Liquid Facelift -Part 2

The eye area

eyes

The eye area is a main personality feature of a person so we don’t want to freeze all emotion here. Treatment must be subtle enhancing the natural beauty and also remaining with what is age appropriate. The skin around the eye is thin and prone to ageing due to loss of elasticity, bone and collagen in this area. Fine wrinkles and pigmentation appear. Thin skin under the eye appears darker as the muscles and veins around the area are more visible.

Fine wrinkles are treated using botox for the crow’s feet to open up the eye and soften wrinkles and a very fine dermal filler to fill and soften the wrinkles. The deep hollow under the eye called the tear trough area is filled to plump the area stopping that hallowed look as the area is not sunken and dark as it is rejuvenated making a person look less tired and old.

The tear trough

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The eyebrow and temporal region are also treated with dermal filler to lift the eyebrow and to fill the hollow in the temporal region that ages us.

I use a fine dermal filler and also use a micro- cannula to prevent bruising. A micro-cannula is like a long thin blunt needle. As it is blunt it doesn’t cut through the blood vessels, keeping them intact and thus not bleeding out giving you a bruise.  A sound horrific but it really isn’t. (I’ve treated myself and many patients using this technique.) It may be slightly uncomfortable; luckily the under eye area is easy to anaesthetise using local anaesthetic so you don’t have to feel any discomfort whatsoever.

Remember to ‘like’ my page 

Hyaluronic acid dermal fillers

Dermal fillers (hyaluronic acid) are hygroscopic meaning they attract water. Once injected into your collagen cells they attract water to fill up and thereby plump your collagen cell. Dermal fillers also stretch the microscopic fibroblsts which are the precursor to collagen cells and thus collagen is then produced. Very clever little things – hyaluronic acid cells !! Remember to like my page

hyaluronic acid compoundhyaluronic acid gel

 

The mid face area is a very much overlooked area where a subtle cheek bone lift will take approximately 5 years off one’s look, yet being so subtle that people will not know quite what you’ve done. This is the most overlooked treatment area. When a patient looks in the mirror they generally see the nasolabial lines around the mouth. These are however caused by loss of fat from the cheek bone and eye area. The fat descends and literally falls over a natural ligament around the mouth (the naso labial lines). There is also loss of bone from the cheek and eye area as it degenerates as we age. Hence when we look in the mirror, this is what we see – deep lines around the mouth.

 

The ageing face

The ageing face

Mid face ageing is a dead give-away as to a person’s age – yet is the most under treated area in South Africa. In Europe and the states, this is fast growing to be one of the most popular dermal filler treatments. The muscles keeping the fat pads in place become thin and stretch with age also contributing to the descent of our cheek fat pads.

The technique used for mid face and tear trough dermal filler is quite an advanced technique and you should seek out an experienced practitioner. For mid face, a special measuring technique is employed so I know exactly where the filler needs to be inserted. Remember to like my page: Dr Stasi botha

A very thick volumous filler is used as this area and generally takes 1 ml of filler minimum per side. It is more costly than your general fillers; however I keep the price as low as possible. The filler generally lasts one year to 18 months depending on the individual. I usually advise having retreatment at one year so you don’t lose all the effects of the filler.

 

The lower face is generally also a dead give-away of age as with botox the upper third of the face can look 10 years younger than the lower third. A neat trick: treating the mid – third takes the eye’s focus to the mid face; away from the lower third giving the illusion of a much younger face.

So besides the obvious face lift what can we do.

Quite a bit

Nasolablai Lines

Marionette lines

Vital – fine filler made up of small micro particles that can draw water 10 x it’s own weight into the collagen cells, making wrinkles smoother softer and less evident.

Fill the lips

Straighten the jaw line

MICRONEEDLE MICRONEEDLE MICRONEEDLE

This in conjunction with Restylane Vital which plumps those very fine lines it really rejuvenates the entire mouth area.

All is not lost

And remember…. A face lift cannot give you the volume that filler’s can give you; neither can a filler lift the way surgery can, but in conjunction the two go hand in hand. It’s a personal choice at the end of the day.

