BOTOX AND DERMAL FILLERS FAQ
How does Botox work?Botox produces localized nerve cell dysfunction, resulting in a flaccid paralysis of the affected muscules. It takes 1-2 days for onset of paralysis and 1 week for full effect (occasionally an effect may be observed within hours).
How long does Botox last?Botox is typically effective for 3-6 months or longer, and there is sometimes cumulative benefit to repeat injections.
Are the effects of Botox permanent?No. Effects reverse over several months (including any adverse effects).
What are the cosmetic uses of Botox?Botox is primarily used in the upper face to reduce the appearance of wrinkles. It is also used to treat excess sweating (hyperhidrosis)
How is Botox used?Botox is injected using a small gauge needle, typically directly into the muscle of facial expression responsible for the wrinkle. Some practitioners use subcutaneous or intradermal placement, especially for the crow's foot region in order to minimize bruising.
What are common adverse reactions to Botox?
- Bruising and localized swelling can occur
- Headache, usually a mild discomfort or heavy feeling in the mid-forehead. This usually resolves after several days, though severe long-lasting headaches have been reported.
- Skin eruptions at the injection site and a diffuse dermatologic eruption have been reported.
- Ptosis (droop of eyelids) occurs in less than 2% of glabellar injections. It is temporary, lasting 2-10 weeks. Ptosis can be reduced certain eye drops (e.g. apraclonidine 0.5%, Naphcon A, Vasocon A)
- Over- or under-treatment
- Deep-seated wrinkles may not be fully eliminated.
- Systemic effects are rare (e.g. allergy, anaphylaxis, fever, flu-like symptoms, cough, and nausea.)
Who should not get Botox?
- A known hypersensitivity to any ingredient in the formulation is a contraindication to Botox use.
- Caution should be exercised in patients with neuromuscular disorders (e.g. myasthenia gravis).
- Patient with coagulopathies are at increased risk of ecchymosis and other bleeding complications.
- The product contains albumin (human blood product).
- Patients on aminoglycoside antibiotics should receive lower dosing.
- Botox should not be placed in sites of active infection.
- Botox is pregnancy Category C
What are dermal fillers or skin fillers?Dermal fillers, or skin fillers, are materials injected into the skin to reduce the appearance of wrinkles and add volume to the skin.
Which skin fillers are commonly used?There are a number of approved dermal fillers on the market in the United States, including: Restylane, Juvederm, Radiesse, and Sculptra. The most popular dermal fillers are derived from hyaluronic acid (Juvederm and Restylane/Perlane).
What is hyaluronic acid?Hyaluronic acid is a naturally occurring glycosaminoglycan found in the dermal matrix.
How are hyaluronic acid skin fillers injected?There are several possible methods of injecting hyaluronic acid filler. In the multiple puncture technique multiple injections are made to fill the desired area. In linear threading, the needle is placed almost parallel to skin and injections made while withdrawing (retrograde) or (anterograde) injecting the needle.
Are skin fillers painful?Injections can be painful, especially in the central face and perioral areas, but the newer products have a numbing agent included so the area numbs quickly. Pretreatment with topical anesthesia or ice for 15 minutes prior is usually enough to decrease the discomfort. Nerve block or regional anesthesia may sometimes be required.
Is there anything I should know before a skin filler procedure?Get a consultation first to have all your questions answered. Some general guidance is:
Should I avoid any medications before my skin filler procedure?Avoid aspirin for 7-10 days prior to the procedure and other NSAIDs for 3 days. Avoid all blood thinners, UNLESS YOU ARE TAKING THEM FOR MEDICAL REASONS, in which case consult with your cardiologist or internist before stopping any medication.
What should I do after the skin filler procedure?You can apply ice and/or compression for a few minutes at a time to minimize bruising. Sleep with the head elevated for the first several nights after the procedure in order to minimize swelling and bruising.
I get oral herpes, can I get fillers?Usually yes, but speak to your dermatologist about the need for antiviral medications.
Generally, who should not receive dermal fillers?Dermal fillers should not be used in those pregnant or nursing. They should not be injected through an inflamed or infected site. Fillers should not be used in people with bleeding abnormalities.