dysport « Cosmetic, Facial & Eye Plastic Surgery Blog

October 23, 2011

I am having BOTOX treatment complications and my wedding is in two weeks. What do I do?

Filed under: Beverly Hills BOTOX,Botox,Botox Los Angeles,dysport,Microdroplet BOTOX — Tags: Botox, BOTOX complications, botox side effects, BOTOX treatment, brow ptosis, droopy eyelids, dysport, eyelid ptosis, fixing BOTOX, fixing BOTOX complications, frozen forehead, Microdroplet BOTOX, xeomin — admin @ 8:06 pm

BOTOX® complications can range from minor problems like bruising, frozen forehead, or swelling, to more severe problems like eyelid ptosis, to the even more rare systemic effects including difficulty swallowing. Typically, even these more severe problems will resolve themselves over a period of 4 to 6 weeks without intervention. However, given a very short time frame, it is essential to see a treating physician immediately to determine the best course of action.

Fixing Minor Problems

BOTOX treatments are popular because they are noninvasive and effective in relaxing tense muscles and smoothing wrinkles. BOTOX is a naturally-occurring purified protein that relaxes muscles but is eventually broken down and expelled from your body completely. The effects usually last 4 to 6 months.

With botulinum toxin A products (BOTOX, Dysport, Xeomin), adverse issues are usually the result of an unbalanced treatment. Forehead treatment can be associated with upper eyelid or eyebrow ptosis. Unbalance forehead treatment can result in issues of asymmetry. It is possible to improve your treatment results using the appropriate counter treatment along the eyebrow using Dr. Steinsapir’s Microdroplet method.

Eyelid Ptosis

If your BOTOX treatment has caused eyelid ptosis, Dr. Steinsapir recommends finding an oculoplastic surgeon to help you with this particular issue. Oculoplastic surgeons are trained to assess and treat upper eyelid ptosis. A prescription for Iopidine (aproclonidine ophthalmic solution) can be helpful in this circumstance; this medication is a glaucoma drop that can elevate the eyelid a couple of millimeters. The drops can also be used to assess the severity of the ptosis and predict the likely time frame for the resolution. Dr. Steinsapir recommends trying the drops twice a day for a week. If successful in opening the eye, the ptosis will likely resolve in 4-6 weeks and the drops will help improve the eyelid ptosis until resolution takes place.

The likelihood of upper eyelid ptosis is extremely small in the hands of an experienced injector. Less experienced injectors are more likely to perform a treatment that causes ptosis. It’s important to carefully research a doctor or nurse’s credentials and their track record for successful injections. The individual performing your treatment has a profound effect on the risk of side effects. Upper eyelid ptosis has been reported in as many as 5% of cases. The incidence of upper eyelid ptosis in the hands of experienced injectors is much less. Dr. Steinsapir has seen only three mild cases of ptosis in his last 3,500 treatments.

Other Options

What if your doctor tells you that there are no treatment options? Rescheduling an event like a wedding can be impossible. Consider having a heart to heart with your photographer. Can they photograph you to minimize the appearance of a droppy eyelid or photoshop your images after the fact? If so, consider going forward with your plans and let the photographers cure your eyelid position digitally.

About Dr. Steinsapir

Dr. Steinsapir is a much sought after oculofacial surgeon. He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, Fillers and cutting edge reconstructive eyelid and midface surgery. He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions. He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago. He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage. He is widely published and lectures to other surgeons nationally and internationally. He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA. His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities. Additionally, individuals from all over the country and the world regularly come to Los Angeles for his expert care.

To learn more about Dr. Steinsapir’s specialized BOTOX treatments, please contact us today.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

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October 12, 2011

What should I expect with my filler service?

Cosmetic fillers like Restylane®, Perlane®, Juvederm®, and other hyaluronic acid fillers are an excellent alternative to surgical procedures. These products are composed of a cross-linked sugar gel that can correct wrinkles, volumize the nasolabial fold and lips, fill acne scars, and improve under-eye dark circles. Dr. Steinsapir is the inventor of a unique and effective method that specifically addresses under-eye discoloration. This technique is called the Deepfill™ method. Facial fillers last about a year and treatments are easily adjusted using hyaluronidase, if necessary. For many years, Bovine Collagen was the gold standard of fillers, but has now been displaced by Restylane® which is now the filler to which all others are compared.

