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The
Best Candidates for Botox Botox
is used to treat horizontal lines in the forehead, creases and furrows in the
glabella, periorbital "crows feet" and the platysmal muscle in the
neck. Botox is used for men and women and can be used for all skin colors.
Botox seems to be the most beneficial for the 30-50 year age group whose
facial lines are due more to underlying muscle pull than to dermal elasticity.
All
Surgery Carries Some Uncertainty and Risk Bruising
occasionally occurs around the areas of injection and is the most commonly
reported adverse effect. Approximately
1% of patients develop brow or eyelid ptosis. Sometimes, this is so slight
that it may not even be noticed by the patient. Diplopia or lagopthalmous
(weakness of eye closure) can also develop. These symptoms usually last for
2-3 weeks but have been known to last for up to 6 weeks. General
body symptoms occur in less than 0.1% of patients, but can include skin rash,
general malaise, headaches, drowsiness, fever or flu-like symptoms. Effects
can last for several hours or days but are temporary and can be relieved with
mild analgesia such as acetominophen. Preparing
for Your Surgery Although
the physician is responsible for explaining the procedure, risks and benefits
to the patient, the Registered Nurse plays a valuable role in reinforcing the
patient's understanding. The nurse may also be the one responsible for pre and
post treatment photos of the areas to be injected. A
routine medical history is taken from all patients including medications and
allergies. Botox is contraindicated in patients with a history of
neuromuscular diseases. Botox is contraindicated if there is an infection at
the proposed site or in patients with known hypersensitivity to any ingredient
in the formulation including saline and human albumin. It
is advised not to treat pregnant or lactating mothers with Botox. For
treatment of glabellar furrows, a glabellar "spread test" can assist
in determining a patient's suitability for Botox therapy. By spreading the
glabellar wrinkles apart, the maximal benefit expected can be determined. Patients
with thick sebaceous skin and deep dermal scarring may have deep glabellar
crevices that may respond poorly to Botulinum toxin and therefore, are poor
candidates for treatment. To
minimize bruising at the injection site, it is advisable that patients refrain
from taking aspirin products for two weeks prior to treatment. The
Surgery The
RN will likely have the procedure room prepared prior to the patient entering.
Setup is simply done on a Mayo stand or equivalent with the Botox syringe,
gauze and gloves. Prior to the injection, the patient should remove all makeup
so that the skin is thoroughly clean. Although treatment takes only a few
minutes, patients are more relaxed the more the RN is present and offers
reassurance at the time of treatment. Most patients do not require topical
anesthesia; however topical anesthetic creams such as EMLA cream may be used
45 minutes prior to injection. The area to be injected can also be prechilled
with ice packs. If
required, an electromyography (EMG) recorder can be used for muscle locations,
especially if the patient previously had not responded to a Botox injection.
The patient is seated with the head extended back. Alcohol can be applied to
the injection site but must be allowed to dry completely to avoid any
weakening effect of the Botulinum toxin. Depending on which muscle is being
injected, the patient is asked to frown or smile to visualize the muscle. A 30
gauge, 1/2 or 1" needle is used with a 1 cc syringe. 0.9% saline with out
preservative is used as the diluent. Botox can be reconstituted with as little
as 1 cc saline or as much as 4 cc per 100 Unit vial. The
RN should explain that the injection feels similar to that of an immunization.
There is a minor degree of discomfort and a slight burning sensation as the
Botox is injected into the muscle. There is usually some swelling in the
injected area for a couple of hours after treatment. After
Your Surgery The RN should instruct patients to refrain from lying down for four hours post injection and are advised to frown or squint (depending on the injection site) within the next few hours. Results are usually noticeable between 3 and 7 days after treatment. Evaluation and photos of the injected area are recommended at 7-10 days. Results last for approximately 3-6 months and injections can be repeated indefinitely. © Copyright 2001, American Society of Plastic and Reconstructive Surgeons
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