• What is Botox?
   
• Signs of ageing
   
• What is Hyaluronic acid?
   
• What is a Restylane Injection?
   
• What is Salt A-Peel?
   
• What is Microdermabrasion?

What is Botox?

Botulism is food poisoning produced by a bacterium. Botox is the brand name for a form of botulism toxin type A, which is produced by the same bacteria. Botox is not alive but is a protein that weakens and inactivates muscles. This is another example where natural products are used for medicinal purposes: fungi produce penicillin, cowpox virus protects against smallpox, and foxglove plant produces the ‘poison’ digitalis that millions of patients take daily for heart disease. Now with bioengineering it is common for bacteria to produce the necessary medicine for a specific disease.

First Clinical Use of Botox?
In 1973 Botox? was used as a treatment for patients with crossed eyes. By weakening the overactive eye muscles, this medicine produces an alternative to surgery. After this ‘breakthrough’ Botox?quickly gained access for other ophthalmic disorders including nystagmus and blepharospasm (involuntary spasm of eyelids) to name a few. Extensive Botox research confirmed repeatedly a high success rate with minimal side effects using minuscule amounts of this new found ‘medicine’.

Safety
While Botox?is a high potent medicine in high concentration, it is used in low quantities with high margins of safety. After a muscle is injected, its effects are not seen for 24 hours and the complete effect on the muscle will not be complete for 2 weeks. Fifty units (one half vial) or less of Botox? per session is generally used. To have toxic effects on a patient, over 2000 units (costing £12,000) would have to be injected at one time. Botox? effects are attracted only to muscles, and it has no effect on the central nervous system or on the body if injected accidentally in to a nerve or a blood vessel. Botox? is also safe because complete recovery of the muscle is possible. Recovery is due to the body’s excellent ability to form new fibres that allow activation of the muscle.

Other specialities used Botox for their patients
Gastroenterology and neurology have explored Botox? therapy for their patients. It has now become the main stay of non surgical treatment of spasmodic neck muscles, writer’s cramps, tics, multiple sclerosis, cerebral palsy, post stroke sates, spinal cord injuries, nerve palsies, Parkinson’s disease and facial spasms. Botox? is used for is used in gastro-intestinal cases involving swallowing and ulcer problems and to treat speech problems including stuttering. Also treating gastro-urinary disorders of spastic bladder and other disorders with Botox? has been studied. Congenital muscle disorders or acquired nerve injuries have been greatly improved with Botox?

Background of cosmetic use of Botox?
Cosmetic Botox? injections were pioneered in 1988 by a Vancouver ophthalmologist and her husband, a dermatologist. Since that time this team of doctors have performed over 10,000 sessions on their patients. The ophthalmologist noticed that the wrinkles disappeared in the patients with eyelid spasms who were treated with Botox?. This led to further research, which confirmed the effectiveness and the safety on the Botox? vaccine improving wrinkles due to overactive muscles on the face.

Significant improvement can be achieved on both forehead frown lines and crow’s feet. No significant effects were noted beyond the expected injection discomfort. About 30%of patients experience mild drooping of the upper eyelid, which clears spontaneously. Botox? is not 100% effective in all patients.

Botox? for crow’s feet
Wrinkles radiating from the corners of the eyes caused due to smiling, laughing and squinting are especially distressing to some individuals. Previously no reasonable medical or surgical solution improved this problem due to the strong underlying muscles. Even with the deepest chemical peels or laser resurfacing techniques. Rapid recurrence of these lines around the eyes was inevitable. Now for best results, Botox? injections are used in conjunction with resurfacing procedures. It is the function of Botox? to prevent the recurrence of wrinkles by inhibiting the underlying muscles.
Botox? ? FA Q’s

What should be expected after Botox therapy?
Botox? is a remarkably safe therapeutic agent for wrinkles. Complications have been minor and only transient. Bruising may occur where injected and brief pain or headache may follow. Bruising may be greater in patients taking aspirin or any blood thinning medicine. These products should be avoided prior to the injections, ice helps prevent bruising. Muscle weakness may be noticed for 24 hour it is not immediate.

