Posts Tagged Botox
Botulinum Toxin Injections… A Conservative Rationale?
Posted by admin in Dr D's Truth on May 10, 2013
I had a return patient come in today to consider more Myobloc (the Botulinum toxin that I use in the office the most frequently). Her friends at her office had had alot of Botox…in their foreheads, in their eyelids, in their Crow’s feet… Another doctor had done this. She wondered if she “needed” more. Well nobody “needs” this. The real question is whether or not she might benefit from more.
I discouraged her from using it for more than the central forehead (base of the nose) and a little at the crow’s feet.
Why?
(1) I like people to have some facial expression. Blunting some wrinkles is OK. I don’t like “Stony” faces.
(2) There is some evidence that injecting too much into the entire forehead can drop the eyebrows and lead to the desire to have a forehead lift. I am not comfortable about causing the need for a cosmetic operation that a given patient may not want.
Botox and/or Myobloc is/are fine, but there is definitely a place at which too much makes you look kinda foreign.
Remember my blog = my opinion
Best Regards,
John Di Saia MD
Silly Disclaimer…..like a real commercial (LOL):
The foregoing message has not been approved by any company making outrageous profits from the sale of Botulinum toxins. They would rather you inject every square centimeter of your body on daily basis until you are broke or dead.
Originally posted 2005-09-15 21:07:00.
Age Specific Plastic Surgery – Possible Reasons Why
Posted by admin in Dr D's Truth on April 22, 2013
The American Society of Aesthetic Plastic Surgery publishes statistics every year indicating which cosmetic operations are on the rise. A journalist at the OC Register asked a group of plastic surgeons why this might be. Being that I am opinionated (why do you think I blog here,) I figured I’d take a shot at some of these:
I. Statistic: TEENS – Nosejobs and Otoplasty (commonly referred to as “ear pinning”) on the rise
Dr D: Part of the development of the teen psyche involves becoming aware of social norms. As they do this, they also become aware of differences and develop standards of beauty. Many of these teen nose jobs are justified as medically-needed, but appearance usually factors in. Otoplasty is a similarly social operation.
II. Statistic: YOUNG ADULTS – Breast implants. Ages 19-34. 166,000 a year. (ASAPS)
Dr D: “Beauty standards” are important motivators here as well. Young adults in the workplace (and social groups) see those around them doing these things and often being complimented. Some of these patients may also be seeking after childbirth “body repair.”
III. Statistic: EARLY MIDDLE AGE – Liposuction. Ages 35-50. 143,000 a year. (ASAPS)
Dr D: A slowing metabolism in this age group combined with more involved work schedules (with increased sedentary time) equals increased trouble “holding back the fat.” Liposuction is easy and can help with that. Add some post-pregnancy issues here as well.
IV. Statistic: YOUNG ADULTS – Botox. Ages 19-34. 371,000 a year. (ASAPS)
Dr D: The fad of Botox use in the really young is an advertising phenomenon as there is no good reason for young people to do this other than to “feel” hip.
My opinions of course. 
Best Regards,
John Di Saia MD
Originally posted 2011-07-04 07:30:33.
How Long should Botox Last?
Posted by admin in Dr D's Truth on March 23, 2013
New Botulinum toxin patients come with varying experiences with Botox and the other available toxins on the market. A natural question is:
How long should Botox last?
We have addressed the question indirectly before in stating that there are reasons Botulinum toxins might not work.
Patients often are at a loss to understand why the effects of the toxin might not be as pronounced as they had been before with continuing use. Even when the injections are properly performed, the bodies of some patients (more than others) can “get used to” the effects and continued injections might have diminished effects or duration compared to past treatments. These toxins are proteins and the human body makes antibodies to protect itself from foreign proteins.
Suffice it to say the effects of Botulinum injections will probably last 2-3 months on average and the duration will vary and might decline over time with continued treatments.
Best Regards,
John Di Saia MD
Originally posted 2011-04-28 07:30:37.
Northwest Pharmacy Experience from Hell
Posted by admin in Dr D's Truth on December 14, 2012
Looking to obtain a break on my practice’s botulinum toxin of choice (Myobloc) I yielded to curiosity and ordered from a Canadian Pharmacy…Northwest Pharmacy.com. I figured we would try to break the price point of this popular product. Thankfully I used my credit card.