Like Restylane, Perlane® is intended for volumizing, but it differs from Restylane in that Perlane is intended to provide facial volume in the deep dermis and superficial subcutaneous fat. Perlane and Restylane are not equivalent products. It is essential that your doctor places Perlane deeper than Restylane. When used properly, Perlane is an excellent alternative to volumizing products like Scluptra® and Radiesse® and even fat transfer. Treatment with Perlane also lasts well over a year.

Where are injections commonly performed?

Hyaluronic acid fillers are office-based services. You may see estheticians and unqualified individuals like medical assistants offering injections illegally in spas and salons under the justification that they have a “medical director.” No States permit this arrangement. Unless a doctor is present and performs the service, this type of situation is the illegal practice of medicine. As with BOTOX®, don’t let an unqualified individual perform your Restylane or Perlane service.

Just like BOTOX, only a licensed medical doctor or a nurse under the direct supervision of a licensed medical doctor can inject hyaluronic acid fillers. The exact details of the required qualifications vary by State so it’s important to research the individual you wish to perform the injection to ensure he or she is qualified. However, just because your doctor or nurse is minimally qualified to perform the injection does not necessarily indicate he or she is the ideal choice for the procedure. As with many other medical procedures, the best results require a certain level of qualification, skill and experience; these concerns are perhaps even more important when considering modifications to your physical appearance.

What’s the typical recovery course and what are the physical restrictions?

Many of Dr. Steinsapir’s patients resume their normal activities just after leaving the office with the exception of no workouts for 24 hours. Wait a day before going to the gym. If you don’t bruise, there will be about thirty to forty hours during which you experience minimal swelling. Many patients, both men and women, can hide this swelling right away with a camouflage makeup that matches their skin color if necessary. If your lower eyelid skin quality is poor and you often collect a small bag of puffiness under the eye, the doctor may counsel you regarding the need to consider a procedure like a chemical peel or surgery prior to getting regular filler treatments so you don’t experience prolonged recovery after each filler service. This can be discussed when you have your initial consultation.

What are common complications and how are they addressed?

Most people, about 70 percent, do not experience bruising after a Restylane treatment; the other 30 percent experience some degree of bruising; most of it mild. But a very few (one or two in a hundred) will develop a black eye. The black eye can take about two to three weeks to completely resolve, and this is a cosmetic concern without health dangers. The worst part of this is that many will assume that you were the victim of domestic violence. Glasses and makeup help to hide the bruise while it is resolving. Considering that Restylane will last over a year, the recovery process is very mild and comfortable even for these few.

For the few Restylane recipients who experience bruising, the short-lived bruise is worth the long-term results. It’s a good idea to obtain treatment at least three weeks before big events like vacations. For the biggest occasions such as your own wedding, Dr. Steinsapir advises have treatment 2 months ahead of the event to be completely certain that your pictures will turn out great.

To minimize your risk of bruising, your doctor will ask you to stop taking certain medications that thin the blood, such as aspirin. If you are taking anything prescribed by a doctor, Dr. Steinsapir strongly advise that you consult with your prescribing physician before discontinuing the medication. If your doctor suggests that you continue the medication, this does not mean that you aren’t a good Restylane candidate. If you are willing to be at a slightly elevated risk for bruising, Restylane can still be effective. Your regular doctor and your cosmetic specialist can help you decide the best route to take.

The incidence of allergic reaction varies with the products used and should be discussed with the treating physician but the incidence of allergies to these products is very low.

For unwanted highlights or bumps that occasionally occur after an otherwise excellent filler treatment, the enzyme hyaluronidase makes Restylane injections easily adjustable to a more desired aesthetic, and your doctor can even erase the treatment completely if you determine together that this is your best option. In the event that you experience lumps or unwanted effects from your Restylane treatment, hyaluronidase makes it easy to adjust hyaluronic acid fillers like Restylane, Juvederm and Perlane. This flexibility created by the ability to adjust a service is one of the most important factors making HA fillers such a popular service.

About Dr. Steinsapir

Dr. Steinsapir is a much sought after oculofacial surgeon. He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, fillers and cutting edge reconstructive eyelid and midface surgery. He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions. He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago. He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage. He is widely published and lectures to other surgeons nationally and internationally. He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA. His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities. Additionally, individuals from all over the country and the world regularly come to Los Angeles for this expert care.

To learn more about Dr. Steinsapir’s specialized Restylane treatments, please contact us today.