LIQUID FACELIFT

LIQUID FACELIFT – Part 1

Need a little lift? This month we’ll be discussing : “The liquid facelift” – a mini make-over with botox and dermal fillers

Botox

Firstly for that just had a holiday relaxed refreshed look I inject botox into the frown, forehead, crow’s feet and also into the bunny lines on the nose  to relax the muscles and hence soften the lines. For those that have just joined us: botox or Botulinum Toxin A is a protein and neuorotoxin produced by the bacterium Clostridium botulinum. These bacteria release a neurotoxin protein which causes paralysis of the muscles which allows the muscles to relax which gives the appearance that wrinkles have softened or disappeared.

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Botox is such a superb anti-ageing and wrinkle treatment. It is extremely preventative as it stops muscle movement so the muscles can’t cause those little crinkle wrinkle lines – especially the worry one’s. Even if you only have it twice a year you will still see the anti-ageing effects. Don’t forget to “Like” my page please and share too if you find anything interesting! @ Dr Stasi Botha

Fillers

For a natural aesthetic result, fillers are incorporated into areas that have lost fat, muscle and general elasticity of tissue. Fillers can fill in wrinkles but they are especially fabulous for areas where volume loss has occurred. They can literally be placed anywhere i.e. around the eye, the cheek bone area, around the mouth and even along the jaw line.

The liquid face-lift is a costly procedure so I generally advocate that treatments be spaced a few months apart so treatment is then affordable, less down time is required as bruising may occur and also so that you don’t have that “just done look”

placement of fillers

Firstly for that just had a holiday relaxed refreshed look I inject botox into the frown, forehead, crow’s feet and also into the bunny lines to relax the muscles and hence softening the lines. For those that have just joined us botox or Botulinum Toxin A a protein and neuorotoxin produced by the bacterium Clostridium botulinum. These bacteria release a neurotoxin protein which causes paralysis of the muscles which allows the muscles to relax which gives the appearance that wrinkles have softened or disappeared.

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DR STASI BOTHA SEPTEMBER 2013 NEWSLETTER: BEST SPRING TREATMENTS!

WELCOME!

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This month on my newsletter I want to talk about all the treatments and the procedures that will make you look even more amazing and ready for summer! I will talk about teeth whitening, dermal fillers, Botox and microneedling.

I have spoken about these topics before on my Facebook page and my blog but I thought that since the warmer months are here and we all want to undergo a little bit of a makeover, why not do a recap for you to know what options are available to your to look your best!?

I hope you enjoy this newsletter and as always, remember that my Facebook and Google + pages are very resourceful when it comes to the treatments and procedures I offer so make sure to pay them a visit and share the info with those around you!

Lastly, if you want to know more about all the treatments I offer or if you wish to book an appointment, please do not hesitate to phone (011) 616 4040 or 072 712 3994!

LASER TEETH WHITENING

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One of the first things that people notice in a person when they meet you for the first time is your smile. First impressions last so maybe you should ask yourself if your yellow teeth make you self-conscious.

LASER TEETH WHITENING
While the latest laser technology is relatively inexpensive, the professional whitening gel procedure is the most cost effective option and does not damage your teeth.

In order to extend the longevity of newly whitened teeth, I highly recommend that you follow the instructions below.

  • At-home follow-up or maintenance whitening – implemented immediately or performed as infrequently as twice / three- / four times a year, depending on your habits
  • Avoiding dark-coloured foods and beverages for at least 2 days after whitening.
  • Whenever possible, sipping dark-coloured beverages with a straw.
  • Practicing excellent oral hygiene – brushing and flossing after meals and at bedtime.
  • Using a whitening toothpaste

HOW LONG DOES TEETH WHITENING TAKE?
The procedure takes a total of 2 hours and includes:

  • A general assessment of the teeth, viability of whitening and pointing out any problematic areas.
  • A professional cleaning of the teeth done by a dental professional
  • Preparation of the teeth, enclosing of all the soft tissue and possible sensitive / problematic areas on the teeth
  • 4 sessions of 15 minutes each – exposure under the laser!
  • Post whitening instructions
  • An at home post whitening maintenance kit, to maintain your white teeth

DERMAL FILLERS

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Now I want to talk about the use of dermal fillers at my practice. They make for very effective, safe and reliable treatments with long-term results and a very high patient satisfaction rate.

