Botox

Introduction
Botox® has been a cornerstone of facial and body rejuvenation for several years, consistently ranked as one of the top five cosmetic procedures worldwide. It is most commonly used to reduce wrinkles caused by facial muscles; however, it also is used successfully to help facial and body contouring as well as reduce unwanted perspiration.
  

What is Botox®? 
Botox® is purified protein produced by Clostridium botulinum bacterium, which reduces the activity of the muscles chemically by blocking nerve signals to the muscle.  Botox can also reduce unwanted sweating because Botox works on the same molecule that controls sweating. The purified protein is dissolved in sterile solution, and then injected into the specific locations to achieve the desired effects.

History of Botox
Botox® was initially FDA approved in 1989 for blepharospasm (uncontrolled eyelid twitching) and strabismus (cross-eyed). In 2002, Botox was approved by the FDA for cosmetic use of wrinkle reduction for muscles between the eyebrows (frown lines). In 2004, Botox was approved by the FDA to reduce excess sweating in the underarms. Many other cosmetic uses of Botox® have been demonstrated over the last several years. Botox has been used safely in cosmetics for more than 20 years now.

Before-Forehead wrinkles

After Botox

Before-Drooping Eyelid and Crow's Feet

After Botox

Before-Crow's Feet

After Botox

Before-Frown Lines at Rest

After Botox Followed by Radiesse

How is Botox useful?
The medical literature estimates over 100 different uses of their product. Dr. Liu most commonly uses Botox to relax the muscles of the upper face. More advanced techniques he performs include injections into muscles of the lower face, neck, chest, and even the calves for subtle body contouring.  Below is a partial list of how Dr. Liu uses Botox to treat a wide variety of conditions:

       Wrinkle Reduction

• Frown lines (glabella)
• Crow’s feet
• Forehead lines
• Lip lines (smoker’s lines)
• Downward turning mouth (marionette lines)
• Gummy smile
• Bunny lines of the nose
• Rippled, cobblestoned chin
• Turkey neck
• Décolletage (crêpe chest skin)

• Re-contour square jaws
• Relieve teeth grinding (bruxism)
• Re-contour thick calves
• Lift drooping eyebrows
• Reduce flaring nostrils

       Reduce Sweating

• Armpits
• Palms and Soles

How will I look after? Will I appear "fake" or "frozen"?
Dr. Liu's aesthetic philosophy is to provide a natural result individualized to your specific needs. His meticulous treatment technique delivers a desirable, visible result without a "fake" or "frozen" appearance. Dr. Liu's patients often receive comments from their friends and family that they look "well-rested and refreshed" after coming in for treatment at his practice.

What should I do before treatment?
Before treatment, Dr. Liu and his staff will ask you about your medical history, including allergies and which medicines you take. If you are taking blood thinners, review with your provider if it’s safe to discontinue prior to Botox treatment to reduce the risk of bruising. Botox treatment is contraindicated in certain situations; some of these conditions are listed below:

• Pregnancy
• Myasthenia gravis
• Aminoglycoside antibiotics
• Penicillamine medicine

Does Botox hurt?
A very fine needle is used and the procedure is well tolerated, often not requiring any anesthetic. Many of Dr. Liu’s patients describe his technique as “painless.”

What is the recovery time?
The majority of patients have no down time. Occasionally, a bruise may develop, which resolves in a few days. If you take a blood thinner medication, ask your doctor if it can be discontinued prior to Botox treatment, to minimize the risk of bruising. Other steps can be taken to minimize bruising.

How soon does it work?
Botox takes about 4 to 7 days to take effect with maximum benefits seen around 2 weeks. If any adjustment or “touch-ups” are necessary, it is best to wait about 2 weeks after the treatment when the full effect can be seen.

How long does it work?
The improvement generally lasts about 3-6 months; the effect gradually fades as muscle activity returns. With continued treatment, patients often note longer-lasting results. 

Are there any side effects?
Side effects are uncommon and usually minor and temporary. You may experience soreness or bruising at the injection site. Occasionally, people experience a temporary headache, especially when the frown or forehead areas are treated. In rare instances, patients may develop weakness of the neighboring muscles leading to a temporary droopy brow or eyelid. All of these possible effects are mild, reversible, and self-limiting.

Is Botox safe?
Recent news has noted severe side effects and/or deaths related to Botox therapy. These reports have not been linked to cosmetic use of Botox with proper technique and the use of FDA-approved Botox. Dr. Liu is an active member of the American Society for Dermatologic Surgery, which issued the following statement regarding Botox:

• Botox® Cosmetic has been FDA-approved and in continuous use since 1989 with rare reports of adverse effects, most of which were minimal and transitory.
• In 2005, almost 575,000 Botox® injections were performed by ASDS members with no reports of deaths or other major complications.
• The patient whose death was linked to Botox® by Public Citizen did not have any symptoms of an adverse reaction after injection.  Her death was from infectious pneumonia, seven weeks after the injection, and was not causal.
• Dermatologic surgeons are aware of the potential of side effects of Botox® and thoroughly inform patients of them when administering the drug.
• The ASDS and dermatologic surgeons are not aware of any deaths that have occurred as a direct result of the use of Botox® throughout the history of the product's cosmetic use.
• Many of the people who receive Botox® for non-cosmetic reasons have underlying health issues and co-morbidities that may also contribute to the adverse effects that were reported.
• The AERS database is intended to encourage physicians to report any drug reaction.  A report of an event does not by itself mean that the drug caused the event; just that the event occurred after the drug was administered.