Botox / Dysport

For the treatment of frown lines.

WHAT ARE BOTOX AND DYSPORT?

Both Botox Cosmetic (onabotulinumtoxinA) and Dysport (abobotulinumtoxinA) are prescription medicines that temporarily improve the look of moderate to severe frown lines between the brows in adults under 65 years of age.

This is a simple nonsurgical treatment that is injected directly into the muscles between the brows. These medicines work by blocking nerve impulses to the injected muscles, thereby diminishing muscle activity that causes the line to form between your brows, giving you a smoother more relaxed appearance.

Both Botox and Dysport are highly effective, non-surgical procedures that can smooth the deep, persistent lines between your brows that have developed over time in a 15 minute treatment that can last up to 4 months.

The onset of Botox is about 4-7 days before you will see the lines softened and reduced, whereas the onset of Dysport may be from 3-7 days.

Dr. Silbret again stresses that each person accepts these treatments differently and patients may experience a shorter onset with a longer duration and vice-versa. Follow-up appointment is generally two weeks later to make certain a complete relaxation of the frown lines is achieved.

"Often, I will find that I will see even further relaxation of the wrinkle after one week. A two week follow-up allows me to accurately evaluate a patient's response, thereby avoiding the need for premature or further injections, saving the patient from an unnecessary procedure or any added cost."
-Dr. Silbret

WHAT TO EXPECT

Dr. Silbret will design an injection plan that is unique to your wrinkles and muscle groups. Before injecting, Dr. Silbret will study your facial expressions, the positioning and strength of your muscle groups, and ask you what bothers you personally and what you would like to achieve. She will discuss with you which product will best treat your particular targeted wrinkles. Dr. Silbret's philosophy about Botox and Dysport is "less is more." She calls her approach to someone who has never had Botox, "Baby Botox" or "Botox Light" so no one looks "Botoxed" or has a Dr. Spock look to them. This natural approach to injections is reassuring to patients and sets them at ease that they will look younger, not different.

No anesthesia is required usually, but cold packs or anesthetic creams prior to injecting may be applied prior to the procedure. Discomfort is minimal and brief. Directly afterwards, you may observe some "bug bite" appearing bumps where the medicine was injected which goes down usually within an hour or less of the procedure. Many people come in at lunch time for this procedure and you can go back to work immediately and resume normal activity immediately. It is unlikely that you will experience significant side effects, although some patients develop slight bruising, which can easily be covered with makeup, or mild headache that resolves with over the counter pain relievers. Some of Dr. Silbret's patients who suffer from migraines actually feel that their migraines are less after these treatments with people looking and feeling better at the same time.

IMPORTANT SAFETY INFORMATION

While Dr. Silbret has never had a patient experience a serious side effect from either one of these products, the FDA has now mandated that the companies post the potential for systemic side effects when using these medicines. It is important to note that there has not been a confirmed serious case of spread of toxin effect away from the injection site when Botox or Dysport has been used at the recommended doses for under arm sweating, blepharospasm, or strabismus, or when Botox or Dysport has been used at the recommended dose to treat frown lines.

In some cases, the effects of botulinum toxin products may affect areas of the body away from the injection site. These effects can cause symptoms of a serious condition called botulism. Symptoms of botulism can happen hours to weeks after injection and may include swallowing or breathing problems, loss of strength and muscle weakness all over the body, double vision, blurred vision, and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, or loss of bladder control. Swallowing and breathing problems can be life threatening and there have been reports of death.

The risk of symptoms is probably greatest in children and adults treated for muscle spasm, particularly in those patients who have underlying medical conditions that could make these symptoms more likely. The toxic effects have been reported at doses similar to those used to treat muscle spasms in the neck. Lower doses, in both approved and unapproved uses, have also caused toxic effects. This includes treatment of children and adults for muscle spasm.

These effects could make it unsafe for you to drive a car, operate machinery, or do other dangerous activities.

TELL YOUR DOCTOR

• About all your medications, including prescription and nonprescription medicines, vitamins, and herbs.
• If you have a disease that affects your muscles and nerves (such as amytrophic lateral sclerosis [ALS or Lou Gherig's disease], myasthenia gravis, or Lambert-Eaton syndrome)
• If you are pregnant or nursing
• If you have allergies to any botulinum toxin product
• If you have medical problems like breathing problems (such as asthma or emphysema), swallowing problems, bleeding problems, diabetes, a slow heart beat or other heart rate or heart rhythm problems, plans to have surgery, or plans for facial surgery.
• If you have any weakness of your forehead muscles (such as trouble raising your eyebrows), drooping eyelids, or any other change in the way your face normally looks.
• If you are starting or going to start any new medicines while undergoing Botox or Dysport without talking to your doctor first.

POST-PROCEDURE CARE

• If you are going directly home, you can apply ice to the area to reduce the chance of bruising or swelling.
• Other tactics you can do to minimize the chance of bruising include taking the herb Arnica Montana and eating pineapple which has Bromelain that has anti-inflammatory properties. Of course, check with your doctor before taking any new medication or herb.
• Do not take ibuprofen, aspirin, Motrin, Aleve, or any other aspirin-like product or NSAID for the first 24 hours
• If you do have a headache during the first 24 hours of the procedure, Tylenol is fine as long as you do not have any contraindications to this medicine or preexisting medical conditions that do not permit the use of Tylenol.
• Do not recline for 4 hours (which is never hard for most women).
• "Let everything piss you off!" Dr. Silbret explains, "I like my patients to frown very hard for 10 minutes on the hour for the next 3-4 hours after the procedure. This may potentially increase the uptake of the toxin in the treated muscle."
• Do not expect to be wrinkle free for 3-7 days, with a full effect mark at the two week mark. Remember, there is a delayed onset of action unlike fillers.
• Do not massage or manipulate the treated site. Gentle washes are recommended for the first few days and definitely no facials for two weeks.
• Do not exercises for 24 hours (Doctor's orders).
• Do not consume any wine, beer, or alcohol for 24 hours.
• Expect a tightening sensation at the treated site initially as the medicine takes effect. Then you'll forget that it is even there, except you'll look great! (Contrary to what most people think, Botox and Dysport do not make you feel numb).
• Call your doctor if you have any unusual symptoms, experience eyelid drooping or blurry vision.
• Make your follow-up appointment when you leave the office, so that Dr. Silbret can evaluate your response and determine if you need to be "tweaked," receive additional units or not. See you then!

HOW DO I KNOW WHEN TO COME BACK?

As mentioned above, the duration of effect for Botox and Dysport for each person may be different. "The average is around 3 months, so generally I have my patients make their follow-up touch-up in three months after treatment." Dr. Silbret reassures her patients that, as the toxin wears off, you will not appear more wrinkled than before you started the treatment and it is a gradual process. "You do not wake up one morning with wrinkles that are all of a sudden apparent," says Dr. Silbret. "But if you start seeing or feeling that those etched lines are resurfacing, simply make your appointment for a session and we always try to accommodate you as best we can."