How long does Botox last?
After the first set of injections, re-injection after two weeks allows an accurate localisation of any resistant functioning muscles. With this method 90% or more patients respond to Botox?. This leaves 10% who do not respond. Successful therapy is signed by muscle weakness that begins at 24 to 48 hours after injection with a peaking weakness at 7 days. Relaxation of the muscles after the initial injections lasts between four to seven months in most patients.

How often is re-injection needed?
Re-injection is suggested every 3 – 6 months to keep muscles relaxed and allow the furrows to completely smooth out. Once an area is smooth, patients are instructed to return to therapy only when they notice a return of muscle movement, which may not occur for four months to one year or even longer

Who should not use Botox?
• Although there have been no reports of birth defects with his medicine, no pregnant women will be treated. It is also our policy not to inject Botox? I to nursing mothers.
• Patents with a history of neuromuscular disease (multiple sclerosis and myasthenia gravis) o other types of disease involving neurotransmission should avoid this treatment.
• Patients taking following medicine should not receive Botox? aminoglycoside antibiotics (Streptomycin, Tobramycin, Garamycin injections) Penicillamine, and calcium channel blockers (Calan, Cardizam, Dilactor, Norvasac, Procardia, Verelan).

What are alternatives to Botox?
Alternatives to Botox? are filling agents including hyaluronic acid, fat, collagen, fibril, Gore-Tex; resurfacing procedures with acids or lasers; and lifting operations of forehead, temporal and mid face regions.

What unexpected benefits have come from the use of Botox?
Tension headaches have disappeared for some patients. These headaches occurred in patients who were recruiting forehead and brow muscles during periods of stress and tension. When these muscles were relaxed the headaches faded.

How exactly does Botox inactivate muscles?
Botox inhibits the release of acetylecholine at the joining site of nerve to the Muscle so that the muscle never gets the message to contract. Remember that the muscles only have the ability to contract. An opposing muscle contracts to produce movement in the opposite direction. To rejoin the nerve to the muscle the body organises and produces new motor endplates, which re-establishes connection
Botox and Hyperhidrosis

Hyperhidrosis: Sweating is a natural body function needed for the regulation of body temperature. There are five million sweat glands throughout the body and about two-thirds of these glands are situated in the hands. The secretion of sweat is controlled by the sympathetic or (vegetative) nervous system. In approximately 1% of the population, the nerves are over-stimulated and sweat is produced far greater than needed to keep a constant Temperature. This condition is referred to as Hyperhidrosis. Excessive sweating may be episodic or continuous. Profuse sweating may be caused by warm weather, emotional stress, or for no reason at all. The hands, feet and armpits are the most common locations. The condition usually starts during adolescence and is lifelong.

Axillary hyperhidrosis (sweating of the armpits) that does not respond to topical antiperspirants may be treated with Botox®. When injected into areas of the skin that produce excess sweat, effectively reduces sweat production for many months. Botox®™ injections to the sweat-producing areas of the armpits can frequently provide relief for as long as 6 months. Botox®™ injections are also an effective remedy for palmar hyperhidrosis (sweating of the palms of the hands) and relief can last many months. However, the pain involved in the administration of Botox® to the hands along with occasional problems related to muscle weakness can make Botox®™ a less desirable form of therapy for treating palmar hyperhidrosis.

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Signs of ageing

The visible signs of aging cannot be fully avoided, but can be dramatically minimized. The key is maintenance and to do it as gently as possible. As far as the skin is concerned there are two types of aging — intrinsic and extrinsic. Intrinsic aging involves the inevitable; as we grow older, our skin naturally becomes thinner and drier. A diminished amount of collagen makes the skin less elastic. What used to bounce back begins to sag. Static, deep wrinkles may begin appearing. The rate of these events is genetically determined for each person; the process first becomes noticeable between the ages of 30 and 35.
 
Extrinsic aging results from exposure to the environment. Extrinsic aging is the critical element in determining who looks older or younger than their biological age. Exposure to sunlight is a key contributor to extrinsic aging. Photoaging occurs when elastin and a collagen breakdown are not replaced, causing fine lines and wrinkles to intensify. Photoaging also causes pigment changes with development of age spots and uneven skin tone. Spider veins and dilated capillaries are another sign of photoaged skin.
Lifestyle choices also have an impact on extrinsic aging. Cigarette smoking contributes to the breakdown of elastin and collagen and impairs the body's healing capacity.
The simplest way to see the contrast between intrinsic and extrinsic aging is to compare skin commonly exposed to the sun (face, hands, and neck) and skin not exposed to the sun (usually on the breasts, inner arms or buttocks).

