"The Beauty of BOTOX" presentation by Heidi LaForge, DO, Via Christi Clinic family medicine physician. Dr. LaForge explains how BOTOX is made and how it can help eliminate wrinkles.
Botox Injection is a commercially successful non-surgical cosmetic procedure, to gets rid of the deep wrinkles in the skin between eyebrows, of the forehead, of the corner of eyes. Effective for 3 - 4 months, and the procedure is repetitive in nature.
Best facial cosmetic surgeons Best facial plastic surgeon Browlift Charlotte endoscopic brow lift Charlotte’s top facial plastic surgeon Facial plastic surgeons Facial plastic surgery Face lifts Facial mini-tuck Lip enhancement Lip augmentation Nose job Nose job cost Nose surgery Rhinoplasty Rhinoplasty Expert Rhinoplasty and teens Revision rhinoplasty Teen Rhinoplasty, Charlotte Teen Rhinoplasty, North Carolina Teen Rhinoplasty Expert Top rhinoplasty surgeons Best Charlotte rhinoplasty surgeons Most experienced rhinoplasty surgeons
We are truly in an “era of injectables,” with access to a varied armamentarium of products that yield dramatic aesthetic results with minimal recovery downtime. From its first published mention as an aesthetic treatment for glabellar lines in 1992, the use of commercially available BoNT type A (BoNTA) has captivated healthcare professionals and lay people alike. The availability of newer BoNTA formulations, with more expected in the near future, poses an exciting opportunity for aesthetic practitioners to reach an ever expanding potential patient base and provide increasingly refined treatment
Botox Injection is a commercially successful non-surgical cosmetic procedure, to gets rid of the deep wrinkles in the skin between eyebrows, of the forehead, of the corner of eyes. Effective for 3 - 4 months, and the procedure is repetitive in nature.
Best facial cosmetic surgeons Best facial plastic surgeon Browlift Charlotte endoscopic brow lift Charlotte’s top facial plastic surgeon Facial plastic surgeons Facial plastic surgery Face lifts Facial mini-tuck Lip enhancement Lip augmentation Nose job Nose job cost Nose surgery Rhinoplasty Rhinoplasty Expert Rhinoplasty and teens Revision rhinoplasty Teen Rhinoplasty, Charlotte Teen Rhinoplasty, North Carolina Teen Rhinoplasty Expert Top rhinoplasty surgeons Best Charlotte rhinoplasty surgeons Most experienced rhinoplasty surgeons
We are truly in an “era of injectables,” with access to a varied armamentarium of products that yield dramatic aesthetic results with minimal recovery downtime. From its first published mention as an aesthetic treatment for glabellar lines in 1992, the use of commercially available BoNT type A (BoNTA) has captivated healthcare professionals and lay people alike. The availability of newer BoNTA formulations, with more expected in the near future, poses an exciting opportunity for aesthetic practitioners to reach an ever expanding potential patient base and provide increasingly refined treatment
Slide presentation to give a better understanding of the benefits of Botox. Covers facial muscles that benefit most from botox due to the bodies natural aging process.
Grow your skin with Botox and Dermal fillers. World class treatements by experienced professionals in Fairfax VA which reduces side effects and it is safe as well as effectual in the treatment of wrinkles.
Cheek Fillers|Facial Aesthetic| Facial Aesthetic by Dr Rajat Sachdeva| Facial...Dr. Rajat Sachdeva
Cheek Fillers rejuvenate the cheeks and to regain last volume.
Autologous Fat Injection, where your own fat harvested from some other area can be used to restore volume of cheeks.
Some other fillers like Hyaluronic acid, Ca Hydroxide and Polymethyl Metacrylate are injected with fine needles in the target area eliminate wrinkles and enhances cheeks volume.
Mesotherapy treatment is frequently used to solve many problems regarding health issues. In this treatment injections are adminstrated into the supposed part of the body.
http://www.informationonmesotherapy.com
Nonsurgical Facial Rejuvenation: Botox and Facial FillersJoshua Zuckerman
An overview of injectable techniques of nonsurgical facial rejuvenation, focusing on Botox Cosmetic and Juvederm. Includes extensive before and after photographs.
Derma fillers are gel like substances that are injected beneath the skin to restore lost volume,smooth lines and soften creases, or enhance facial contours.They can be used as "volumizers" plumping and lifting cheeks,chins,jawlines and temples, filling out thin lips.Mostly Hylarudonic acid fillers like Juvederm are used.The procedure takes around 30-45 minutes and patients can see results in about 10 days-2weeks.
