eyelid surgery in Los Angeles. Please browse his Asian eyelid surgery before and after photos to see his abilities for yourself, and then ask questions and learn more at a no-risk individualized consultation. Dr. Steinsapir is world-renowned for his West Los Angeles practice that focus on cosmetic eyelid surgery with an emphasis in Asian eyelid surgery needs. Dr. Steinsapir is a Clinical Associate Professor of Ophthalmology at the Jules Stein Eye Institute of UCLA and has been multi-fellowship-trained in both oculofacial and cosmetic surgery. If you would like to find out how an individualized treatment program can enhance your natural features, contact us today to learn more.

Do Asian doctors make the best Asian eyelid surgeons?

Finding the Best Asian Eyelid Surgeon

Many wonder if Asian doctors make the best Asian eyelid surgeons. This seems like a natural question to ask, even if it is not the most logical upon closer examination. A surgeon is as good as his or her training, skill, experience, ethical values, education, leadership, medical understanding, and a myriad of other dynamic factors that come together to make a capable and reputable physician. Every physician has particular areas of strength and specialization, so of course you will not choose the same surgeon to operate on your heart, brain, or eyelid. You of course will choose the specialist. So, in short, the best Asian eyelid surgeon is a specialist.
There are many Asian doctors who are excellent at performing procedures like Asian blepharoplasty and double fold surgery, and this is because they have studied and specialized in Asian eyelid surgery.

A Unique Approach

Consult with an Expert

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July 19, 2010

I am thinking of getting lip filler but I am afraid of getting my lips overdone.

Filed under: lip augmentation,lip fillers,lip injections,Restylane,Restylane Injections — Tags: injectable lip fillers, Restylane, restylane beverly hills, restylane in los angeles, Restylane lip augmentation, restylane los angeles, Silicone oil — admin @ 3:07 pm

Lip augmentation is a great option for those with thinning lips, aging lips, lip lines, or volume deficiencies. Lip fillers have the ability to change your appearance from aging and ordinary to youthful and sensual. It’s surprising what a difference full lips can make on the face, which is why so many people overlook the important role their lips play when they consider how to improve their appearance. Don’t forget that we use our lips to smile, speak, kiss, eat, and express ourselves. The full lips associated with youth and beauty can make a great difference in how others perceive us and how we feel about ourselves. Both men and women can benefit from lip fillers, provided that both the individual and the doctor determine that this is a suitable treatment option.

Lip Filler Before and After Photo

One major reason great candidates for lip fillers hesitate to seek treatment is because they worry about getting their lips overfilled. Thanks to media hypes, sitcoms, and a few publicized incidents of poor judgment, this is a common concern. The truth is that with just a bit of foresight and planning, you needn’t worry about overdoing your lip filler treatment. There are many fillers available, and the ones best for the lips are very forgiving, enabling your doctor to easily adjust the treatment should you be unhappy with your results.

How Can I Avoid Overdoing My Lips?

Seeking nonsurgical cosmetic treatment for the lips should be an extremely rewarding, low-risk experience as long as you do some research first and choose your doctor with care. First, let’s look at some filler options.

With so many fillers available on the market today – Restylane, Radiesse, Perlane, Juvederm, Artefill, Sculptra, Matridex, and even silicone oil, to name a few – that have all been used as lip fillers, it can be easy to feel overwhelmed by the options. However, not all of these fillers should be used as lip fillers under normal circumstances. Hyaluronic acid fillers like Restylane, Juvederm, and Perlane are much more suitable for lip augmentation than permanent and semi-permanent fillers. This is because they are much more forgiving, do not tend to lump, and can be simply and easily adjusted with the enzyme hyaluronidase. Should you be dissatisfied with your treatment for any reason, experience an irregularity, or simply change your mind about what kinds of goals you have for your appearance, this enzyme can be injected to modify your treatment.

We have found that Restylane is usually the best fillers for lip volume deficiencies. This is because the lips are very sensitive and can irregularities that may arise from treatment. Fortunately, Restylane doesn’t tend to form bumps, and an experienced physician specialist can skillfully place Restylane for natural looks and long-term benefits.

