Spa, MD: The Results-oriented Revolution

cosmetic treatment with botox injection

Tables

Neuromodulator Options

	Botox*	Reloxin**
Product source	Purified form of botulinum exotoxin A	Purified form of botulinum exotoxin A
Indications	Frown lines between eyes, forehead wrinkles, crow’s-feet, upper lip, lower face and neck	Frown lines between eyes, forehead, crow’s-feet, upper lip, lower neck
Onset	Three days—the peak effect takes place 7–10 days after treatment	2–3 days—the peak effect takes place 7–10 days after treatment
Duration	3–4 months	3–4 months
Treatment protocol	A series of injections every 3–4 months	A series of injections every 3–4 months
Cost	$400–1,500, depending on the number of injections and the amount of material used	$400–1,500, depending on the number of injections and the amount of material used
Benefits	Temporarily paralyzes the muscles that cause lines through negative facial expressions	Temporarily paralyzes the muscles that cause lines through negative facial expressions
Risks	If performed properly, almost none, although bruising, an incomplete effect, brow droop, eyelid droop, lip droop and asymmetry of the effect can occur.	If performed properly, almost none, although bruising, an incomplete effect, brow droop, eyelid droop, lip droop and asymmetry of the effect can occur.

Collagen Options

	Bovine collagen	Human collagen	Porcine collagen
Product source	Naturally occurring protein from purified cow skin	Naturally occurring protein from lab-grown human foreskin tissue	Porcine (pig) tendons
Indications	Fine and moderately deep lines and creases around eyes and lips; lip and lip edge augmentation; scars	Cosmoderm* for superficial lines, glabellar lines, lip edge; Cosmoplast* for superficial and moderately deep lines and wrinkles, lip edge, lip body and acne scars	Evolence Breeze for superficial lines, glabellar lines, lip edge, lip body; Evolence for lip edge, lip body, and superficial and moderately deep lines and acne scars
Duration	2–6 months	2–6 months	Long-lasting temporary—at least 12 months
Treatment protocols	A series of injections every 2–6 months	A series of injections every 3–4 months	One time per year
Cost	$400–800 per syringe	$400–800	$600–1,000 per syringe
Benefits	Versatile, short-acting filler	Versatile, short-acting filler	Versatile, short to mid duration-acting filler
Risks	Allergic reaction, required skin test, bruising, swelling, incomplete correction, asymmetric results	Rare allergic reaction, bruising, swelling, incomplete correction, asymmetric	Rare allergic reaction, bruising, swelling, incomplete correction, asymmetric

Hyaluronic Acid Options

	Restylane and Perlane*	Juvéderm Ultra and Ultra Plus**
Product source	Genetically engineered streptococci	Hyaluronic acid
Indications	Lips, nasolabial folds, marionette lines, tear trough, adding volume to cheeks	Lips, nasolabial folds, marionette lines, tear trough, adding volume to cheeks
Duration	6+ months	6+ months
Treatment protocols	A series of injections every 4–8 months	A series of injections every 4–8 months
Cost	$600–1,000	$600–1,000
Benefits	Natural looking results; lasts for at least 6 months; Restylane good for finesse areas; Perlane good as an underlay and for volume enhancement	Natural looking results; lasts for at least 6 months; Ultra good for finesse areas; Ultra Plus good as an underlay and for volume enhancement
Risks	1–2 days of redness, swelling, bruising, tenderness	Less redness and swelling than with Restylane and Perlane

Semi-permanent Filler Options

	Radiesse*	Sculptra**	Autologous fat
Product source	Calcium hydroxyl apatite	Poly-L-lactic acid	Fat harvested from other parts of the body.
Indications	A volume filler for deep nasolabial folds, marionette lines, and hollow cheeks.	A volume filler for deep nasolabial folds, marionette lines, and hollow cheeks.	A volume filler for deep nasolabial folds, marionette lines and fat loss related to aging
Duration	12–18 months after a single treatment; if a touch-up treatment is provided, results are even better and duration is longer	1–2 years after a series of between 3–6 treatments	Six months to life-long; results are best and effect is longer if one or two touch-ups take place
Treatment protocols	Every 12–18 months	May need touch-ups	May need touch-ups; varied by individual
Cost	$800–2,000 per treatment	$800–2,000 per treatment	$1,000–4,500
Benefits	Allergic reactions are rare, and results are long-lasting.	Allergic reactions are rare, and results are long-lasting.	No possibility of allergic reaction, ubiquitous material, natural appearance
Risks	Swelling, redness, bruising and lumping	Redness, swelling, bruising and lumping; requires a series of treatments to obtain the desired effect	Redness, swelling and bruising

Permanent Fillers Options

	Artefill*	Silicone
Product source	Synthetic beads of methyl methacrylate in a base of bovine collagen	Liquid form of the chemical polymer silicone
Indications	Superficial, moderate and deep lines and folds, acne scars, volume loss	Lips, acne scars, sunken cheeks, nasolabial folds and marionette lines
Duration	Permanent	Permanent
Treatment protocols	One treatment with one or two touch-ups provides the best result	Depends on number of sites and amount of correction desired
Cost	$2,500	$500–1,000 per injection
Benefits	Long-lasting benefit; once the desired result is achieved, touch-ups are needed only as the client ages and lines deepen with time	Long-lasting benefit after a series of treatments; once the desired result is achieved, touch-ups are needed only as the client ages and lines deepen with time
Risks	Swelling, redness, bruising and permanent lumps; should not be used in the lips	Swelling, redness, bruising permanent lumps, and the rare possibility of a late foreign body reaction or migration of the material

By: Jeffery S. Dover, MD, and Amy Kamin

Posted: May 29, 2008, from the June 2008 issue of Skin Inc. magazine.

Until recently, the only effective procedure available to the individual wanting appearance enhancement was a face lift. Throughout the past few years, treatments featuring Botox and fillers, as well as laser and light procedures—in conjunction with good skin care—have revolutionized the ability to rejuvenate an aging face.

Statistics

According to a consumer survey by the American Society for Aesthetic Plastic Surgery (ASAPS) of 1,000 American households in 2007, 83% of women and 78% of men would not be embarrassed to undergo cosmetic surgery. This has been a major shift in society’s views toward cosmetic procedures. It has become trendy to openly contemplate procedures with peers, discuss a physician’s techniques and compare results. This trend, however, is occurring in regard to noninvasive, nonsurgical procedures. Recent statistics from the ASAPS reveal that, of 11.4 million procedures performed, 17%—or 1.9 million—were surgical, such as face lifts, eyelid lifts and liposuction, while 83%—or 9.5 million—were nonsurgical, such as the injection of Botox and fillers, and laser and light-based treatments.

Fillers and injectables

While face lifts are surgical procedures associated with anxiety, high cost,and significant recovery periods, filler and Botox treatments are relatively simple, safe, quick, relatively inexpensive and, in many instances, without downtime. Many individuals who would never consider a cosmetic surgical procedure are happy to have a noninvasive procedure. Because of this, the potential pool of candidates has increased dramatically.

At the same time, there have been incredible technological developments related to these noninvasive options. Product and equipment manufacturers have initiated more aggressive marketing approaches, using increasingly sophisticated and expensive direct-to-consumer television and print campaigns.

History

Since the early 1900s, there has been an interest in finding filler substances to enhance the face. The goal was safe and effective tissue augmentation. The early history, however, is full of examples of poor results and terrible reactions.

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