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| Adventures of a Middle-Aged Editor |
GH Editor Michael Egan takes a terrifying trip
to Las Vegas. |
| New Hope for Alzheimer’s Sufferers |
| GH Medical Reporters discuss a series of dramatic breakthroughs. |
| GH Survey Winners |
| You could be the lucky recipient of a gift certificate. |
| Are You Older Than Your Boss? |
| Here are eleven coping strategies for dealing with a younger manager. |
| The Amusement Park |
| A new cartoon feature by Michael Egan. |
| A Whiskey a Day Keeps the Doctor Away |
| Moderate alcohol consumption is good for you! |
| Brother Noland Sings |
| Cover story features one of the Islands’ most popular musicians. |
| Heart Check |
| The American Heart Association offers women good advice. |
DEPARTMENT:
Botox, Yes or No?
by Patricia L. Chinn, M.D. Advanced Skin Care Medical Center
BOTOX
COSMETIC ® (Botox) injections are the number-one non-surgical
cosmetic procedures performed in North America today. In 2003, over
4,000,000 procedures were performed. In 2008, 10,000,000 procedures
are predicted. Why so many? Simply put, Botox works magic. Years of
wrinkles fade away virtually within a few days. No surgery or anesthetic
is needed. It is quick and safe in experienced hands. It is so safe
that the first patients to receive Botox were actually children in
the 1980s who had strabismus (lazy or ‘crossed’ eyes).
From this experience, doctors realized that as Botox relaxed the eye
muscles, it also relaxed the wrinkles in the skin above those muscles.
Botox was picked up by the Hollywood crowd early, but was only approved
by the FDA about five years ago. Although only FDA-approved for injection
around the glabellar or frown area, most experienced practitioners
are also injecting the mid- and lower-face and neck. Botox is currently
being studied at the Shriner’s Hospital in Honolulu to reduce
post-operative pain in children after bone/joint surgery.
WHAT IS IT?
BOTOX COSMETIC ®, produced by Allergan, is a purified and sterilized protein complex derived from Clostridium botulinum, that can be injected to treat excessive wrinkles caused by overused muscles. It is also used to treat hyperhidrosis or excessive sweating, and migraine and tension headaches. Botox injections treat excessive wrinkles in the forehead, the glabellar area (the two vertical creases between the eyebrows), crow’s feet, bunny lines (caused by scrunching the nose), transverse wrinkles in the bridge of the nose, dimpled or bumpy chins, and smoker’s mouth (vertical upper and lower lip lines).
HOW DOES IT WORK?
When injected, Botox works by blocking nerve cells from releasing a substance called acetylcholine that normally causes a muscle to contract. Relaxing a muscle also relaxes the skin overlying it. As the skin relaxes, wrinkles soften and can often disappear completely.
Dynamic wrinkles are those wrinkles that form when you express yourself, e.g. frown lines, smile lines, and Crow’s feet. Over time, as skin loses elasticity, these dynamic wrinkles become static or permanent wrinkles, and they are present all the time, becoming deeper and deeper, and more resistant to treatment. Botox can make dynamic wrinkles disappear completely if used early enough. However, when a dynamic wrinkle has become a static wrinkle, Botox may not completely reduce the wrinkle and a patient may need to have it filled (with ‘fillers’ of hyaluronic acid).
HOW IS IT GIVEN?
A few drops of Botox are injected using a very tiny needle. The injections cause minimal if any discomfort. At the most, they may feel like a mosquito bite.
HOW LONG DOES IT LAST?
Botox results are temporary. After injection, results are typically seen within a few days, peak at 1-2 weeks, and last for 3-4 months. Following the first year of treatments, the injections last longer, about 6-8 months, as the muscles lose their memory and ‘forget’ how to wrinkle. The cost of Botox injections therefore goes down after the first year and results last longer.
WHO IS A CANDIDATE?
Women and men of all ages. Men gen- erally require more Botox, presumably because their muscles are stronger. Botox is generally contraindicated in pregnancy, in patients with a history of autoimmune disease, muscle weakness, neurological disease such as myasthenia gravis, serious liver, heart, or kidney disease, and acute or chronic infection in the treatment area. Botox is also not indicated in patients with unrealistic expectations. Although Botox works magic, it is not a replacement for a facelift, if that is what is truly needed. Your doctor can help you to decide which is best.
WHAT ARE THE RISKS?
With proper technique, side effects and risks are minimal, temporary, and generally limited to injection sites—e.g. bruising, muscle asymmetry. Occasionally, drooping of the eyelid with/without double vision, or facial muscle weakness may occur, but is temporary.
IS IT COVERED BY INSURANCE?
Botox injections are not covered by health insurance unless medically indicated for hyperhidrosis or headaches. Because Botox treatments must be individualized, it is difficult to predict an average price. However, depending on the amount of Botox used and the areas treated, a single treatment session may cost $250 to $600 or more.