Derma Fillers are done at Dr Sachdeva's Dental clinic and Facial aesthetic centre in Delhi. So hurry up and come book an appointment with us at Dr.Sachdeva’s Dental Institute, Ashok Vihar, Delhi which has state of the art clinic and all the latest and advanced equipments.
To book an appointment contact:
Dr. Rajat Sachdeva
Director & Mentor
Dr Sachdeva’s Dental Aesthetic And Implant Institute
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
Phone : +919818894041,01142464041
Our Websites:
www.sachdevadentalcare.com
www.dentalimplantindia.co.in
www.dentalclinicindelhi.com
www.dentalcoursesdelhi.com
Facebook- dentalcoursesdelhi
Youtube- drrajatsachdeva
Linkedin- drrajatsachdeva
Slideshare- Dr Rajat Sachdeva
Twitter Page- drrajatsachdeva
Instagram page- surgicalmasterrajat
Slide presentation to give a better understanding of the benefits of Botox. Covers facial muscles that benefit most from botox due to the bodies natural aging process.
Grow your skin with Botox and Dermal fillers. World class treatements by experienced professionals in Fairfax VA which reduces side effects and it is safe as well as effectual in the treatment of wrinkles.
Cheek Fillers|Facial Aesthetic| Facial Aesthetic by Dr Rajat Sachdeva| Facial...Dr. Rajat Sachdeva
Cheek Fillers rejuvenate the cheeks and to regain last volume.
Autologous Fat Injection, where your own fat harvested from some other area can be used to restore volume of cheeks.
Some other fillers like Hyaluronic acid, Ca Hydroxide and Polymethyl Metacrylate are injected with fine needles in the target area eliminate wrinkles and enhances cheeks volume.
Mesotherapy treatment is frequently used to solve many problems regarding health issues. In this treatment injections are adminstrated into the supposed part of the body.
http://www.informationonmesotherapy.com
Nonsurgical Facial Rejuvenation: Botox and Facial FillersJoshua Zuckerman
An overview of injectable techniques of nonsurgical facial rejuvenation, focusing on Botox Cosmetic and Juvederm. Includes extensive before and after photographs.
Derma fillers are gel like substances that are injected beneath the skin to restore lost volume,smooth lines and soften creases, or enhance facial contours.They can be used as "volumizers" plumping and lifting cheeks,chins,jawlines and temples, filling out thin lips.Mostly Hylarudonic acid fillers like Juvederm are used.The procedure takes around 30-45 minutes and patients can see results in about 10 days-2weeks.
Derma Fillers are done at Dr Sachdeva's Dental clinic and Facial aesthetic centre in Delhi. So hurry up and come book an appointment with us at Dr.Sachdeva’s Dental Institute, Ashok Vihar, Delhi which has state of the art clinic and all the latest and advanced equipments.
To book an appointment contact:
Dr. Rajat Sachdeva
Director & Mentor
Dr Sachdeva’s Dental Aesthetic And Implant Institute
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
Phone : +919818894041,01142464041
Our Websites:
www.sachdevadentalcare.com
www.dentalimplantindia.co.in
www.dentalclinicindelhi.com
www.dentalcoursesdelhi.com
Facebook- dentalcoursesdelhi
Youtube- drrajatsachdeva
Linkedin- drrajatsachdeva
Slideshare- Dr Rajat Sachdeva
Twitter Page- drrajatsachdeva
Instagram page- surgicalmasterrajat
Dr. Patrick Treacy Botox 'Myths & Facts' lecture to AAAD in Mexico CityDr. Patrick J. Treacy
The cosmetic effect of BTX-A on wrinkles was originally documented by a plastic surgeon from Sacramento, California, Dr. Richard Clark, and published in the journal Plastic and Reconstructive Surgery in 1989. Canadian husband and wife ophthalmologist and dermatologist physicians, JD and JA Carruthers, were the first to publish a study on BTX-A for the treatment of glabellar frown lines in 1992. Similar effects had reportedly been observed by a number of independent groups (Brin, and the Columbia University group under Dr. Monte Keen]). After formal trials, on April 12, 2002, the FDA announced regulatory approval of botulinum toxin type A (Botox Cosmetic) to temporarily improve the appearance of moderate-to-severe frown lines between the eyebrows (glabellar lines). Subsequently, cosmetic use of botulinum toxin type A has become widespread.[19] The results of Botox Cosmetic can last up to four months and may vary with each patient. The US Food and Drug Administration approved an alternative product-safety testing method in response to increasing public concern that LD50 testing was required for each batch sold in the market. The global botox market is forecast to reach $2.9 billion by 2018. The entire global market for facial aesthetics is forecast to reach $4.7 billion in 2018, of which the US is expected to contribute over $2 billion.