I think I’ve already had too much lip augmentation.

Resolving this issue of course depends on the nature of the problem and the type of filler you received. If you were treated with something like silicone oil, there is both good and bad news: this is a permanent filler. If you like your results, that’s great, and you can expect them to last basically forwever. If you don’t, well, it is virtually impossible to improve the lip. Receiving treatment with a long-term filler is somewhat of a gamble because the long-term fillers have been shown to be less reliable than a filler like Restylane, and if you are discontent with your outcome then it’s harder to reverse.

If you feel you’ve had too much of a hyaluronic filler, adjustment will be very easy. You can usually return to your original doctor to resolve the problem, unless the relationship has deteriorated or you are not confident in your original doctor’s skill level in regards to lip treatment. In such cases, you should seek a second opinion.

If you were treated with a long-term filler like Sculptra or Matridex, treatment will be more challenging. You may be able to a receive a saline injection to try to break up the filler. In some cases excision is indicated as an appropriate treatment. This will depend on the severity, location, and nature of your irregularity or other concern.

It’s possible that you are early from your treatment and simply experiencing some normal swelling. Give yourself time to heal. Wait a couple of weeks to let the swelling settle before evaluating whether or not your lip treatment was excessive. If you have a bruise, you are likely experiencing swelling and need to let things settle down a bit before deciding to seek an adjustment.

How do I prevent a problem with my lip filler?

With some basic understanding of lip fillers and a carefully chosen cosmetic surgeon in Los Angeles to perform your nonsurgical cosmetic treatment lip filler, you really don’t need to worry about regretting your treatment decision. Weigh your options with potential doctors and be sure to ask many questions about what filler he or she recommends, and how easy it is to modify treatment in the off-chance that you’re dissatisfied with it. For example, you can feel great about a Restylane lip filler treatment because it has a strong history of working well as an ideal lip filler. The benefits of Restylane can last for over a year, yet you needn’t worry that you’ll be stuck with results you don’t like because Restylane is both modifiable and not permanent.

Even more important than exactly what filler goes into your lips is the doctor you choose. Find a cosmetic doctor with whom you are comfortable. Your doctor should specialize in facial cosmetic surgery and nonsurgical facial treatment and be extremely knowledgeable about facial fillers. You should feel at ease around your doctor and confident in his or her abilities. How can you be confident? Look into your doctor’s credentials, areas of specialization, experience record, and unretouched before and after photos. What your doctor says should make sense to you. Further, your doctor should personally perform all of your treatments without passing this job to an assistant or “physician extender.”

Dr. Steinsapir is a cosmetic surgeon in Beverly Hills who specializes in minimally invasive treatments and is an expert in facial fillers. In fact, he has served as a physician consultant to Medicis, Inc., who distributes Restylane and Perlane. He is widely considered a leader in facial fillers because of his innovative methods like Deepfill Restylane, extensive experience, and practical artistic skill. He is widely respected and a Clinical Associate Professor at UCLA in oculofacial surgery. Please call us today for a consultation to find out how Dr. Steinsapir’s lip filling techniques can refresh your appearance.

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July 17, 2010

I’m pregnant. Is it OK if I get a squirt of BOTOX?

Filed under: best cosmetic surgeons,Beverly Hills BOTOX,Botox,Botox Los Angeles — Tags: Botox, Botox Los Angeles, botox side effects, is botox dangerous, is botox safe, los angeles cosmetic surgeon — admin @ 10:31 pm

Let’s skip formal introductions and get straight to the basics: when you are pregnant or breastfeeding, you should not take any risks against the health of your child. We have no evidence that the combination of BOTOX and pregnancy will harm you or your child, and given the safe nature of BOTOX it probably won’t, but why would you take any risk at all when BOTOX is an optional cosmetic treatment? While we have no evidence that BOTOX during pregnancy will cause any harm, we simply do not have enough evidence to justify such a practice. We likely never will, as ethical implications make it problematic to study an elective treatment that is not necessary to your health during pregnancy.

: BOTOX Before and After Photo

Is BOTOX Dangerous?

