Botox Cosmetic® (Botulinum A Toxin)

Botox Cosmetic® is a non-surgical method of treating facial wrinkles in the forehead, between the eyes and in the "crows feet" areas (upper third of the face). Botulinum toxin, or Botox Cosmetic® works by weakening the muscles of facial expression. Once the resting tone of the treated muscles is weakened, the pull of the muscles relaxes and the overlying skin flattens. This approach is different than the other local treatments for the aging face. Silicone, collagen, autologous fat transfer, Alloderm, Softform etc. all work by filling in wrinkles or depressions. These fillers are frequently not as effective as Botox Cosmetic® in removing wrinkles in the upper third of the face. By physiologically weakening the muscles, wrinkles are lessened naturally.

Injection of Botox Cosmetic® into the small muscles between the brows, in the forehead, and at the corners of the eyes causes those specific muscles to halt their function (be paralyzed), thereby improving the appearance of the wrinkles. This paralysis is temporary, and re injection is necessary within three to ten months. Options for alternative treatment include injection of either collagen or free fat, or the surgical excision of the muscles, usually through a brow lift incision. Complications are rare but may include paralysis of a nearby muscle resulting in its temporary loss of function (e.g., a drooping eyelid).

Botox Cosmetic® is prepared fresh on the day of injection. Once prepared, the medication needs to be used within 12 hours as the potency diminishes with time. Because of the short shelf life and the cost, Botox Cosmetic® is not available every day in our office. In order for the treatment to be cost effective, more than one patient must be treated on the same day. Very small amounts of Botox are injected into the muscles to be paralyzed using a very tiny needle. Depending on the areas being treated, 5 15 needle pricks (or more) may be required. Discomfort is minimal and lasts only a few seconds.

There are no known generalized side effects to Botox. Botulism toxin has been used safely in the treatment of muscular facial spasms for approximately 15 years. Occasionally, the tiny needle may puncture a small blood vessel during the injection and a small black and blue area may develop. Such an area can last 5-10 days and requires makeup to cover. If any of the Botulism toxin reaches a facial muscle not being treated, partial weakness of that muscle may last for several months. (It is for this reason that you are requested not to massage the injected areas for 12 hours following injection.) In the event of an area of unwanted muscle weakness, the only "treatment" is to wait for the effect of the toxin to wear off in several months. Botox Cosmetic® injected in conjunction with nearby facial surgery may cause the spread of the toxin and unwanted facial weakness. For this reason, we will inject Botox Cosmetic® only as an isolated facial procedure or treatment.

The specific risks and the suitability of Botox Cosmetic® for a given individual can be determined only at the time of consultation. All procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are rare.
 

Chin Implant

You may be a candidate for chin enlargement if you have a small or receding chin. A chin that looks too small in comparison with other facial features and possibly makes the nose appear longer. Desire for increased chin prominence. A chin implant is intended to give the patient an improved profile, as well as a more attractive jaw line that creates a better balance between the chin and other facial features.

The procedure is done on an outpatient basis under sedation and local or general anesthesia. An incision is made inside the lower lip or under the chin, and an implant is placed. In an alternative method called sliding osteotomy, a portion of the chin bone is permanently moved forward. The patient goes home with a small pressure dressing over the chin. Initial discomfort is easily controlled with oral medication. Swelling, tenderness, and possible local numbness gradually subside within a month or two. Additional procedures that would enhance the result are: Liposuction of the neck, nose reshaping (Rhinoplasty), Neck Lift, or Laser Skin Resurfacing.

The specific risks and the suitability of a chin enhancement procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.
 

Eyelid Lift

You may be a candidate for eyelid lift (blepharoplasty) if you have excessive, sagging, or wrinkled upper or lower eyelid skin. Eyelid lift can also be helpful if you have excess upper eyelid skin that interferes with vision or if you have lost your natural upper eyelid crease. Eyelid lift may also be indicated if you have puffy pouches of fat in the upper or lower lids that create a tired or aged appearance. The eyelid lift (blepharoplasty) procedure is intended to produce a more youthful and rested appearance of the eyes. The procedure may also widen your visual fields if excessive upper lid skin has partially blocked vision.