Training for periorbital and upper face treatment with botox and JuvedermDokter Frodo Gaymans
Training for periorbital and upper face treatment with botox and Juvederm
Training for experienced injectors.
no rights may be derived from this training
The Art of Liquid Face Lift (Dermal Fillers)Osama Moawad
Soft tissue fillers are flexible substances that can be injected into the skin to improve the appearance of fine lines and wrinkles, plump lips, fill hollow cheeks, repair various facial imperfections, improve scars, and elevate deep folds. Perhaps nothing is more gratifying for cosmetic patients than having an immediate correction of rhytides or scars as a result of the injection of a dermal filler The result is a smoother, more youthful appearance with minimal "downtime" and maximum safety. Prof. Moawad uses a variety of soft tissue fillers, including, hyaluronic acid, and autologous fat (one's own fat) among others. Since filler substances do not involve major surgery and are generally cost-effective, men and women are using these youth-enhancing techniques more than ever. With the increasing desire for people to achieve a more youthful appearance, the aging baby boomer population, and the increased demand for "lunch-time procedures," the pharmaceutical market has responded by providing the cosmetic surgeon with an increasing number of options to meet the demands of the cosmetic patient.
Whether you are a doctor or a medical researcher, details regarding the face anatomy can help you explain your patients about the latest surgeries and medical actions that are taking place. Further, using excellent Face anatomy PowerPoint Templates can instantly easy your effort and make the overall explanation process instant. More information: http://www.medicalppttemplates.com/medical-ppt-templates.aspx/Face-Anatomy-173
Will non invasive radio frequency Pelleve skin tightening give you the results you are after? Today's presentation answers your questions about Pelleve facial treatments and gives you the information you need to make the right beauty treatment decisions. See Pelleve before and after pictures and decide for yourself if a non-surgical facelift is right for you or if a more radical cosmetic surgery is called for. Take a look at the results of this popular anti aging wrinkle treatment and decide for yourself. See the original article, website, and video resources for more in depth information and treatment.
Lecture by Dr. Patrick J. Treacy to Las Vegas Cosmetic Conference 2011 about his experiences and preferences with different European Botox and Dermal Fillers
1. Botox: A Beginner’s Guide.
2. 5 Reasons To Use Botox.
3. Regain Your Youthful Glow with Anti-Ageing Treatment.
4. Can Botox Help Your Mental Health?
5. 4 Things That You Didn’t Know About Botox.
It's viewed as a protected, compelling treatment by the Best Cosmetic surgeon in Kolkata for scarce differences and kinks around the eyes. It can likewise be utilized on the temple between the eyes. If you want to know more about Botox Treatment then go through this Slideshow. Visit our website to know more about plastic and hand surgery- https://plasticandhandsurgeryclinic.com/
Myths and Facts About The Botox Treatment.pdfMusk Clinic
A state of the art multispeciality skin & cosmetic clinic promising world class treatments done by highly specialized professionals in environs that assure optimum care and comfort for each of their clients is what defines Musk Clinic, the Best Hair Transplant Clinic in Ahmedabad.
Studies have shown something very interesting about everyone’s favourite wrinkle-blocker. Although Botox is known to reduce emotional expression, this can actually be beneficial to people struggling with depression that are resisting regular treatment.
>> Botox vs dermal fillers.
>> The bonus.
>> The best candidate for the procedure.
>> Can it help under eyes wrinkles.
>> What to expect after a botox under eyes procedure.
>> How long will it take for the procedure to work.
Conditions That Can Be Treated By Botox Orlando FLseosliddles
You may have heard that Botox Orlando FL has a lot of benefits other than treating wrinkles and fine lines and are wondering if that is true. Botox is made of botulinum, which is a neurotoxin that relaxes muscles for up to several months.
Your temporomandibular joint is a hinge that connects your jaw to the temporal bones of your skull, which are in front of each ear. It lets you move your jaw up and down and side to side, so you can talk, chew, and yawn.