With dermal fillers I can:

    • Smooth away facial lines and wrinkles
    • Create fuller lips
    • Shape facial contours, such as cheeks and chin
    • In more recent times I use dermal fillers to revitalize the skin

The most common treatment areas for dermal fillers:

  • Nose to mouth lines (the nasolabial folds)
  • Between the eyebrows (the glabella lines)
  • Lips (adding volume and shape)
  • Cheek augmentation
  • Skin rejuvenation

Dermal filler skin rejuvenation treatments are effective in reversing the damage caused by photo-aging particularly in those difficult to treat areas that ‘give away’ your age, such as:

    •  Neck
    • Décolletage
    • Backs of your hands.

And of course everyone wants to have young and beautiful looking skin all year long but especially in summer, when you show more skin than usual, it can be a really great asset!

Lip fillers will usually last 6-9 months while nose and mouth areas are expected to last 9-12 months. The dermal filler is gradually broken down and absorbed by the body. If no further top-up treatments are done the wrinkles and lines will return to their previous appearance.

BOTOX

Now I would like to talk about Botulinum toxin, which, I am sure, you have heard of before? Maybe you’ve already had Botulinum Toxin (Botox®, Dysport) before or know someone who has?

With this product, I can:

  • Soften wrinkles
  • Reshape eyebrows
  • Reshape lips
  • Treat excessive sweating
  • Reshape the nose

The most common area of treatment is frown lines of the forehead. But Botulinum toxin may also be used to treat numerous areas including:

    • Smokers lines
    • Crow’s feet
    • Nasal reshaping
    • Excessive sweating
    • Migraines

The list is continually growing and I will continue to study new techniques and applications to keep you at the forefront of modern aesthetic medicine.
If you could wish for an aesthetic treatment where and what would it be?

Although the results are easily visible, a Botulinum toxin treatment will not radically change your appearance or make you look as if you “had work done.” The muscle activity that causes wrinkles is simply reduced.

There is no recovery period and no down-time after a Botulinum toxin treatment. You can go directly back to your normal activities, which is so convenient for you to squeeze an appointment in your busy schedule!

The Botulinum toxin will wear off in an estimated four months, and returning patients can be in and out within minutes. Great news to maintain the younger looking you.

SKIN NEEDLING

Have you ever heard of skin needling? It is a great rejuvenating procedure that I offer at my Bedfordview practice. I will tell you what it is, who it is for and how it can transform your skin.

You can also book a skin needling treatment with me at Bedfordview. This treatment combines well with Chemical Peels too for ultimate skin rejuvenation.

Microneedling, also known as Facial Mesotherapy and Collagen Induction Therapy (CIT) involves using a digital hand-piece infused with multiple, fine-pointed needles on the skin’s surface to stimulate its own regenerative properties and rejuvenate it.

Some techniques also involve handheld needling, but as technology develops so too does technique. At my practice I utilise the latest Vee Way needling technology.

Mesotherapy can be defined as a series of micro-injections of a cocktail of vitamins, serums, medication or amino acids into the middle dermal layer of the skin. Its purpose is to heal and reverse skin ageing and damage.

When small amounts of serums are injected into the skin, via needling techniques, the blood flow automatically increases to the treated area. This increases nutrition and oxygen to the site. This also improves lymphatic drainage and removes toxins in the skin.

NOTE: This technique can also be effective when treating cellulite.

During the Microneedling session, I use a sterile needle grouping and mechanically stimulate the epidermis and the top layer of the dermis. This, in turns, tells your brain to send collagen to the injured site in order to repair it.  This signal creates an abundance of collagen, which will plump up the injured area.

What is left after a needling session? Softer, yet tighter skin.
Your wrinkles, acne scars and other depressed areas will be a lot less noticeable. As an added benefit to skin needling the efficiency of serums and moisturizers is increased as they can now penetrate deeper.

The most exciting element to skin needling is that your skin’s production of new collagen continues for up to 12 months after the procedure.

That’s it for my September newsletter; I hope you found it informative and are now looking even more forward to the warm summer months!

Remember to check follow my Facebook page and do not hesitate to phone my rooms on (011) 616 4040 to book an appointment or find out more about the treatments and procedures I offer.

DR STASI BOTHA’S MAY NEWSLETTER: AFTERCARE

 WELCOME TO MY MAY NEWSLETTER! 

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This month I thought it would be interesting for me to talk about aftercare and how to make sure you take the right steps when it comes to recovering after an aesthetic treatment.