Blepharoplasty is done on an outpatient basis under sedation and local or general anesthesia. The incisions are made where the natural crease should be in the upper lids and below the lash line in the lower lids. Excess fat and skin are removed. If only excess fat is present in the lower lids, it may be removed through an incision inside the lower lids with no external incision or scar (transconjunctival blepharoplasty). All sutures are usually removed within 4-6 days. Initial mild discomfort is easily controlled with oral medication. Bruising and sensitivity to light last at least a week or two. Swelling progressively disappears in 1-2 weeks. Eye makeup can be used after sutures are removed. Contact lenses can be worn when comfortable usually within 7-10 days. Additional procedures that may enhance the result of an eyelid lift (blepharoplasty) are: Forehead Lift, Face Lift, Chemical Peel or Laser Skin Resurfacing.

If eyelid lift surgery is being done to improve the field of vision, insurance may cover upper lid surgery. Otherwise, these procedures are considered cosmetic, and the patient is responsible for payment. The specific risks and the suitability of eyelid lift for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are rare.
 

Facelift

You may be candidate for facelift (rhytidectomy) if you have experienced a loss of skin elasticity and muscle tone of the face and neck. A facelift may also be desirable if you have the appearance of jowls and deep creases between the base of the nose and the corners of the mouth, developed facial and neck wrinkles. A facelift may also be helpful if you believe you lack youthful chin and neck contours and/or feel you have a tired facial appearance. A facelift is intended to give the patient a more rested and youthful contour to the face and neck.

Facelifts range in size from "mini" to "standard" depending on location and extent of skin laxity. The operation is done on an outpatient basis under local anesthesia with sedation, or under general anesthesia. Incisions are made within the hairline (or along the hair margin) above the ear, extending down around the lobe and ending in or below the hairline behind the ear. The subcutaneous layers and neck muscles are tightened, the facial skin is redraped and lifted, and the excess skin is removed. The patient goes home with head and neck wrapped in dressings, which are usually removed the next day. Minimal initial discomfort is easily controlled with oral medication. Sutures are removed within 14 days. Bruising and swelling decrease to "socially acceptable" levels in 10-20 days. The final result of a facelift procedure is evident in 4-6 weeks or sooner, with continued improvement for several months. Additional procedures that would enhance the result of a facelift are: Eyelid Lift, Brow Lift, Chemical Peel, Facial Sanding (dermabrasion), Chin Enlargement, Nose Reshaping (rhinoplasty), Fat Suction, and Laser Skin Resurfacing.

The specific risks and the suitability of facelift (rhytidectomy) procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.
 

Forehead Lift (Browlift)

You may be a candidate for a forehead lift if you have a sagging forehead or brows that hang too low and too close to the eyes. You may also desire a forehead or brow lift if you have deep vertical furrows between the eyebrows (frown lines). A forehead lift (browlift) is intended to give a more youthful and rested appearance to the forehead and upper eyelids.

Browlift is done on an outpatient basis under general anesthesia or monitored sedation. The incisions are usually made behind the hairline. For patients with high foreheads, the incisions can be placed in front of the hairline. The operation is done using an endoscope (a narrow hollow instrument with a fiber optic light source and camera, through which the procedure is done with small special instruments.) The forehead skin is lifted and repositioned. The muscles that cause frown lines are weakened. The patient goes home with head wrapped in dressings, which are usually removed on the first or second day after surgery. Initial discomfort is easily controlled with oral medication. Sutures or staples are removed within 10 days and most swelling and bruising is gone in 7-10 days. Additional procedures that may enhance the result of a forehead lift are Lower and/or Upper Eyelid Lift, Face Lift, or other facial procedures or implants.

The specific risks and the suitability of the forehead lift procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.
 

Liposuction of the Neck/Chin Area

You may be a candidate for liposuction of the neck if you have localized deposits of fat in the anterior part of the neck under the chin. Liposuction of the neck is intended to give the patient a more youthful neck with a better contour.

The procedure is done on an outpatient basis under sedation and local or general anesthesia. The procedure requires an incision under the chin. Fat is suctioned or directly excised depending on individual findings. The patient goes home with chin and neck in an elastic neck sling. Initial discomfort is easily controlled with oral medication. Swelling and bruising disappear over approximately 2 weeks. The final result is evident in 1-3 months. Procedures that may enhance the result are: Face Lift, Liposuction and Chin Augmentation.

The specific risks and the suitability of neck liposuction for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are rare.