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BOTOX® Cosmetic

Dermatology Associates of Ithaca offers its patients Botox® treatment administered by board-certified dermatologist Dr. Josephine McAllister. Botox® can smooth out wrinkles caused by overactive muscles in the face, including the “elevenses” and “Crow’s feet.” Treatments generally last 3-6 months.

Facial lines and wrinkles are caused by several factors: aging, heredity, gravity, sun damage, and muscle action. Muscles of facial expression can cause frown lines, horizontal forehead lines, crow’s feet and neckbands. If these are exaggerated or made worse by intentionally making that expression, muscle activity is partly responsible for these lines. BOTOX® Cosmetic is a prescription medication that is injected into muscles of facial expression. They work by blocking nerve impulses to the injected muscles. This reduces muscle activity and leads to a reduction of the wrinkles that are caused by muscle contraction. Typically, the muscle action will return in 3-5 months. At this time, a repeat treatment will relax the muscles and soften the lines again.

Description
Each treatment takes approximately 15 minutes. Your provider will ask you to make expressions to locate the areas of injection. Ice is applied to each site prior to injection to minimize discomfort.

Risks & Complications

  • Immediate redness and swelling may occur at each injection site. Bruising may occur. Substances that increase bruising include Vitamin E, aspirin, Motrin and other non-steroidal anti-inflammatory drugs.
  • Possible side effects include: transient headache, swelling, bruising, pain during injection, twitching, itching, numbness, asymmetry (unevenness), temporary drooping of eyelids or eyebrows. These side effects are rare, but have been reported.
  • Cold sores can be triggered by any facial procedure. If you have a history of cold sores, be sure to notify your doctor prior to your procedure, so that you can be given a medication to reduce the chance of a breakout.
  • There is no guarantee of results, and though it is unlikely, there may be minimal or no improvement of the condition. In a very small number of individuals, the injection does not work as satisfactorily or for as long as usual.

Contraindications

  • Pregnancy
  • Nursing
  • History of diseases of muscles and nerves (such as ALS or Lou Gehrig’s disease, myasthenia gravis or Lambert-Eaton syndrome)

Before Your Botox Treatment

  • Aspirin and ibuprofen should be avoided 10-14 days prior and 2 days post treatments to minimize risk of bruising. If you have been told to take aspirin daily by your doctor, please let us know before stopping it. Other medications to avoid include Excedrin™, Motrin™, Naprosyn™, Aleve™, Gingko, garlic supplements, fish oil, and Vitamin E.
  • Avoid alcohol 2 days prior to treatment to minimize risk of bruising.
  • If you have a history of cold sores, please let us know before the day of the procedure so that a medication can be given for you to take.
  • Be sure that you have communicated any pertinent medical history to your doctor, particularly any history of neurologic or muscular disease, medication allergies, new medications, pregnancy, breastfeeding, and previous cosmetic procedures.

After Your Botox® Treatment

  • Immediately after the procedure you can reapply makeup and resume your skin care routine.
  • Avoid massaging the areas, lying down, or bending for the next 4 hours.
  • Use the treated muscles by making facial expressions over the next few hours to maximize your results.
  • The full effect of the treatment is seen in about 2 week after the procedure.
  • We would like to follow up with you 2 weeks post treatment to make sure you are pleased with the results.

Frequently Asked Questions (Botox)

The best candidates for Botox® treatment are adults with dynamic facial wrinkles—that is, those that are accentuated with facial expressions such as raising one’s eyebrows, smiling, or frowning. We target the “11’s” or “frown lines” between the eyebrows as well as “crow’s feet” on the sides of the eyes with Botox®.

Botox® treatment relaxes and softens wrinkles in the treated areas about 4-7 days after injection.

Contraindications to receiving Botox® treatment include prior allergic reaction or allergy to cow’s milk protein, albumin, or egg whites; injection into areas of infection or inflammation; pregnancy; or breastfeeding. Additionally, patients with a neuromuscular disorder such as myasthenia gravis, ALS, or Lambert-Eaton syndrome should not receive Botox treatment. Those with “static wrinkles” may be more effectively treated with fillers instead.

Botox® is a medication that relaxes muscles into which it is injected. It has been used for more than a decade in children and adults for muscle spasm treatment. Botox® Cosmetic is FDA approved for the treatment of frown lines. The effects last for about 3-5 months, at whcih time a repeat treatment will relax the muscles again. Botox® has a Black Box warning from the FDA due to the rare risk of spreading from the site of injection causing potentially serious side effects.

Most patients tolerate treatment well with no problems; however, mild discomfort from the injection itself may be experienced, as well as swelling, bruising, and mild headaches. Patients with a history of cold sores should tell their provider, since treatments around the face can trigger cold sores. Allergic reactions are rare, as is weakness of an adjacent muscle resulting in drooping of the eyelids, eyebrow, or double vision. Some patients do not respond as expected or need more frequent treatments.

The effects of the treatment usually last for about 3-4 months. When the effects wear off, we recommend a repeat treatment.

  • We recommend avoiding aspirin and ibuprofen 10-14 days before, and 2 days after, treatments to minimize the risk of bruising. The exception is that if your doctor has instructed you to take aspirin daily, do not stop it. Other medications to avoid include Excedrin™, Motrin™, Naprosyn™, Aleve™, Gingko, garlic supplements, fish oil, and Vitamin E.
  • Avoid alcohol 2 days prior to treatment to minimize risk of bruising.
  • If you have a history of cold sores, please let us know before the day of the procedure so that a medication can be given for this condition.
  • Be sure that you have given any pertinent medical history to your doctor, particularly any history of neurologic or muscular disease, medication allergies, new medications, pregnancy, breastfeeding, and previous cosmetic procedures.

Dr. McAllister will ask you to frown to assess which area would best benefit from treatment, then inject the solution with a small needle. You will then apply ice and pressure to the area. The entire procedure takes 15-30 minutes.

We recommend staying vertical (not lying down flat) for at least 4 hours after the procedure and avoiding vigorous exercise. You should avoid manipulating the area including rubbing or pressing; however, it is helpful to exercise the facial muscles as much as possible by making facial expressions. Results are usually seen about a week after treatment

Helpful Links
Botox® Handout

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