Generally speaking, BOTOX is not dangerous, but it’s important to recognize that there is always at least a small risk with any medical practice. We consider a procedure safe when the associated risks are very low and tend to be mild. Such is the case with cosmetic BOTOX and Dysport. Problems with BOTOX are usually limited to disappointing cosmetic results such as the forehead or “BOTOX freeze,” which can usually be avoided by choosing an experienced cosmetic surgeon who specializes in cosmetic facial procedures and has performed hundreds of BOTOX treatments. In turn, you must listen to your doctor’s advice and not ask him or her to give you more treatment than recommended. Since BOTOX results are temporary, this is not a major problem, and it is one that can be avoided with a qualified specialist physician.

There is a concern about a rare but potentially serious complication if BOTOX is used to treat small children with cerebral palsy, but this has never been observed with cosmetic applications where smaller doses are used and the FDA’s own Dr. Unger has stated that this risk may be zero.

So where does that leave us? We have seen that BOTOX is remarkably safe and effective, making it an ideal treatment option for many people with problems like forehead lines and overactive facial muscles. But does this mean we condone BOTOX for pregnant women? Absolutely not! While we have no evidence that BOTOX will harm either you or your child, we simply do not have evidence to confidently say that it does not. Before we can do that, we will need hard scientific data from controlled research studies, but we likely will never have that, because conducting such a study is unethical.

Please Wait to Get BOTOX Treatment

We do not condone any unproven treatment, including BOTOX during breastfeeding or pregnancy, because we don’t want to find out if there is a risk. Wait until you are no longer pregnant and are finished breastfeeding to seek treatment with BOTOX or really any cosmetic service. Please by an adult about this and “conveniently forgetting” to tell your doctor that you might be pregnant just because it’s “probably okay.” This is irresponsible and believe it or not, some would argue that it is a reckless act tantamount to child endangerment. You will not be pregnant forever, so please wait until you know that there is absolutely no risk of hurting your child before you get BOTOX. BOTOX benefits can dramatically enhance your appearance under the right circumstances, so it is something to keep in the back of your mind to consider after you have given birth and are no longer breastfeeding. At that time ethical practitioners will be happy to help.

The Best BOTOX in Los Angeles

Dr. Steinsapir is a board certified doctor with expert training in both cosmetic and oculofacial surgery, so he understands the complex anatomy and needs of the face. Dr. Steinsapir is the inventor of the acclaimed, patent-pending Microdroplet BOTOX procedure, which successfully elevates the brow and lifts the forehead without causing the “freeze” effect that the media loves to talk about. This creates a natural, youthful appearance through a safe and minimally invasive treatment. If you are ready to find out if you are a good BOTOX candidate, consult with the best. Contact us today to learn more about how Dr. Steinsapir can make your safe treatment experience exactly what you need at a time that’s best for you.

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July 16, 2010

Will skin bleachers help my dark circles?

Filed under: Beverly Hills Restylane,Cosmetic Facial Fillers,Restylane,Restylane Injections,safe cosmetic surgery,Under Eye Restylane — Tags: Restylane, restylane beverly hills, restylane in los angeles, skin bleachers, Under Eye Restylane, under eye treatments — admin @ 1:01 pm

Dark circles under the eyes is a problem that is both common and commonly misunderstood. Dark undereye circle treatment can help, as long as you get the right treatment. There are a variety of remedies as well as so-called remedies, so finding a qualified cosmetic doctor to accurately diagnose your problem will be crucial in determining the best treatment route. In many cases, the best solution is an under eye filler like Restylane or surgery like the midface lift to correct the underlying problems.

Undereye Restylane Before and After Photo

Diagnosis Is Key to Effective Treatment

Many people wonder if a skin bleacher will improve dark circles. After all, when they look in the mirror they see too much darkness under the eyes, and the logical solution may seem to be simply lightening the skin in this area. However, in most cases the problem is not too much skin pigment. This is why if you put on an opaque foundation makeup, you can disguise the problem to some extent, but your under eye area still looks haggard.

