Botulinum Toxins Overview
Botulinum toxins have been used for neck spasms, cranial nerve disorders and eye spasms. With the recent FDA approval for cosmetic use, the drug is used to smooth facial wrinkles. When injected into facial wrinkles botulinum toxins block nerve impulses, temporarily paralyzing muscles and smoothing wrinkles. Currently Botox is the only form of botulinum toxin approved by the FDA for cosmetic purposes, but two others, Myobloc TM and Dysport are under FDA review for cosmetic use.

More than 850,000 people had Botox injections in 2001, according to ASPS, representing 15 percent of non-surgical cosmetic plastic surgery procedures. Fifty-five percent of all Botox procedures were performed on people between the ages of 35 -50.

Botulinum toxin injections (BTX), often referred to by the product names Botox or Myobloc, are biological toxins (botulinum toxin) transformed into a therapeutic agent. Work with BTX began in the late 1960s to treat neurological disorders. Today, BTX is used for the treatment of frown lines, forehead furrows, "crow’s feet," lines and wrinkles of the lower face, and even nasal muscles (to decrease nostril flaring). BTX injections have proven to be a very popular nonsurgical cosmetic procedure. Aesthetic plastic surgeons have found that the type of lines and wrinkles that respond to BTX injections are those caused by the muscles — specifically those muscles that contract during facial expressions such as frowning or squinting.

Technique
The patient is asked to contract the muscles in the area being treated so the surgeon can determine the proper location for injection. In most cases, BTX is injected directly into the muscle with a tiny needle. It takes a few days to realize the effect of BTX injections.

Benefits
• No downtime. Patients can immediately resume normal activities.
• Long experience has proven BTX to be safe. To date, no systemic complications associated with BTX injections have been documented.
• Treatment is reversible within several months.
• May be beneficial for treatment of migraine headaches.

Other Considerations
• BTX injections are a temporary solution for the treatment of wrinkles. The effects last from 3-4 months and require repeat treatments.
• Possible side effects include local numbness, swelling, bruising, or a burning sensation during injection. Some patients have reported temporary headache and nausea. Most complications are of short duration and can be avoided with proper injection techniques.
• A small percentage of patients are reported to experience no improvement at all.

ASAPS Position
The American Society for Aesthetic Plastic Surgery (ASAPS) maintains that BTX injections for aesthetic purposes appear to be safe and effective. Patients who show early signs of aging, as well as those who may not be suitable candidates for more extensive aesthetic facial surgery, may be good candidates for this procedure. Certain medications (some antibiotics, anti-inflammatories, or aspirin) and even some vitamins and herbs may increase the potency of BTX and may increase bleeding and bruising at the time of injection. Therefore, patients should be candid with their surgeon about all medications and supplements. Pregnant or nursing women should postpone undergoing this procedure. It is not known whether injection of BTX has any effect on a fetus or whether it is found in breast milk.

Dr. Stefan performs a variety of facial and body aesthetic procedures. In your consultation we will provide you with a comprehensive review of the particular procedure that you are considering.

Your consultation includes a medical history, review of your goals and objectives clarified by computer imaging and review of before & after pictures.

In addition, please note that all surgery carries some uncertainty and risk. You can reduce your risks by closely following the protocols established by Dr. Stefan, both before and after the surgery.