Botulinum toxin must be kept cold to retain its potency. We traditionally receive this product on dry ice and have never had much of a problem with effectiveness. I was promised by the pharmacy rep that this product would arrive cold within 2-5 days of shipping. Only after I gave her my credit card information did she share with me that the product would be coming from Great Britain. This was not welcome news. I was reassured that the product would be cold and usable.
The product arrived ten days later at room temperature, a completely questionable situation. The pharmacy rep said to go ahead and use it. I said nope. As I was summarizing the dispute, it occurred to me one more reason why patients having their botulinum toxin elsewhere sometimes describe such a variation in their experiences. Other practices might actually use this rotten Botox. Mine doesn’t.
For other docs thinking of ordering from Northwest Pharmacy: They were way too Type B for me. You have been warned.
Best Regards,
John Di Saia MD
Originally posted 2011-01-13 07:30:09.
@VariantVal Question About Good Botox
Posted by admin in Dr D's Truth on September 6, 2012
@VariantVal‘s Question:
“Have you ever done a “signs you should start having Botox” blog?”
The tweets went back and forth after this one. I am always blogging about those who have had too much, but not about those who are done well. The biggest problem with Botulinum toxin use in Southern California is “overuse.” People start looking freaky when they have had too much. When people get too much, their faces don’t move quite right. When used selectively this doesn’t happen.
Here’s an example in which just one muscle was treated:
This woman was treated with Myobloc (Botulinum Toxin B) to decrease the appearance of one wrinkle at the upper part of her nose (where her Procerus muscle was causing a fold.) The rest of her face as preserved so she would not look like a Botox freak. The key to a pleasant experience with these toxins is a conservative approach unless you want to look more foreign that is.
Consider having Botulinum toxin when there are folds that you feel contribute to an older or more troubled appearance. The folds that seem to respond the most favorably are those near the upper nose and the sides of the eyes. Seek an experienced injector who will tell you when the areas you are considering are not well-advised and will treat to preserve as well as take away. If you go too far, learn from the experience and use less the next time.
Best Regards,
John Di Saia MD
Originally posted 2010-08-24 07:30:12.
Botox Didn’t Work – Why?
Posted by admin in Dr D's Truth on July 20, 2012
The botulinum toxin industry is complicated. These compounds are proteins and there are a number on the market. Botox was the first, a botulinum type A protein. Myobloc followed as an alternative type B product. Then we have Dysport, another type A. These are the most common three in the US anyway. There are differing trade names for these compounds and they vary in potency. Your injector needs to know what he or she is doing and part of this is picking and knowing good material.
People often complain that they have had varying experiences with their different treatments. The truth about it is that the reasons for this are complicated. A particular injection might not work as well as another due to several factors:
(1) The exact compound used – A reliable material is a key to a good result.
(2) The potency of the material – These toxins must be kept cold to retain their strength. When they get warm they lose their punch. They might work less well or for a lesser period of time.
(3) The dilution – Cheapie outfits simply dilute the compound to make the price lower. It will then last a shorter period or not affect as much of a change.
(4) The injector’s skill – Better injectors can get better results by more carefully targeting the proper muscles.
(5) Individual sensitivity – These compounds simply work better on some people than others.
So when you get to a injector who gets a good result for you, consider staying put. He or she is working the combination right for you. And when you go to a cheap injector, understand why it might make a difference.
Best Regards,
John Di Saia MD
Originally posted 2010-11-23 07:30:48.
Reader Laura On Dental Course on Botox and Fillers
Posted by admin in Dr D's Truth on June 29, 2012
Reader Comment:
This is a company that is offering training for “Botox® and Dermal Fillers for Every Dental Practice”. They are offering a 1 day course to train Dentist on how to use Botox and fillers. How much training do plastic surgeons receive to do these procedures? How likely will it be for a regular dentist to be able to perform these procedures without mishaps?
Source: commonsensedentistry.com/BotoxDermalFillersCourse.aspx
I could teach a monkey to inject Botulinum toxin. Plastic surgery residents pick it up very quickly. Fillers are just about as easy as long as reasonable limits are observed. Some users do not know where to stop and/or inject the less safer “semi-permanent” fillers in large quantities. This can lead to scary results.