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What is Hyaluronic acid?

Restylane is a non-animal hyaluronic acid, manufactured by a unique method in the
Q-Med Laboratories in Sweden. Hyaluronic Acid is a naturally occurring substance in the body so it naturally dissipates into the body with time
All living organisms have Hyaluronic Acid in their bodies. In humans this is the substance that creates volume in ones face, giving it a healthy, young appearance.
Your skin is made of two layers, with supporting columns holding them apart. The area in-between includes the clear-jelly like substance Hyaluronic acid, while young, the Hyaluronic acid is in abundance. As you grow older, the acid between these layers diminishes, and the skin somewhat caves, causing a wrinkle along the line. The wrinkle would be gone if you filled that area back up with the Hyaluronic Acid jelly-like substance. That's where Restylane come in.

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What is a Restylane Injection?

In simple terms, Restylane is filler. It is injected into the skin to replace Hyaluronic Acid, which has dissipated over time. Q-Med has 3 different types of Hyaluronic Acid fillers; "Restylane", "Restylane touch, and "Perlaine". Each of these gels has a different consistency to work best for the type of area being treated.
Facial lines and features that can be corrected using Restylane
• Worry lines that run across the forehead (forehead lines)
• Crow's feet at the corner of the eyes (periorbital lines)
• Frown lines that run between the eyebrows (glabellar lines)
• Smoker's lines which are vertical lines on the mouth (perioral lines)
• Marionette lines at the corner of the mouth (oral commissures)
• Deep smile lines that run from side of the nose to corners of the mouth (nasolabial furrows)
• Cheek depressions
• Redefining lip border
• Acne scars
• Some facial scars
• Lip enhancements

Side Effects
While Restylane enjoys a low number of side effects, here are some of the side effects that might occur with a relatively small number of patients.

Common Injection related Side Effects
After receiving a Restylane Injection some common side effects may be pain, redness, swelling, itching, discoloration, brusing and tenderness at the point of injection. These side effects typically subside within two days of the Restylane injection procedure.

Rare Restylane Side Effects
While more severe reactions occur in only 1 of 2000 patients on average, some have experienced localized swelling at the injection point, thought to be brought on by hypersensitivity. Tenderness, redness, and very rarely acne-like formations have appeared.

Reactions can typically occur only a few days after the injection, or as long as four weeks. When a reaction does occur, its average lifespan is only a few weeks, and is typically described as moderate and mild.

RESTYLANE vs. other treatments

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What is Salt A-Peel?

The following excerpts were taken from the October edition of VOGUE magazine. The context is exact with only two (2) footnotes added as depicted within the excerpts below:

As it turns out, the fountain of youth exists after all. Not, perhaps, in the marbled Trevi sculptural sense of the word, but there is a secret to looking as though you've dipped face first into those legendary reviving waters: exfoliate. Unfortunately, the "what" is the only part of the secret that dermatologists and aestheticians can agree upon; opinion on the proper "how" has more variations than this season's hemline. Across the board, skin experts insist that the best way to maintain (or create the illusion of) youthful looking skin is to polish the old until it shines like new. That, however, is where the common thread unwinds. Some dermatologists think that laser peels are the only surefire way to reveal smooth, radiant skin; others advise caution when scrubbing even with washcloths for fear of overdoing it. With aestheticians hawking active grade products and derms giving facials, it's no wonder that trying to pin down the "best" method is like trying to get a straight answer from a politician it all depends on the spin.