As your physician, I cannot stress enough the importance of protecting and soothing your skin after a session at my practice. Whether you came for Botox, dermal fillers, Skin needling or Fraxel, you need to know exactly what to do once you leave my rooms in order to maintain beautiful, long lasting results.

Of course, after your treatment I will give you all these recommendations again and will guide you through the aftercare process. I will answer any questions and make sure you know exactly how to proceed once you get home.

Remember to visit my Facebook page regularly; this is where I post about all the procedures and treatments I offer and also where you will find out about any specials I may run!

I hope you enjoy what follows!

→After Fraxel

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After your Fraxel Laser treatment, you should clean the treated area by washing with non-allergic cleansers that are soap-free but you should not clean the area more than twice daily. After you have washed the area, it is recommended you pat it dry lightly.

This patting is also great advice for after a shower. Try it, you’ll see what a difference it makes to your skin.

Do not rub the treated area after the Fraxel treatment as it may irritate the treated skin.

There is no need to take time off work after a Fraxel treatment but there will be 2 to 3 days of redness and in some cases you might experience some swelling, which can be covered with makeup. This is completely normal and of short duration.

Knowing that you can be back in the social world within a day gives you great confidence in the procedure.

It is important that you keep the treated areas moisturized by using creams and moisturisers that I will recommend. I will explain how to use these creams, how often to apply them and for how long.
After a Fraxel treatment, it is important that you eat and sleep well in order to ensure the best recovery and results possible.

I always advise my patients to apply large amounts of SPF and make sure they stay out of the sun. If you have to go in the sun, you will need to make sure that the treated area is well covered. Sunblock must be applied hourly and a hat must be worn.

SPF should be part of your daily anti-ageing routine too, sunblock actually only lasts for one hour, therefore you should apply it often.

→After Skin needling

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It is very important for you to avoid direct exposure to sun rays for at least 4 days after the procedure. But I will still ask you to wear a high quality SPF for more protection.

This is because of the damage caused by the needling, and additional sun damage will delay the healing process. This is why winter is also a great time for micro-needling, because the sun is not so harsh.

Carefully following my guidelines is very important as it will prevent any skin damage. You must keep in mind that a good healing is a process that cannot be rushed or overlooked as it would counteract the benefits of the actual procedure.

After the micro-needling, I need you to avoid the use of sensitizing drugs or skin cosmetics or cosmetics that contain mineral oils, Vaseline, lanoline, petroleum or acids. It is also important to avoid steam bath or sauna the first day after the treatment. Make up and after-shave (because men love micro-needling too) cannot be applied within the first two days post treatment.

→After Botox

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Botox is a popular procedure at my practice that most patients enjoy without any complications. However, it is always good to be reminded that after the injections you may notice some small red dots and bumps which usually fade after a few hours. Minor bruising may occur and last a few days.

It is still very important that you follow my instructions for BOTOX® after care to help ensure that you achieve optimal results.

After a Botulinum toxin session, some patients like to apply a lightweight cold compress to the treated area for a few minutes after the procedure. Even though the injections are not painful per-se, you may still want to get some immediate relief in order to be as comfortable as possible.

If you make sure to carefully follow my instructions, your recovery after Botox will be quick and pleasant. You will be able to resume normal activities immediately after the treatment.

Nonetheless, I usually advise my patients to wait 24 hours before taking part in any strenuous activity i.e. gym or cardio sessions. I also recommend that you avoid lying down for four to five hours following the treatment and that you avoid touching the treated area.

We just want the Botulinum Toxin to settle down. It does take a few days for the treatment to take effect and these tips assist with more accurate results.

→After Dermal Fillers

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Like with any other procedures, there are some risks. With dermal fillers, there is a small possibility of allergic reaction. There is usually localised redness and swelling that can last a day or two.

Should this be the case, a simple script for antihistamines will do, but this is a very rare occurrence.

Bruising is a more common side effect after dermal filler injections which can last up to a 5 days. But together during the consultation we will go over the possible risks and complications. I want you to feel as comfortable and confident as possible.

If you do bruise we do have great medical make-up available in the shape of Oxygenetics, which we can match with your skin tone.

Healing time varies from person to person, however, so some may experience redness and swelling slightly longer than others but overall the recovery and healing process after dermal filler injections is quick and easy.

There should never be any healing side-effect that cannot be covered by well placed make-up, and this is why dermal fillers are proving so popular.