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September 9, 2011

I had facial fillers and BOTOX and now I look older

If this happened to you, there is no doubt that you are dissatisfied with your treatment and that it makes you feel old – the exact opposite of the reason you chose to undergo the procedure! There are many reasons your treatment may not have turned out the way you expected it to, but it is not the fault of the BOTOX or the filler, whether it’s Juvederm®, Perlane®, Restylane®, or any other hyluronic acid filler. Complications from non-surgical treatments like fillers and BOTOX are almost always the result of your surgeon’s talent. Choosing a skilled surgeon to perform your injections is important, but once the damage is done, choosing a skilled surgeon to fix the problem is imperative.

The Truth About Treatments

As the effects of your BOTOX treatment begin to wear off after several months―Restylane wears off more slowly―your face will slowly regain the looks it had immediately before your treatment. Restylane and BOTOX treatments will not make you look worse than your original pre-treatment appearance as they wear off, nor are they supposed to make you look worse when treatment is new. Provided you did not let someone put silicone oil

in your face and treatment is provided by an experienced injector fillers and botulinum toxin A have few side effects. But if you aren’t happy with your results, you do have options and it is not necessary to wait more than a year for the filler to wear off.

Options for Fixing BOTOX Treatments

Treatments like BOTOX and Restylane are popular because they are noninvasive treatments that together can smooth wrinkles, relax tense muscles, and fill in hollow areas. BOTOX and Restylane will not permanently alter your looks. BOTOX is a naturally-occurring purified protein that relaxes muscles, and Restylane is made from a biodegradable sugar-gel that occurs naturally in the body. Both of these are eventually broken down and expelled from your body completely.

Generally with the botulinum toxin A products (BOTOX, Dysport, Xeomin), the issue is an unbalanced treatment. These services typically freeze the forehead. The treatment results can be improved by having the appropriate counter treatment along the eyebrow using Dr. Steinsapir’s Microdroplet method. However, if your BOTOX treatment has caused eyelid ptosis, Dr. Steinsapir recommends finding an oculoplastic surgeon to help you with this particular issue. Oculoplastic surgeons are trained to assess and follow upper eyelid ptosis. They are familiar and have experience treating upper eyelid ptosis. A prescription for Iopidine (aproclonidine ophthalmic solution) can be helpful in this circumstance. This medication is a glaucoma medicine that can elevate the eyelid a couple of millimeters. The drops can also be used to assess the severity of the ptosis and predict the likely time frame for the resolution of ptosis. Dr. Steinsapir recommends trying the drop twice a day for a week. If the drop is working to open the eye, then it is likely that the ptosis will resolve in 4-6 weeks.

Options for Fixing Filler Treatments

Dr. Steinsapir often sees individuals frustrated with treatments they received elsewhere. Surprisingly, many people are not aware that the hyaluronic acid fillers can be adjusted using the enzyme hyaluronidase. This enzyme is delivered with a small injection during a very comfortable office visit. Dr. Steinsapir has helped people who put up with unsatisfactory treatments for much longer than they need to. These issues are easily dealt with using the enzyme in one or two visits. It is the ability to make these adjustments that makes it feasible to provide many of the advanced filler services. Do you have a hyaluronic acid filler issue that is not responding to hyaluronidase? Some patients have been told they were injected with hyaluronic acid filler but in fact were treated with silicone oil. Correction of some of these issues can be challenging and need to be approached on a case by case basis.

Restylane is a long-lasting, but not permanent sugar-gel facial filler that is preferred for improving facial contours due to its natural results, even in sensitive areas like dark circles under the eyes and the lip edge. Restylane and Perlane offer the ability to modify results when necessary. This includes treatments that were performed in the past and need fine-tuning. The ability to adjust a treatment with the enzyme can take a good treatment and make it great. In some cases, as the body slowly breaks down the material over time, slight irregularities may develop despite the initial quality of the treatment. Sometimes, the answer is adding filler rather than subtracting volume. For this reason, it is best to start with a detailed assessment with an expert like Dr. Steinsapir.

About Dr. Steinsapir

To learn more about Dr. Steinsapir’s specialized Restylane treatments, please contact us today.

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July 26, 2011

How does BOTOX and the new product Xeomin compare?

Filed under: Beverly Hills BOTOX,Botox,Botox Los Angeles,dysport,myasthenia gravis — Tags: Botox, Botox Los Angeles, Botulinum Toxin A, dysport, FDA Approval, Merz, xeomin, Xeomin vs. BOTOX — admin @ 7:55 am

Xeomin® is a Botulinum Toxin A, made by Merz Pharmaceuticals that contains the same active ingredient found in BOTOX® and Dysport®. Unlike BOTOX however, Xeomin does not need to be refrigerated before reconstitution. Xeomin isn’t currently approved for cosmetic uses but it is comparable to to BOTOX and Dysport.