The issue of the dark circle is actually optical. There is too little subcutaneous fat under the eyes, and the tear trough skin in this area is too thin, compounding the problem. Light penetrates the skin and is then absorbed by the dark red muscle below the thin skin, which normally would be offset by a healthy layer of fat. Yes, too little fat can be a bad thing, contrary to what popular diet blurbs may tell you – some fat in the face (but not too much) is desirable in order to give the soft appearance associated with youth and beauty. You can bleach the skin all you want here, but this will not correct the problem, and instead may give you a strange pigmentation effect.

Treatment to Address the Underlying Problem

What we often see in individuals who present with under eye cosmetic problems is a descent of some of the soft cheek tissue known as the malar fat pad, which hollows out the under eye, contributes to the midface groove, and causes excessive fullness in the nasolabial fold. Correcting these problems should be considered on an individual basis, but most often the best solution is either a midface lift or under eye Restylane. These treatments address the fundamental problem of the way light interacts with the tissue here.

Restylane restores a natural fullness to the under eye area while allowing the flexibility needed to give precise treatment that is easily adjusted by your doctor should the results be less than ideal. The midface lift is an excellent option for those with more severe symptoms, while Restylane can still help those who need surgery for dark circles but may be apprehensive for personal reasons.

Skin Bleachers – When to Use Them, and When Not To

Skin bleachers do have their place in cosmetic treatment. For example, they can be utilized in combination with a chemical peel. One such use is treatment with an alpha hydroxyl acid to produce smoother skin that, when combined with skin bleachers, has a synergistic effect of lightening the skin. If you have a problem with hyperpigmentation, then an expert chemical peeler can skillfully use skin bleachers to enhance your appearance.

Skin bleachers are not appropriate when the fundamental problem is not with the color of the skin. Effective dark circle treatment usually doesn’t involve skin bleachers, because pigmentation is rarely the problem here; rather, the impact of the descending malar fat pad and the resulting fat deficit impacts your facial optics, and this is what you need to address.

Seek Expert Treatment

Administering under eye fillers is an art form, as is the midface lift. When you are seeking a cosmetic under eye filler or surgery, you need a facial cosmetic surgeon with the medical training, clinical expertise, experienced specialization, technical skill, and artistic understanding it takes to yield the best results. We invite you to consult with Dr. Steinsapir, who is one of the few doctors in the world who makes the treatment of dark circles under the eyes a major emphasis of his practice. Dr. Steinsapir is multi-fellowship-trained in facial cosmetic procedures, and he emphasizes minimally invasive solutions that are proven to work. Please contact us today to learn more about the best options for your individual concerns.

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July 10, 2010

Eye Color Surgery: A Really Bad Idea?

Filed under: eye color surgery — Tags: change eye color surgery, eye color surgery — admin @ 7:01 am

In Los Angeles, marketing has appeared for a surgery described as “Eye Color Surgery.” The promotional materials promise a safe, simple procedure to permanently change your eye color with results that are “instant and amazing.” You have brown eyes and have dreamed of having blue eyes; hazel eyes but you want to have green eyes: this could be your ticket. But wait a minute, is this too good to be true? How safe can it be if you have fly to Panama to have the surgery?

First, the procedure requires an intraocular surgery. Technically, the surgery is very straightforward. A small incision, under topical anesthesia drops, is made into the front of the eye at the edge of the cornea, which is the clear window of the eye, and in front of the iris, the colored part of the eye. A small thin, sterile, colored disc of silicone is folded and inserted into the eye where it is unscrolled in front of the iris. The disc is colored and is chosen based on the desired eye color. The disc has a central hole for the pupil but otherwise covers the iris so the eye color is now the color of the implanted disc. The incision is small enough that it self-seals and does not need a stitch: a few days of eye drops, and you’re good to go. So what could possibly go wrong?

Let’s consider what has been reported regarding the clinical experience of this device. The device was invented by a Panamanian ophthalmologist named Delary Kahn, M.D. and is covered by a US patent issued in 2004. According to his promotional materials, he invented the implant to help the Kuna Indians of Panama who suffer a high incidence of ocular albinism rendering them light sensitive. However, the implant is now promoted as a cosmetic treatment to permanently change eye color.