Injury to your jaw, the joint, or the muscles of your head and neck-like from a heavy blow or whiplash can lead to TMD(temporo mandibular disorders)
Common symptoms include:
-Pain or tenderness in your face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide.
-Problems when you try to open your mouth wide.
-Jaws that get "stuck" or "lock" in the open- or closed-mouth position.
-Clicking, popping, or grating sounds in the jaw joint when you open or close your mouth or chew. This may or may not be painful.
-A tired feeling in your face.
-Trouble chewing or a sudden uncomfortable bite as if the upper and lower teeth are not fitting together properly.
-Swelling on the side of your face.
Dr Sachdeva's Dental and Facial aesthetic center is one of the leading clinics in Delhi. So hurry up and come book an appointment with us Ashok Vihar, Delhi which has state of the art clinic and all the latest and advanced equipments.
To book an appointment contact:
Dr. Rajat Sachdeva
Director & Mentor
Dr Sachdeva’s Dental Aesthetic And Implant Institute
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
Phone : +919818894041,01142464041
Our Websites:
www.sachdevadentalcare.com
www.dentalimplantindia.co.in
www.dentalclinicindelhi.com
www.dentalcoursesdelhi.com
Facebook- dentalcoursesdelhi
Youtube- drrajatsachdeva
Linkedin- drrajatsachdeva
Slideshare- Dr Rajat Sachdeva
Twitter Page- drrajatsachdeva
Instagram page- surgicalmasterrajat
Dr. Patrick Treacy is Chairman of the Irish Association of Cosmetic Doctors and Irish Regional Representative of the 'Botox Myths and Facts' lecture by Dr. Patrick Treacy to American Academy of Aesthetic & Anit-Aging Medicine Mexico City 2012
Dr. Treacy is Chairman of the Irish Association of Cosmetic Doctors and Irish Regional Representative of the British Association of Cosmetic Medicine. He is European Medical Advisor to Network Lipolysis and the UK's largest cosmetic website Consulting Rooms. He practices cosmetic medicine in his clinics in Dublin, Cork, London and the Middle East.
Maggie Ward, with the Via Christi Cancer Outreach and Risk Assessment program, discussed cancer genetic testing at the October, 2015, Women's Connection luncheon.
Miki Matsuda, a podiatrist with Via Christi Health in Wichita, KS, recently presented about common foot and ankle issues to a Via Christi 50+ audience. Topics included ingrown toenails, onychomycosis, callouses and more.
Via Christi Women's Connection: Six ways to a better youVia Christi Health
Via Christi Clinic physicians Tara Katz, DO and Sara Purdy, DO, share their top 6 list for better health at the August Via Christi Women's Connection luncheon.
Via Christi Women's Connection presentation on summer safety tips from Safe Kids Wichita Area. Tips for safe swimming, biking, camping, car seats and walking.
Lisa D. Sandell, OD, with Via Christi Clinic, presented "Keeping an Eye on Your Health" to Via Christi 50+ May 21, 2014, at the Sedgwick County Extension Office in Wichita, KS.
Via Christi Women's Connection presentation on advance in depression treatment by Matthew Macaluso, DO, medical director of Via Christi Psychiatric Clinic.
Oct. 2013 Via Christi Women's Connection presentation on breast cancer genetic testing featuring Patty Tenofsky, MD, with Via Christi Clinic in Wichita, Kan.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Dehradun #ℂall #gIRLS Oyo Hotel 9719300533 #ℂall #gIRL in Dehradun
The Beauty of BOTOX
1. Botox - Medical Uses
Dr. Heidi LaForge
Via Christi Family Medicine
2. Where does Botox Come From?
• Botox is derived from a bacteria that is found in the soil—Clostridium
Botulinum
3. Botox
• Botulism toxin (BOTOX®) is a material that has been known for over a
century and used for medical purposes for more than 50 years.
• In 2002, it was approved for improving and relaxing frown lines in the area
between the eyes on the forehead.
• Since 2002, BOTOX has been used successfully in more than two million
patients.
4. How Does It Work?
• Botox works by blocking a chemical that aids in muscle contraction called
acetylcholine
• When the nerve sends a signal to the muscle to contract, acetylcholine is
released as before, but it can't bind anywhere on the muscle due to the
Botox
• The muscle has no idea it is supposed to contract. It is essentially
paralyzed, but not because the muscle or the nerve have been damaged.
