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Q&A With Metropolitan Dermatology: Botox and Other Fillers

What is Botox and why is it used?

Botox is the name of injectable medication used to smooth out facial wrinkles. Botox is a muscle relaxant. It acts at motor nerve endings (the areas where nerves connect to muscles). Many lines and wrinkles on the face are created by the movement of facial muscles. These muscles relax and cannot contract after treatment with Botox. This results in a reduction of wrinkles, and smoothing and rejuvenation of the skin. In many cases the improvement is very dramatic. Botox is among the most common and popular cosmetic treatments.

How long does Botox last?

Botox is a non-invasive (non-surgical) injection performed approximately every four months. Many of the patients in our practice who have had Botox injections for years are able to stretch time between injections to about six months or longer. After Botox “wears off,” the appearance of the face will not worsen. Some studies suggest that wrinkles will be less deep than before the treatment.

Is Botox risky? Does it have any potential for permanent damage?

While Botox is not permanent, it also does not carry serious risks that surgery does. The risks related to Botox are very mild and temporary. The main risks are bruising, headache and rare temporary drooping of eyelids. A rather welcome side effect for some patients is the disappearance of tension and migraine headaches. The safety of Botox has been confirmed in multiple studies. Millions of patients have had Botox treatments all over the world with no long-term side effects. Many patients are concerned about having a “paralyzed” look after Botox treatment. If done correctly, Botox injections produce a refreshed and relaxed look without any unnatural features.

How long does the procedure take?

The procedure takes 10 to 15 minutes with no downtime. Because very fine needles are used, the treatment is almost pain-free. Botox is most commonly used for treatment of wrinkles around the eyes and on the forehead (upper third of the face). The chin area, lip wrinkles and neck bands may also be treated. Botox treats a multitude of other conditions ranging from sweating to crossed eyes.

Is every physician able to inject Botox and get good results?

Results depend on the skill of the physician using Botox. Many physicians in non-cosmetic specialties (family practice, internal medicine, gynecology etc.) and even non-physicians now inject Botox. I would recommend using only a board-certified dermatologist, plastic surgeon or oculoplastic surgeon for your Botox injections. The skill, experience and training of these physicians are paramount. A weekend course in Botox treatment does not replace years of residency training. Doing your homework and checking the credentials of a potential provider will ensure the best possible results.

How much experience with Botox do physicians in Metropolitan Dermatology have?

Dr. Alex Doctoroff specializes in cosmetic treatments in our practice. He started using Botox more than 14 years ago, while in his residency. At that time Botox was not even officially approved for wrinkle treatment. That is certainly an amazing amount of experience with the product. Currently Dr. Doctoroff is one of the leading Botox providers in the New York/New Jersey area, pioneering many advanced aesthetic techniques.

What are fillers? What are hyaluronic acid fillers, such as Juvederm and Restylane?

When you look at the face of a young adult, you will see youthful plumpness of the skin without lines or wrinkles around the eyes and mouth. As we age, gravity causes jawlines to sag, and lines to develop. To smooth out wrinkles and add volume to an aging face, cosmetic physicians use multiple fillers (substances injected into the skin to “fill” various skin imperfections). Once in the skin, most fillers are gradually degraded by the body. How long the filler lasts depends on its chemical composition, as well as the speed the body gets rid of it.

Currently hyaluronic acid fillers are the most popular worldwide. They have become the new gold standard, replacing collagen fillers. The popularity of these fillers derives first and foremost from their safety. The choice of fillers depends on individual facial imperfections that need to be corrected.

What is hyaluronic acid?

Hyaluronic acid (HA) is a substance found naturally in the connective tissue of the human body. The role of this substance is to cushion and lubricate. HA also provides volume and fullness to the face, giving it a healthy, youthful appearance. HA fillers are produced as clear gel substances and are injected directly beneath the skin’s surface. They add natural volume and lift resulting in smoother lines and less prominent folds. HA treatment results are immediately visible and typically last from 6 to 12 months.

How does hyaluronic acid maintain volume?

HA maintains its shape using the body’s own moisture. It naturally binds to water molecules. As HA gradually degrades, each molecule binds to more water and over time, the same volume can be maintained with less HA. This ability of HA to bind to water is what helps provide long-lasting results. Over time, HA dissolves without any residue.

Do hyaluronic acid fillers have side effects? Are there any people allergic to them?

No testing for allergy is required for any of HA fillers. They can be used whenever a patient is ready. Side effects of HA fillers are usually mild and transient. Swelling and bruising around the injection sites are sometimes seen, but usually disappear within several days. HA fillers are biodegradable. Even if too much filler is injected into the skin, within a short time the body breaks down the excess amount. This is a real plus as compared to permanent fillers. If an area is “overfilled” with a permanent filler (such as Artecoll or Silicone), it is very difficult to get rid of the excess amount that has been injected. HA fillers have a good safety record, and provide excellent results.

By Dr. Alexander Doctoroff

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