Dr. Kahn has not formally published any results in peer-reviewed journals, which is the accepted standard for meaningful scientific communication. However, Dr. Kahn has had several abstracts accepted which briefly describe his studies and are published in association with a presentation at a meeting. The standards for publication of abstracts are much lower than those for the publication of an article in a scientific journal because abstracts are considered preliminary scientific reports—a preview, if you will, of a current line of investigation.

The iris implant surgery is being advertised in the United States but it is not available in the United States. The device lacks FDA approval and the inventor makes no mention of current efforts, if any, to obtain FDA approval for cosmetic use. Potential patients have to travel to Panama for the surgery. The presentations to date by Dr. Kahn and his colleagues only include 12 patients. In terms of complications, these authors have reported that a 2.6% loss of the cells that line the back surface of the cornea at 8 months after the procedure. These cells called endothelial cells are responsible for keeping the cornea clear. If enough of the endothelial cells disappear, the corneal becomes filled with fluid and vision is degraded, possibly necessitating a corneal transplant. One patient also needed their color iris implant removed due to intraocular inflammation and the development of elevated eye pressure.

Only one report concerning these implants appears in the peer-reviewed literature: a paper by Thiagalingam et al (Thiagaligam, et al. Complications of cosmetic iris implants. J Cataract Refract Surg 2008; 34:1222-1224). These authors report the case of a 19-year old man who presented 2 weeks after implantation of colored iris implants with reduced vision, inflammation inside the eye, and glaucoma. Both color iris implant were ultimately removed to treat the inflammation. The authors of this report found that this man had lost a larger percentage of endothelial cells and had early cataract changes thought to be directly related to the placement of the colored iris implants.

With such limited information about this particular implant, is there any other body of information that might give us some insight on the likely effects of this particular surgery? There is a long history of anterior chamber implants to correct vision after cataract surgery and more recently so-called phakic intraocular lenses have been introduced to correct vision for individuals who are not candidates for refractive surgery on the cornea, like LASIK. Unlike the colored iris implant, a number of these intraocular implants are FDA approved. Further, clinical experience with these phakic intraocular lenses is well described in peer-reviewed papers. Even these FDA approved devices are, well, controversial. The key issue is related to the balance between risk and benefits. When the benefits are outweighed by the risks, responsible surgeons will strongly discourage the treatment. Unfortunately, these generally well-tolerated lens seem to damage the corneal endothelium over time.

With so little information about eye color surgery, can we say if it is safe or unsafe? The simple answer is yes. Even without the reports of eye inflammation following this procedure necessitating the remove of the implant, the risk/benefit ratio of this procedure is not good. The primary purpose of the surgery is permanently changing eye color. If you are not albino and missing iris pigment or have part of the iris missing either from a birth defect or from trauma, then there is no compelling medical reason for this surgery. Therefore, any risk of harm makes it very difficult to justify permanent eye color surgery just because you desire a different eye color.

The colored disk that is put in the eye has been shown to cause harm and this is completely foreseeable based on a long history of intraocular implants that have been used to correct vision either following cataract surgery or with so-called phakic intraocular lenses. When the natural lens is removed, the change in refraction is so profound, there is a very reasonable need to replace the natural lens with a man made implant. When this is done with an implant that sits in front of the iris, there is a much higher rate of complications then when the implant is placed behind the iris, which is the preferred method. Also, the colored iris implant has a fixed pupil size so it will interfere with adapting to dark lighting conditions and may interfere with examination of the back of the eye when necessary.

Don’t like your eye color? Well, contact lenses may be an option. However, trying to change your eye color with a surgical implant seems like a really bad idea. Having this type of eye color surgery is likely to result in long-term damage to the eyes and the real risk of additional surgery to remove the implant. AskMen.com called it right in reviewing the technology: “Normal people don’t permanently change their eye color. Crazy people permanently change their eye color.” If you still feel compelled to have eye color surgery, see you personal general ophthalmologist, and ask them what they think of the idea. After all, this is the person who will be responsible for saving your vision when things go awry after your eye color surgery.