6. Does it Work Right Away?
• Botox takes 72 hours to reach maximum effect in most patients (some
patients it can be as long as 5-7 days)….be patient because beauty takes
time.
• Often After a Botox treatment I have patients periodically exercise the
muscles that have been treated to create the desired affect of blocking all
of the neuromuscular junctions faster
7. Can A Patient Build Antibodies to
Botox?
• At large doses this can happen resulting in a loss of therapeutic effect over
time.
• Neutralizing antibodies have been reported in 3-5% of patients with
cervical dystonia (torticollis)
• Resistance to Botox in individuals treated for cosmesis and hyperhydrosis
has not been reported.
8. What Does Botox Look Like
• When Botox comes in the mail from the manufacturer Allergan it is a fine
dry gray powder packed on dry ice. (it looks like there is nothing in the
bottle)
• Botox must be refrigerated
• Once a patient is selected, it is mixed with a sterile saline preservative
and should appear colorless and free of particulate matter.
9. How Long Does Botox last in the
Bottle?
• Botox will last you 6 months in the refrigerator as long as it is not mixed
and is still in powder form.
• Once mixed with sterile saline it lasts 6 weeks
• If non-sterile saline is used you must use the Botox within 24 hrs or waste
it.
• Bottom Line----always mix it with sterile saline !!! Sterile saline is
inexpensive but Botox is not
10. Botox Approved Applications
• Strabismus
• Blepharospasm---in patients greater than 12 years of age
• Cervical Dystonia (Tortacollis)
• Glabellar lines
• Chronic Headaches (Migraines)
• Hyperhidrosis (this application typically lasts 9 months)
11. Strabismus—Crossed eyes
• is a condition in which the eyes are not properly aligned with each other.
• It typically involves a lack of coordination between the extra ocular
muscles, which prevents bringing the gaze of each eye to the same point
in space
• Strabismus can be either a disorder of the brain in coordinating the eyes
or a disorder of the strength of eye muscles.
• Botulinum Toxin (Botox) may also be used in the treatment of strabismus
by improving vision and to improve cosmetic appearance. To perform
treatment Botox is injected into the stronger muscle, causing temporary
paralysis and causing a more symmetric appearance and allowing
convergence of gaze.
• Usual amount 15 units
12. Blepharospasm
• benign essential blepharospasm is a neurological movement disorder
involving involuntary and sustained contractions of the muscles around
the eyes.
• The cause is unknown, but fatigue, stress, or an irritant are possible
contributing factors.
• Botox injections have been used to induce localized, partial paralysis.
• Among most sufferers, botolinum toxin injection is the preferred
treatment method
• Usual amount is around 10-15 units
13. Cervical Dystonia
• Spasmodic torticollis is a chronic neurological movement disorder causing
the neck to involuntarily turn to the left, right, upwards, and/or
downwards. The condition is also referred to as "cervical dystonia".
• There are several treatments for spasmodic torticollis, the most
commonly used being botulinum toxin injections in the dystonic muscle of
the neck
• I have not seen a patient treated for this with Botox and would only
consider it if NSAIDs, muscle relaxers, OMT and PT are unsuccessful as
BOTOX would be an expensive approach. There is also risk in treated a
patient with Botox in the neck (many important things here)
14. Glabellar lines
• on April 12, 2002, the FDA announced regulatory approval of botulinum
toxin type A (Botox Cosmetic) to temporarily improve the appearance of
moderate-to-severe frown lines between the eyebrows (glabellar lines).
• Subsequently, cosmetic use of botulinum toxin type A has become
widespread with many celebrities viewing it as less intrusive and/or
artificial than other types of plastic surgery
• Injection into the Glabella is not difficult. There is little subcutaneous
tissue here and the muscle is easy to find.
• Usual dose is 10-15 units
15. Glabella Continued
• While injecting the muscle is not difficult it is
important to remember to stay out of the
orbital rim. You do not want to create ptosis
• Also stay one finger widths above the eyebrow
so that you do not make them droop. (real
eyebrows not pencil eyebrows).
16. Headaches
• FDA approval for treatment of chronic migraines on October 15, 2010. The
toxin is injected into the head and neck to treat these chronic headaches.
• Approval followed evidence presented to the agency from two studies
funded by Botox maker Allergan, showing a slight improvement in
incidence of chronic migraines for migraine sufferers undergoing the Botox
treatment.