Uses for Xeomin

Xeomin is approved by the US FDA for the treatment of adults with cervical dystonia, severe neck spasms, or blepharospasm, advanced eyelid spasms. It is not approved for the treatment of wrinkles and crows feet in the United States, but it is used throughout Europe and Canada for this purpose.

Merz, the company that developed Xeomin, reports that clinical studies for cosmetic applications are underway. Doctors are able to use this product in what is referred to as “off-label” manner, meaning that your doctor can prescribe Xeomin at doses and for procedures other than those recommended by the FDA, however in these situations, you are using the product at your own risk. It is possible to obtain treatment for cosmetic indications with Xeomin. Just note that such uses have not been tested rigorously and may pose higher risk than being treated with drugs that are formally approved for treating cosmetic issues such as BOTOX® and Dysport®. Based on studies so far and the use of Xeomin in Europe – where it is available for cosmetic purposes – doctors anticipate that Xeomin will work very much like BOTOX for cosmetic applications.

Botox versus Xeomin

There is no scientific evidence to suggest that Xeomin will be better than BOTOX, or less effective. If you are treated with Xeomin, the dose your doctors uses may be the same or slightly different than the dose used for BOTOX. These products are not bioequivalent and for this reason, treatment may vary.

Like any product introduced into the market as a competitor to existing brands, the use of Xeomin, once it is approved by the US FDA for cosmetic use, will be based largely on personal preference. But as with any Botulinum Toxin A injection, it’s important to remember that only an experienced cosmetic surgeon should perform the procedure. Just as BOTOX and Dysport cannot be administered by an esthetician, an unsupervised nurse, or anyone other than a licensed professional, Xeomin is no different. Do not assume that because it is new and has different dosing and storage requirements than BOTOX, that it can be administered by anyone.

About Dr. Steinsapir

Dr. Steinsapir trained alongside the inventor of BOTOX and has performed thousands of BOTOX treatments in Los Angeles since 1988 and recently patented his Microdroplet BOTOX technique. He is a board certified eye surgeon and fellowship trained in oculoplastic surgery and cosmetic surgery in Southern California where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in BOTOX, which can be a vital part of your evidence-based treatment plan.

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July 7, 2011

What’s the Best Eye Wrinkle Treatment?

Filed under: Beverly Hills BOTOX,Beverly Hills Restylane,Botox,Botox Los Angeles,dysport,hyaluronic acid fillers,Restylane,restylane in los angeles — Tags: Botox, Botox Los Angeles, botox side effects, eye wrinkles, facial fillers, Restylane, restylane los angeles, Under Eye Restylane — admin @ 2:28 pm

Eye wrinkles are treatable, but not unavoidable. There is no cure for aging and therefore, no cure for wrinkles, especially around the eyes―our most expressive feature. However, you can take preventative measures to delay and even reduce the appearance of wrinkles. There’s no magic cure, but using sunscreen on a daily basis and wearing sunglasses are an excellent way to limit the effect of sun damage and squinting, which are thought to play important roles in the development of periocular wrinkles. It is generally thought that smoking also damages the delicate elastin in the skin speeding the development and severity of facial wrinkles. Once these wrinkles do appear you will need more than a skin moisturizer to help improve these lines.

Fillers and Muscle-relaxers

Treatments like BOTOX®, Dysport®, and Restylane® are popular because they are noninvasive treatments that can smooth wrinkles, relax tense muscles, and fill in hollow areas. These injections are not permanent and will wear off. Touch-up or maintenance treatment is repeated as necessary. This is typically twice a year for the botox service and commonly a year for the filler service.

BOTOX and Dysport are naturally-occurring protein that prevents treatment muscles of facial expression from contracting, and Restylane is made from a naturally occurring sugar-gel that is found in the body. Both of these products are eventually organically broken down and expelled from your body completely primarily in the form of water and CO2. You’ll notice as this happens that your wrinkles will slowly return. They may stand out to you after many months of looking much better. When should you be retreated? Dr. Steinsapir does not believe that your next treatment needs to occur more frequently than once a year.

Can BOTOX and Restylane prevent problems?

We know that BOTOX and Dysport does not aggravate wrinkles or make them worse in the long run. We also know that the face is subject to gravity and general usage as we age, and that wrinkles can be caused by tense muscles. When these overactive muscles relax, as they do in response to BOTOX and Dysport, the skin is no longer constantly creased. While there are no clinical studies suggesting that ongoing treatment with these agents prevent wrinkles from forming, it does make sense that less skin creasing should help preserve skin integrity and reduce the formation of lines and wrinkles.