Dr. Steinsapir is a renown Cosmetic, Facial and Eye surgeon in the Los Angeles / Beverly Hills area. Those interested in cosmetic surgery have traveled the world to be treated by a professional of his caliber and training. If you are interested in any of his available cosmetic treatments, please contact us today for a consultation.

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July 6, 2010

Are there any reasons why I should avoid BOTOX or Dysport?

Filed under: Beverly Hills BOTOX,Botox,Botox Los Angeles,dysport,facelift alternative — Tags: Botox, Botox Los Angeles, botox side effects, is botox dangerous, is botox safe — admin @ 9:48 pm

BOTOX is a nonsurgical cosmetic treatment that has been proven to be both effective and medically safe. Millions of people enjoyed treatment with BOTOX and Dysport, another botulinum toxin A product, last year to improve their cosmetic concerns.

Microdroplet BOTOX Before and After

However, this does not mean that BOTOX is the right choice for everyone, and this is a decision your doctor can help you make. The short answer to “Is there any reason to avoid BOTOX?” is that it is extremely unlikely that you will experience any complications from BOTOX, and given the temporary nature of the treatment, you needn’t worry that your looks will be changed permanently; on the other hand, side effects can occur even if you are treated by a highly qualified injector. It is also reasonable to expect that side effects will be more likely when treatment is performed by relatively inexperienced injector.

Are BOTOX and Dysport safe and effective?—absolutely. But like every medication, these drugs need to be used in an expert fashion, which includes knowing when treatment is not appropriate.

New Black Box Warning for BOTOX

The FDA has recently required the manufacturer of BOTOX, Allergan, Inc. and the distributor of Dysport, Medicis, Inc. to include a special health warning regard the use of these drugs, which both contain botulinum toxin A as the active ingredient. Experience with these drugs since they were approved has demonstrated these drugs to be very safe and effective when used in the small doses needed for cosmetic treatment.

These drugs are also used for medical purposes in much higher doses. At these higher doses, there have been serious side effects leading to the new FDA warning regarding systemic or so-called spreading effects. Specifically, larger doses of either of these drugs can cause systemic side effects including a generalized weakness, medically referred to as asthenia, double vision, blurred vision, eyelid droopiness, difficulty swallowing, difficulty breathing, difficulty speaking, and urinary incontinence. Note that droopiness of the eyelid and double or blurred vision is possible, though fortunately rare, if cosmetic treatments spread to other parts of the face. Breathing and swallowing difficulties can be life threatening and have contributed to death in already very sick individuals in the treatment of medical conditions. It is thought that very high doses of these drugs used to treat certain medical conditions in small children present the greatest risks. Individuals with life threatening heart conditions should also be treated with caution.

No definitive systemic side effects have been reported for the doses typically used for cosmetic purposes or for treating excessive sweating in the armpit area. However, certain precautions seem reasonable even for cosmetic use.

If you have had any prior episodes of any of the systemic side effects described above, you should advise your doctor and not accept additional treatment with any botulinum toxin agents unless it is for medical purposes and your treating physician and you agree that the potential treatment benefits out weigh the adverse side effects. If you are not sure, discuss your prior reactions with your doctor. Although, quite rare, if you have a known allergic response or hypersensitivity to any botulinum toxin preparations it is advisable to avoid these treatments in the future.

It is your responsibility to be completely honest with your doctor about your medical history and anything that may affect your treatment. BOTOX has a great track record for safety in both clinical studies and in practice, helping to relax select facial muscles at the eyebrow and restore a more youthful appearance. While systemic side effects of these drugs probably occur even for cosmetic treatments, these effects must be very rare or mild. But for this reason, there are a few instances when BOTOX should be avoided.

If you are pregnant or breastfeeding, you should not be treated with BOTOX or Dysport. There is a very small study of women who were treated with BOTOX while pregnant with no problems, but this is not enough evidence to state that BOTOX and Dysport are safe during pregnancy or while breastfeeding. What should you do if you discover you were pregnant when you received BOTOX? Don’t panic. While this practice is not recommended, this single study suggests that the exposure may be safe enough that there may be no reason for action. However, it is recommended that you see your gynecologist/obstetrician for personalized care recommendations. For the same reasons, reputable physicians will not treat you for cosmetic reasons if you are known to be pregnant or breastfeeding. Treatment with these agents for medical reasons is determined on a case-by-case basis.