17. Who Should get Botox for Headaches?
• A patient who is refractory to Triptans, and other
conventional methods.
• Most insurance companies will not pay for BOTOX
unless many other avenues have been explored (and
even then some just flat don’t pay)
• The forehead is traditionally injected first to see if
this aids in preventing headaches as the approach is
easier and less costly than injecting near the
posterior occiput.
18. Hyperhidrosis
• While treating patients with hemifacial spasm at Southend Hospital in
England in 1993, Khalaf Bushara and David Park were the first to show that
botulinum toxin injections inhibit sweating.
• This was the first demonstration of non-muscular use of BTX-A.
• Due to this research, Botox was later approved for the treatment of
excessive underarm sweating. (hyperhidrosis)
• If we all remember back from Medical School sweat glands are the only
sympathetic cholinergic glands in the body. Usually our fight or flight
response is thought of as being related to Eppi and Norepi
19. Hyperhydrosis continued
• Hyperhydrosis is the only application of Botox where we are not injecting
the muscle. We are now aiming for sweat glands with our injections.
• The most common place to inject for hyperhydrosis is the axilla
• It usually takes around 15-20 units per axilla to make a significant
difference and this application does cause more pain with injections as
there is more swelling of the skin (more sensitive).
• It is important to use many needles and syringes with small amounts of
BOTOX to avoid dulling the needles.
• I pinch or tent the skin between my fingers for two reasons……to keep my
needle from going deep (near brachial plexus and other important vessels)
and to decrease the sensation of pain with the needle stick.
20. How do I know where the sweat glands are?
• More Chemistry…….Fun!!!
• Use Betadyne thickly over the axilla and place corn starch over the entire
area. Allow this to sit for 1-2 minutes. The sweat glands will produce a
black reaction to the skin. Have the patient shake off the excess powder
and you are ready to inject (this is messy so put down towels first)
• I like to inject with sterile gloves in a grid pattern about one to two units
of Botox every square cm.
• The patient will notice results in 72 hrs. Make sure they are not planning
to wear white for a few days as the yellow betadyne and dark corn starch
can seep out of pores for a while. ( I would say 2 weeks before a
wedding)
22. Off Label Uses of Botox—For the
adventuresome
• Other facial lines
• Platysma Bands
• Bruxism
• Back and Neck Spasms
• Other spastic conditions---esophagus, bladder,
vascular, anal fissure, clubfoot.
23. Facial Lines
• Forehead--- Usually 10-20 units. You need to remember to stay one finger
above the eyebrow and to inject between the lines. Remember we are
injecting muscles….not chasing lines. I like to inject more medial for
women as it creates a nice brow lift (make it and even spread for men as a
brow lift looks less than manly).
• Crows Feet —Stay out of the orbital rim and be realistic. You are only
smoothing muscle not getting rid of fine lines. These are sometimes
better injected with dermal fillers (whole new talk). Use technique to
point the needle away from the eye.
24. Platysma Bands
• The Platysma is a muscle that is a broad sheet arising from the fascia
covering the upper parts of the pectoralis major and deltoid; its fibers
cross the clavicle, and proceed upward and medially along the side of the
neck.
• By injecting Botox into this thin muscle you can reduce the fine lines often
noted in the neck as we age.
• RESERVE THIS ONE FOR HOUDINI……YOU PROBABLY REMEMBER THIS
MUSCLE FROM CADAVER LAB (OR LACK OF THIS MUSCLE) WHEN IT
COMES TO THE NECK I LIKE DERMAL FILLERS ALL THE WAY!!
25. Bruxism-- grinding teeth
• is characterized by the grinding of the teeth and typically includes the
clenching of the jaw.
• It is an oral activity that occurs in most humans at some time in their lives
and can be worsened by stress or fatigue
• In most people, bruxism is mild enough not to be a health problem but is
one of the most common sleep disorders
• In the treatment of bruxism, Botox weakens the muscle enough to reduce
the effects of grinding and clenching, but not so much as to prevent
proper use of the muscle
• (not sure how much Botox is used as I have not seen this application)
26. Back and Neck Spasms
• Botox is often used by orthopedic and neurology specialists to decrease
spasm in paraspinal muscles that boarder our vertebrae.
• These specialized injections are targeted at relieving pain in small joint
segments. This can truly help patients with post-operative pain or
scoliosis.