I was actually approached by a CME company not long ago about teaching such a course. It would be pretty easy. The question of how good the attendees will actually be at the procedures and what their judgment might be is another question entirely. In the right hands with the right judgment, internists inject these items safely every day.
Best Regards,
John Di Saia MD
Originally posted 2010-11-05 07:30:31.
Brotox – Hyped Botox for Men?
Posted by admin in Dr D's Truth, plastic surgery news on June 13, 2012
The public’s common image of a Botox patient is a middle-aged woman hoping to look more youthful through the minimally invasive procedure. But plastic surgeons say that “brotox” — the use of Botox by men — is gaining in popularity.
Source: health.usnews.com/health-news/news/articles/2012/06/08/enter-the-brotox-era
Brotox – Botox for men. Now that’s a funky term.
I have used botulinum toxin for over ten years so I guess I qualify, but I am not using Allergan’s Botox. I haven’t used it for five or six years. I inject my own toxin of choice (Botulinum Toxin Type B) when it suits me…a benefit of the job I guess.
[M]en tend to request spot treatment for smoothing of specific facial details whereas women tend to want a complete makeover. “Men want a little more subtlety than women. They want movement of the face, but they don’t want deep furrows in their forehead.”
That is pretty much the purpose for which I use toxin injections and I use them sparingly to preserve movement.
Best Regards,
John Di Saia MD
Botox Not Working for John Mayer
Posted by admin in Medicine in the News on May 25, 2012
John Mayer is still waiting for his singing voice to return after his damaged vocal cords were frozen twice.
Mayer says he’s still without much of a singing voice, but that hasn’t stopped him from writing hits, and now he thinks he might just stay away from the microphone. He says, “I can’t sing, so I’m writing.”
Talking about his throat problems, he tells talk show host Ellen DeGeneres, “It’s not a health concern whatsoever, but it has taken me out of singing. I tried to beat it the first time and couldn’t. What they actually do is they cut this thing out of your throat and then they inject your vocal cords with Botox, which freezes your vocal cords so that this thing can heal without smacking up against the other side. I just need more Botox next time.
Source: music.msn.com/music/article.aspx?news=729027
Botox is used in some “medically necessary” applications as well as the cosmetic. As I have mentioned before, I use botulinum toxin to help ease my wife’s migraine headaches.
In Mr Mayer’s case, Botox is being used used to temporarily freeze a vocal cord so it can heal after surgery. Botox like any drug is not always effective. Mayer reports hopes that a higher dose will work better.
Best Regards,
John Di Saia MD
Dr D on a “Ten Years With Botox Story”
Posted by admin in plastic surgery news on May 17, 2012
….10 years ago, to the U.S. Food and Drug Administration’s approval of Botox for treating frown lines.
Over the course of that decade, botulinum toxin, as it is technically called, has profoundly changed the work of dermatologists and plastic surgeons, and broadly expanded the use of cosmetic procedures by the general public.
Source: htrnews.com/article/20120513/MAN04/205130436/We-ve-
been-stuck-Botox-10-years
The most interesting things about botulinum toxins are not really mentioned in this article. It is true that a number of doctors realized far before Botox TM was FDA approved for cosmetic purposes that it could help with them. In 1997 in the Los Angeles area it was popular as an “off label” use drug for wrinkles. At first Botox TM was the only product of its type on the market. I was well aware of it before the FDA approved it for cosmetics and was using it in 1997 like many others.
What most people have only recently discovered is that there are several versions of botulinum toxin on the market. There are three botulinum toxin A products and one botulinum B product marketed under different trade names. These different products act slightly differently.
Another important point is that many others other than plastic surgeons and dermatologists are administering them. You can get them in Med Spas and the offices of doctors of all specialties looking to augment their bottom line with some easy discretionary cash. These toxins are not really all that dangerous as long as the injector is reasonably prudent but you can end up looking funny with the really inexperienced ones. At least it wears off even in this sad case.
Best Regards,
John Di Saia MD
Dr D – Your Orange County Surgeon
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