If you have a known neuromuscular disease, you should generally avoid cosmetic BOTOX and Dysport treatment. These are unusual and debilitating health conditions like myasthenia gravis, Lambert-Eaton syndrome, and peripheral motor neuropathic conditions like amyotrophic lateral sclerosis. If you have an existing difficulties breathing or swallowing, it is important to make your doctor aware of these issues. Because BOTOX and Dysport treatment could make these conditions worse, it is generally advisable to avoid treatment under these circumstances due to the potential spreading effect of these treatments in higher doses. Again, no definitive problems have been reported for the smaller doses used for cosmetic treatment, but caution is warranted with these types of medical conditions.

Botulinum toxin products contain a tiny amount of human albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases. A theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD) also is considered extremely remote. No cases of transmission of viral diseases or CJD have ever been identified for albumin.

BOTOX and Dysport can be potentiated by aminoglycosides, a type of potent antibiotic, or other medications that interfere with neuromuscular transmission including curare-like nondepolarizing blockers, lincosamides, polymyxins, quinidine, magnesium sulfate, anticholinesterases, and succinylcholine chloride. If you are using any of these drugs, the effect of the toxin may be potentiated and caution is advised. For this reason, it is important that you fully discuss with your doctor all medication that you may be using.

If you develop any unusual symptoms (including difficulty with swallowing, speaking, or breathing), or if any existing symptom worsens, notify your doctor at once. If the symptoms seem serious, call 911 for emergency help and notify your treating doctor when this is convenient. If you do experience loss of strength, muscle weakness, or impaired vision avoid driving a car or engaging in other potentially hazardous activities and seek medical care.

Very few people reading this and getting BOTOX or Dysport will have any of these issues. However, if these warnings do apply to you, be honest with your doctor and seek alternatives to these products.

How Individualized Treatment Plans Make All the Difference

The key to effective BOTOX treatment and other cosmetic treatment in Los Angeles is to find a doctor who specializes in the help you need and has experience, education, recommendations, and results to prove that he or she is skilled and the best qualified. If you are worried because you have heard of unsatisfactory results like the “BOTOX freeze,” you are likely hearing about a few examples of people either going to unqualified practitioners (they may not even be doctors; for example assistants and “physician extenders”). Just because one of your favorite actors or actresses show up with a frozen forehead, don’t assume that this is a desirable treatment result. There are great alternative to this type of treatment result.

Seek Help from Qualified Cosmetic Botulinum Toxin Specialist

Only a private consultation with a physician who is fully qualified to administer BOTOX and Dysport will be able to help you understand your best course of action. BOTOX is a minimally invasive, safe, and effective treatment that helps millions of people each year restore balance to their face. Dr. Steinsapir is multi-fellowship trained in both cosmetic surgery and oculoplastic surgery, and with many years of practical experience. He is a Clinical Associate Professor at UCLA and has the practical know-how needed to understand complex facial dynamics and establish unique treatment plans that work. Please contact us today to find out if you are a good candidate for BOTOX or Dysport treatment.

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Lidlift Kenneth D. Steinsapir, M.D. Cosmetic, Facial & Eye Plastic Surgery

July 20, 2010

Do Asian doctors make the best Asian eyelid surgeons?

July 19, 2010

I am thinking of getting lip filler but I am afraid of getting my lips overdone.

July 17, 2010

I’m pregnant. Is it OK if I get a squirt of BOTOX?

July 16, 2010

Will skin bleachers help my dark circles?

July 10, 2010

Eye Color Surgery: A Really Bad Idea?

July 6, 2010

Are there any reasons why I should avoid BOTOX or Dysport?

Lidlift Kenneth D. Steinsapir, M.D.
Cosmetic, Facial & Eye Plastic Surgery