Aesthetic Surgery Blog.com

The truth about BOTOX

In this tough economy when budgets are tight, Botox and soft tissue fillers can be the most cost effective way of achieving your aesthetic goals.

What is BOTOX?
Simply stated, Botox is a medication that paralyzes the muscles causing facial wrinkles (chemodenervation). It was first used in 1980 to correct hyperactive eye muscles (strabismus) and first used for cosmetic purposes in 1989. Botox was FDA approved for forehead administration April 15, 2002, and now used not only to soften facial wrinkles but also to correct facial asymmetries and the aging neck. Currently there are 8 subtypes (A, B, C1, C2, D, E, F, and G) with A and B the most potent. Botox cosmetic (subtype A) produced by Allergan is widely available in the US and injected over 3 million times in 2008, Dysport (subtype A) will soon be available in the US and manufactured by Inamed and named Reloxin. Hopefully, with competition, the cost of the products will be reduced, but only time will tell! Myobloc (subtype B) is not as potent and not available in the US.

How does it work?
Botox is a toxin purified from Clostridium botulinum. In very small dosages, it blocks acetycholine release (muscle stimulator) from within the muscle cells preventing contraction and thus paralyzing the muscle (s) that cause the facial wrinkle. Botox works by diffusion into the targeted muscles and is not systemically absorbed. It is important to note, that Botox will soften the muscles that cause active (dynamic) wrinkles and will not treat permanent (static) wrinkles. Soft tissue fillers such as the hyaluronic acids (Restylane, Juvaderm, Preville silk) or calcium hydroxyapetite (Radiesse) are most effective for the deep static wrinkles.

What results can I expect?
Botox is administered in an office setting after placement of a topical anesthetic gel which reduces injection discomfort. The most common areas treated are superficial wrinkles of the forehead and around the eyes and mouth. Injections take less than 5 minutes, are essentially painless, and results are typically seen at 3-5 days. One can expect the results to last 3 to 6 months, although wide variability exists due to dilution techniques and individual muscle activity. Certainly with the addition of soft tissue fillers, facial and neck wrinkles can be reduced and with more advanced injection techniques, lifting of sagging soft tissue can be obtained.

What are the potential complications?
Complications are extremely rare. However, side effects such as injection site pain, bruising, and edema resolve within 24 hours. Paralysis of unintended adjacent muscles can occur and obviate an experienced physician injector with thorough understanding of the facial anatomy. To decrease the possibility of complications and side effects and thus unhappy clients, I always examine the patient, discuss the product and options available, mark my intended injection sites, and personally perform the procedure. Please call my office for consultation and to discuss your facial aesthetic goals 713-797-0085. DR LIVINGSTON

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Liposuction is one of the most common cosmetic procedures performed.  Most patients that maintain a healthy lifestyle with regular exercise (3-4 times/week) and a controlled diet (low fat and moderate proportions) but still have small amounts of fat in subborn areas are candidates.  Certainly, realistic expectations and nonsmokers are mandatory in my practice.  Traditional liposuction utilized larger diameter canulas with suction and general anesthesia.  Bruising, swelling, several weeks of restricted movement, and the possiblity of irregularities were common.  In addition, general anesthesia added to the total cost of the procedure.  With the introduction of ultrasonic liposuction (as well as laser liposuction), the canulas have become smaller and the amount of suction has diminished.  Tumescent anesthesia (combination of saline, lidocaine, and epinephrine infiltrated into the target areas) can be performed without general anesthesia in certain instances which reduces the cost and allows patients to literally walk into and out of surgery.  Yes, you are awake during this minor procedure and able to communicate with the surgeon as he/she operates.  I have found that ultrasonic liposuction reduces swelling and bruising as well as post-operative pain.  Most importantly, the results are improved over traditional liposuction (in my practice).  I recommend this technique to my patients that have only small target areas and BMI (body mass index) less than 30 and are otherwise healthy individuals.  Certainly, these areas can include the abdomen, inner and outer thighs, hips, back, and arms.  Males with large breasts (gynecomastia) can also be candidates.  If considering this procedure, make sure that your plastic surgeon is board certified and has experience in liposuction and ultrasonic techniques.  Each patient is different as is each doctor that advertises liposuction.  DR L

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Just because 2008 was a extremely bad economic year, doesn’t mean that you should neglect your health and wishes to jevuninate.  There are many non-surgical (non-invasive) cosmetic procedures that can turn back the hands of time and take only minutes to perform within the clinic setting.  Most of the these procedures are considerably less expensive than invasive procedures.  Botox is one such example.  It paralyzes the facial muscles that cause forehead wrinkles.  Typical costs are $100-400 and results can last up to 6 months.   Soft tissue fillers, such as restylane, juvaderm, preville silk, perlane, radiesse, sculptra are short and longer acting products that can fade and sometimes erase the fine line and wrinkles caused my age and sun exposure.  Again, they are clinic procedures that take only minutes to perform, have immediate results, and usually cost $300-600.  Financing is accepted and usually easy to obtain.

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Breast augmentation (breast implant) is one of the more popular cosmetic procedures performed on women and is usually a very satisfying operation with predictable results.  However, their are documented studies of secondary procedures of up to 25%.  What are secondary procedures or revisions?  And why such a high precentage?  Well, in some instances, the implants can be too small (rarely) or too large (more common).  The implants can be placed too high or there can be significant asymmetry.  An implant rupture can occur or the implants begin to feel hard and painful (capsular contracture).  Capsular contracture rates are approximately 15% depending on the type of implant and placement.   If these occur, then a secondary or revisonary surgery is usually necessary to satisfy the patient and plastic surgeon.  Revision breast surgery can include implant exchange, implant reposition, release or removal of the capsule around the implant, or breast lifting.  The outpatient surgical procedure is usually shorter in duration and less painful.  Results are very dependant on the experience of the plastic surgeon, as well as the amount of deformity, and overall health of the patient.  Certainly, multiple breast procedures can increase the risk of complications, all of which can be discussed in detail with the board certified plastic surgeon of your choice.

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Each night I try and prepare a cosmetic surgery question to answer and discuss, however I find it more rewarding when a question is asked for which I have an answer.  Although each patient is different, there are procedures that work well for every cosmetic surgery patient.  In any event, if a someone would like to comment or a question answered, don’t hesitate!

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