I usually advise my patients to avoid touching and massaging the product situated in the treated area for the first 24 hours after their dermal filler injections as this could disturb the dermal filler gel and impair the results.

Of course this can be difficult, but the advice is to be aware of your treatment area. These are simple tips to prolong the life of your result.

As part of the dermal filler aftercare procedure, it is also advisable to use a cold pack as needed to reduce swelling and redness at the injection site. With the use of cannulas bruising and swelling is reduced, but should you swell a cold pack will do nothing to the result, but will get you out and about again.

A cold pack will be available at the time of treatment.

Remember to follow me on Facebook and “Like” my page. This is where you will find all the updates and news about the treatments and procedures I offer at my practice. 

Before and After Botox Photos

Today I would like to post some photos of men and women at different stages of their “Botox experience”.

These Botox sessions were specifically aimed at improving moderate to severe frown lines between the brows.

I want to mention that these photos were NOT taken by me at my practice and these people are not my patients. They were taken from the official Botox website which you can visit by clicking here.

I hope you enjoy and as always, feel free to leave a comment or a question here or on my Facebook page.

botox 1

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botox 3

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Long-Term Effects of Botulinum Toxin Type A (Botox) on Facial Lines

A Comparison in Identical Twins
William J. Binder, MD
Arch Facial Plast Surg. 2006;8(6):426-431

INTRODUCTION

Hyperfunctional lines such as horizontal forehead lines, glabellar lines, and crow’s feet can develop from the repeated contractions of certain muscles (the frontalis, procerus, corrugator, and orbicularis oculi muscles). By blocking the release of acetylcholine from the presynaptic terminal of the neuromuscular junction, botulinum toxin type A (Botox; Allergan Inc, Irvine, Calif) can inhibit the contraction of these muscles.

Botox is approved by the US Food and Drug Administration for the treatment of glabellar lines, and its efficacy in the treatment of these and other hyperfunctional facial rhytides (eg, horizontal forehead lines and crow’s feet) is well documented. 1-10 Its duration of effect when used for the treatment of glabellar lines is generally at least 3 to 6 months and has been reported to be effective up to 11 months. 6, 11 Furthermore, it appears that repeated treatments can result in a progressively longer duration of action.5 (Note: Dosing and results reported in this study are specific to the formulation of Botox manufactured by Allergan Inc. The Allergan Inc formulation is not interchangeable with other botulinum toxin products and cannot be converted by using a dose ratio.)

Most published studies evaluate the efficacy and tolerability of Botox for no more than 1 year, and there are few reports evaluating the clinical benefits of repeated treatments over the course of many years. Nevertheless, patient satisfaction is generally high, and it is likely that many patients will continue treatment for several years. 2, 12-15 Although controlled studies of this duration are impractical, the evaluation of facial lines in identical twins who have had different exposures to Botox can offer insight into the long-term benefits of Botox treatment. This report evaluates the presence of hyperfunctional facial lines in identical twin sisters, one of whom had regular Botox treatment in the forehead and glabellar regions over many years and one of whom did not

METHODS

Hyperfunctional facial lines were evaluated in identical 38-year-old twin sisters. The first twin (hereafter, the regularly treated twin) had received Botox injections in the forehead region and the glabellar region approximately 2 to 3 times each year over the past 13 years ( Figure 1). She had also received a total of 2 treatments with Botox in the crow’s feet area in the last 2 years ( Figure 1). She was last treated with Botox more than 4 months before the “at rest” photographs of the forehead, glabellar, and crow’s feet were taken and 7 months before the “when smiling” photographs of the crow’s feet were taken. The other twin (hereafter, the minimally treated twin) received only 2 treatments with Botox, both in the forehead and glabellar regions. The first of these was administered 7 years ago, and the second was administered 3 years ago

botox twin studies

Figure 1. Approximate sites of botulinum toxin type A (Botox; Allergan Inc, Irvine, Calif) injections in the forehead, glabellar, and crow’s feet regions.

RESULTS

In this study, neither twin experienced any adverse effects from Botox.


FOREHEAD AND GLABELLAR LINES 
Photographic documentation shows that hyperfunctional forehead and glabellar lines are not evident at rest in the regularly treated twin. In contrast, they are visible in the minimally treated twin (Figure 2 and Figure 3).