At the uptown offices of Jim Baral, M.D., the head of the American Dermatology Center, microdermabrasion is hailed as the ultimate lunch hour facial. It's quick, it's painless and the post treatment recovery is simply the time it takes to grab a cab back to the office. Baral's claim to fame is that he's "a Dermatologist with a difference," meaning that he prides himself on being cutting edge in a profession that rivals the computer industry for speedy gains from new technology. Not surprisingly, his office is equipped with a newer version of the original microdermabrasion: the salt peel . It, too, exfoliates the top layer of skin to help reduce signs of aging. What makes it different from its older sibling is that the flow of pressure is positive i.e., it's not a vacuum which, supporters claim, makes it safer and more effective. Why? Some believe that the youthful luster attained from aluminum oxide is short term, a superficial plumping caused by the negative pressure; there are also claims that the vacuum increases the risk of suffering redness or "hickeys." Considering that you run the risk of getting hit by a bus every time you cross the street, passing symptoms of rosacea seem a small price to pay for what could be flawless skin. But there are also safety concerns surrounding the use of aluminum oxide, such as allegations that it is subjected to fewer quality controls than salt (which is specially milled to meet regulations for shape and size), and soft data studies linking aluminum oxide to Alzheimer's.

"Using salt is a move in the right direction," agrees Gross. "If you abrade the skin with aluminum, there is a theoretical chance that the aluminum will enter the blood.

Baral admits that his bookings for the aluminum oxide version have decreased recently. But it's not, he'll tell you, for any other reason than that his clients who include Cindy Crawford and Gisele Bundchen are like children; they're swayed by the shiny and new. Which, perhaps, explains the never ending quest for a teenager's complexion.

And now everyone wants the salt peel. After all, cooks have known for centuries that a sprinkling of salt transforms the dull and lackluster into the vibrant and vivacious. Not surprisingly, these v-words have the beauty coterie clamoring for its own bit of kitchen alchemy. Baral himself is so taken with the salt peel that he has redecorated his treatment room with an ocean motif; as he puts it, "Sitting under that salt spray is like spending a day at the beach, but it's good for your skin." He's also instituted a souped up version of the method that uses Sonophoresis (ultrasound energy) to enhance the peel's effects. By increasing the permeability of the already exposed skin, ultrasound allows nutrients applied post-treatment (vitamin C and, buffered glycolic acid) to have a greater impact on the skin's condition. Baral is among just ten Dermatologists currently using the Sonophoresis2 technology in conjunction with the salt peel, and one of the only Derms on the East Coast to offer the procedure which makes an appointment in his Manhattan office difficult to book. But the week's wait is worth it, according to the good doctor. "You will not believe how gorgeous you can look after a little salt rub."

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What is Microdermabrasion?

Microdermabrasion is one of the most frequently sought after non-surgical, non-invasive skin care treatments available. It has been performed successfully for years in Europe and is now one of the most popular cosmetic procedures in this country for:

• Reducing fine lines and minor scars
• Treating acne blemishes
• Removing sun and age spots
• Cleaning enlarged and clogged pores, blackheads and whiteheads
• Restoring a healthy, smooth feel to skin
• Helping fight signs of aging
• Hyperpigmentation

Microdermabrasion is safe, quick, convenient and proven effective for all skin colors and types, from light to dark, dry to oily. This age-defying process can give a brighter, smoother appearance to any skin area in need of exfoliation such as face, neck, hands and chest. Whether you have a problem area or just want a quick pick-me-up; brighter, smoother skin is waiting for you in just a few treatments.

Microdermabrasion promotes the production of new cells in the basal (deepest) layers of the dermis and stimulates the growth of collagen to further smooth and improve skin tone and appearance. Best results are achieved through a series of treatments and a regular maintenance program.

Recommended for all skin types.

Microdermabrasion appeals to younger patients as a great way to reduce occasional blemish flare-ups, a deep cleansing facial and as preventative skin care to fight the first signs of aging before they actually appear.

For optimum results, Microdermabrasion involves a series of treatments. True, modest results may be achieved with a single visit. However, it is unrealistic and unfounded to expect significant change from just one treatment.

In the final analysis, the number of treatments depends on the type of skin you have. Our highly trained professional technicians will suggest a personal treatment plan designed to reach your desired result.

Microdermabrasion cannot remove tattoos, major acne scarring, other deep scars or deep wrinkles. It treats only the skin’s outer layer (stratum corneum). This being the case, serious side effects are not an issue. Being totally non-invasive, there is virtually no discomfort, down time or recovery. Patients typically experience some redness for about an hour after the procedure. Healing time for most is just a few days.
 
Treatments usually last 20-30 minutes for the face and longer if you include your upper chest and hands.