About Dr. Steinsapir

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May 22, 2011

How young is too young to receive BOTOX?

Filed under: Beverly Hills BOTOX,Botox,Botox Los Angeles,dysport,Microdroplet BOTOX — Tags: Botox, Botox Los Angeles, botox side effects, is botox safe, Right age for BOTOX — admin @ 4:22 am

In March 2011, Good Morning America aired a story about a pageant mother who regularly injected her 8-year-old daughter with BOTOX®. As shocking as it is to see a child worrying about wrinkles at such a young age, it’s equally shocking to learn that her mother, an esthetician, was performing the injections herself. It is illegal for anyone other than a licensed medical doctor or nurse under the direct supervision of a licensed medical doctor to inject BOTOX. In May 2011, Child Protective Services took the young girl from her mother and while no one likes to see a child removed from their parents’ custody, it’s a relief to hear that this behavior is not normal. The story has a lot of people asking: How young is too young to use BOTOX?

Food and Drug Administration guidelines

The FDA has approved cosmetic BOTOX and Dysport® for anyone between the ages of 18 and 65 and medically-necessary BOTOXv for children as young as 12. However FDA approvals and recommendations operate as guidelines, not legal mandates. This means that a physician may use his or her judgment when administering BOTOX, Dysport, or Xeomin®; a physician has the freedom to use it in ways that are not FDA-approved. Using BOTOX, Dysport, or Xeomin in this manner is referred to as “off-label use” and many drugs are used in this fashion with great benefit to the individual receiving treatment.

BOTOX for medical applications

BOTOX and the other clinically available botulinum toxins are often used to treat muscle spasms, cerebral palsy, migraines, excessive sweating, and a number of other medical conditions. In these situations, physicians will often use BOTOX in an off-label manner and administer it to children younger than 12. If a physician recommends BOTOX for a young child with one of these medical conditions, the physician has reason to believe that the child’s quality of life will be improved by BOTOX treatments even though medical treatment with these agents for young children is associated with death and life-threatening side effects.

BOTOX for cosmetic applications

The benefits of BOTOX and Dysport on worry-lines in the forehead and around the eyes are undeniable. However, children have very elastic skin and sub dermal fat to give their faces volume that adults lose as they age. This elasticity and sub dermal fat is what makes children’s skin so smooth and wrinkle-free. Receiving cosmetic BOTOX before you’re skin begins to lose these youthful features is not necessary. So what’s the right age to begin receiving cosmetic BOTOX injections? That’s a question only you can answer with help from your doctor. However any reasonable person can understand that injecting an 8 year-old to make her more competitive for a beauty pageant is shockingly inappropriate and abusive.

About Dr. Steinsapir

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May 12, 2011

I have mild myasthenia gravis. Is it okay for me to have cosmetic Xeomin treatment?

Filed under: Beverly Hills BOTOX,Botox,Cosmetic Surgery,dysport,myasthenia gravis — Tags: Botox, botox side effects, Cosmetic Surgery, myasthenia gravis, xeomin — admin @ 8:20 am

Xeomin® (incobotulinumtoxinA) is FDA approved and being distributed for use in the United States. However, the current FDA-approvals for this product only extend to two medical conditions: blepharospasm and cervical dystonia. Xeomin is is not currently FDA approved for cosmetic procedures.

Xeomin and FDA approval for cosmetic use

Xeomin and myasthenia gravis

Regardless of FDA approvals, Xeomin, or any other clinical botulinum toxin, should not be used on individuals with myasthenia gravis. If you have myasthenia gravis, you have antibodies that attack the neuromuscular junctions causing weakness. You are especially susceptible to the effects of botulinum toxin. Even relatively low-dose treatments can be associated with unwanted systemic effects including unpleasant or even life-threatening effects on the muscles responsible for swallowing and breathing. Individuals with neuromuscular junctional disorders like myasthenia gravis or Lambert-Eaton syndrome, treated for blepharospasm are at increased risk of complications due to reduced blink function including dry eye, corneal exposure, and even corneal ulceration. For these reason avoid botulinum toxin injections for cosmetic purposes and carefully monitor treatments if you are receiving them for medical reasons.

About Dr. Steinsapir

To learn more about Dr. Steinsapir’s specialization in botulinum toxin treatments, please contact us today.

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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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