• (I have not seen this used)
27. Other spastic conditions
• Botulinum toxin A can also be injected into muscles that are either spastic
or have contractures, the aim being to relieve the disability and pain
produced by the inappropriately contracting muscle.
• This can help treat: cerebral palsy, spastic quadriplegia or any movement
disorder with spastic or stiff muscles
• I do have a patient with severe CP who was so spastic he could not walk
with braces or crutches and now can use a walker instead of a wheelchair
due to the greatness of Botox
28. Who is not a candidate for Botox?
• People who have:
– Myasthenia Gravis, Lambert-Eaton Syndrome, ALS
– Pregnant or breast feeding
– Allergy or sensitivity to Botox
– Marked facial asymmetry, ptosis or other anatomic defects
– Infection of the skin
– History of facial nerve palsy (Bells Palsy)
29. Botox Rules
• In general the use of BOTOX poses few risks. BOTOX may cause temporary
headaches, bruising or temporary drooping of the eyelid.
• Certain antibiotics—Levaquin, Cipro or Clindamycin—shorten the
therapeutic effect of BOTOX…..it is unclear as to why but the theory is that
these antibiotics decrease the affinity of the Botox to stay bound to the
muscular junction.
30. Most Common Complications
• Most are largely aesthetic (Patients like
pre-treatment appearance better)
• Asymmetry
• Flattened brow or brow elevation
• Upper eye lid ptosis
31. Can Cosmetic side effects be “fixed”
• If you happen to have drooping eyes (ptosis)
following an eye treatment eye drops known
as Iopidine can be used to help elevate the
upper eyelid by 1-3 mm
• Additional Botox can be used on one side of
the face to aid in fixing any asymmetry that
may result
32. Cosmetic Botox and Patient $$
• We all age differently and have different attitudes about what we're
willing to do about it.
• Let's start out with one thing from the start. There are "needs" and
"wants" when it comes to our personal health. Cosmetic enhancement is a
"want.“
• What do I tell patients……………..
33. Broken on the Inside
• I'd never want to fly a plane that looked nice on the outside but was
mechanically unsound on the inside—and neither should you.
35. Look Good for You
• There are good reasons and bad reasons for wanting to look good. Good
reasons include, wanting to look good for "your self."
• It's not reasonable to think that these products will improve your love life
or your marriage.
• They may help give you more self confidence—and that can be a good
thing as long as your self-confidence doesn't rest entirely on an enhanced
appearance.
• Remember that cosmetic enhancement can't reverse aging—it can only
reverse some of the outward appearances of aging.
36. Botox or Bust
• Anyone who considers any type of cosmetic procedure needs to balance
the potential benefits, risks and costs.
• It's nice to look our best but not at the risk of our overall health, financial
ruin and our children's college education.
37. Why I Love Botox Cosmetic
• With all of that being said……..I love Botox and all things girly…..make-up,
shoes, and nails
• I think of Botox as yet another way to enhance natural beauty
39. How is Botox administered?
• Botox is given by fine needle injection. The number of injections will
depend on the number of areas you wish to have treated.
• Most women say that the pain is minimal.
• A typical treatment takes 10-15 minutes—again, depending on the
number of areas you wish to have treated.
41. What Can I Expect If I am a Patient?
• There may be some temporary swelling and occasional bruising. The
swelling typically lasts a few hours so you don't want to have this done just
before an evening out on the town.
• After treatment you should squint or use the muscles treated but don't
massage the injection sites.
• It's important that you don't lie down or bend over for 4 hours after
injection. I generally ask women to not exercise for 4 hours afterwards as
well. (other than use of treated muscles)
42. How long does it last?
• For most women BOTOX seems to last 3-4 months. The effects wear off
gradually and you'll be the best judge of when to come in for your next
appointment.
• About 9 Months for Axillary injections.
43. Is There anything else I should know?
• Avoid aspirin and non-steroidal anti-inflammatory drugs (Ibuprofen, Advil,
and Aleve) for at least one week prior to your planned treatment. This will
reduce the possibility of bruising afterwards.
• Also, avoid Ginkgo and ginseng, Vitamin E, Fish Oil supplements and red
wine for two days prior to treatment—again to avoid bruising.
• (our office advises to avoid alcohol, aspirin and NSAIDS which is usually
sufficient)
46. I am ready for Botox…now what?
• Finally, in closing, be realistic and establish a budget!
• Botox can improve your Patient’s lives and your pocketbook but do it
because you love it.