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Figure 2. The minimally treated twin (images on the left) and the regularly treated twin (images on the right). Hyperfunctional lines in the forehead and glabellar regions are visible in the minimally treated twin but not in the regularly treated twin.

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Figure 3. Oblique views of the forehead and glabellar lines that are visible in the minimally treated twin (left side images) but not in the regularly treated twin (right side images). The crow’s feet are also shown at rest

CROW’S FEET 
At rest, there were no marked differences between the twins in terms of crow’s feet (Figure 3). This is not unexpected because the regularly treated twin had started receiving Botox injections in the crow’s feet area only 2 years previously.
When the twins smiled, there was a marked difference between their crow’s feet (Figure 4)

twin study pic 4

Figure 4. Crow’s feet when smiling are more visible in the minimally treated twin (left side images) than in the regularly treated twin (right side images), even though the crow’s feet of the regularly treated twin had been treated with botulinum toxin type A (Botox; Allergan Inc, Irvine, Calif) only twice in the last 2 years

NASOLABIAL FOLDS 
Neither twin received any Botox injections in the lower half of the face, and the nasolabial folds in the regularly treated twin were at least as noticeable at rest as those in the minimally treated twin (Figure 3). This suggests a generally similar degree of aging in untreated areas of the face in both twins, giving credence to the belief that the differences between the twins in the severity of their forehead and glabellar lines are attributable to the difference in the number of Botox treatments that each received over a long period of time (rather than a greater propensity for skin aging in the minimally treated twin)

COMMENT

It is well known that a single injection of Botox into a target muscle can inhibit a patient’s ability to contract that muscle for several months and so reduce the appearance of facial lines that would have been apparent during active muscle contraction. The results presented herein suggest that long-term treatment can also result in additional benefits and prevent the formation of permanent lines—so-called imprinted lines—that slowly manifest over time as part of normal aging as a result of dermal and epidermal tissue breakdown caused by repeated muscle contractions. This comparison of identical twins (one of whom received regular injections of Botox in the forehead and glabellar region for 13 years and one of whom did not) demonstrates that long-term treatment with Botox can prevent the development of these imprinted facial lines.

Once these lines develop, they can be rectified only by using other treatment modalities such as fillers or skin resurfacing techniques. As long-term Botox treatment appears able to dramatically slow, if not halt, this aspect of the aging process, it would also appear able to delay, if not avoid, the need for such treatment.

It is likely that long-term treatment with Botox is able to prevent the development of imprinted lines not only by inhibiting the patient’s ability to contract the target muscle but also perhaps through behavioral modification. With long-term treatment, the patient may become used to having little, if any, need or ability to contract the target muscle and may eventually “learn” to avoid even trying to contract it. It is also thought that, by relieving the mechanical pressure of chronic muscle contraction in this way, dermal remodeling may be facilitated. 6

In the regularly treated twin, the clinical effect of Botox was consistently sustained for at least 6 months after each injection, and the duration of effect did not diminish with repeated treatments. The dosage also remained stable over the 13 years of treatment. It has been reported in the literature that, compared with a single treatment, repeated injections may enhance response rates, prolong the duration of action, and lower the incidence of adverse events. 5, 10 If greater or more prolonged efficacy is achieved with continued treatment, this may afford the opportunity to treat patients less frequently or with lower doses.

In conclusion, long-term treatment with Botox can prevent the development of imprinted facial lines that are visible at rest. Botox treatment can also reduce the appearance of crow’s feet. Treatment is well tolerated, with no adverse events reported during 13 years of regular treatment in this study

AUTHOR INFORMATION

Correspondence: William J. Binder, MD, 120 S Spalding Dr, Suite 340, Beverly Hills, CA 90212-1800 (info@doctorbinder.com ).
Accepted for Publication: June 1, 2006.
Financial Disclosure: Dr Binder is a stockholder of and a consultant to Allergan Inc.
Previous Presentations: This study was presented in part at the Rejuvenation of the Aging Face Course–2006, sponsored by the American Academy of Facial Plastic and Reconstructive Surgery; February 19-23, 2006; Boca Raton, Fla; and as a poster at the 64th Annual Meeting of the American Academy of the Dermatology; March 3-7, 2006; San Francisco, Calif.
Acknowledgment: I am grateful to Gill Shears, PhD, for assistance with the writing of this article.
Author Affiliation: Department of Head and Neck Surgery, UCLA School of Medicine, Los Angeles, Calif