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Botox and Other Dermal Fillers

By Dr. Channy Muhn and Dr. Nathan Rosen

Article printed on page H5 in the October 17-18, 2009 issue of
The Mississauga News under the feature: Health, Wellness & Beauty, Medicine Matters
Guest Column in Dr. Kujtan's Medical Matters.
Dr. Channy Y Muhn, MD, FRCPC, Dermatologist, Google image from http://faceinstitute.ca/assets/editorialboard/Muhn.jpg
Dr. Channy Y Muhn, MD, FRCPC
Dr Nathan Rosen, MD, FRCPC, Dermatologist, Google image from http://faceinstitute.ca/assets/editorialboard/Rosen.jpg
Dr. Nathan Rosen, MD, FRCPC

In response to many inquiries, this week's column comes to you from my (Dr. Peter Kujtan's) colleague, Dr. Channy Muhn, who practises dermatology at the Dermetics Clinic (Dermetics, Centre for Advanced Skin Care and Cosmetic Surgery) in Burlington, Ontario, Canada. Dr. Muhn is a Canadian Board certified dermatologist and a Fellow of the Royal College of Physicians and Surgeons of Canada and an Assistant Clinical Professor of Medicine at McMaster University, Hamilton, Ontario, Canada.

Dr. Nathan Rosen, co-author ot his article, also practises dematology at Dermetics, Centre for Advanced Skin Care and Cosmetic Surgery, in Burlington, Ontario, Canada. Dr. Rosen is a dermatologist with board certification in both Canada and the United States, a Fellow of the Royal College of Physicians and Surgeons of Canada, and a member of the Canadian Dermatology Association, the American Academy of Dermatology and the American Society for Laser Medicine and Surgery.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

In the media and in our society, we see many advertisements about cosmetic treatments. Some people talk about how horrible the results can be, how unnatural people appear after treatments and comment on their safety. When we see some of our media icons with bad cosmetic outcomes, this skews our view. We never hear about the great results of cosmetic treatment, which when done properly is what should be expected. The safety of cosmetic treatments is well documented, and in truth, is scientifically very well documented. The treatments have been here for many years. How do we figure out what is real and what is not? Well, it starts by learning some of the facts.

Botox™ is a medication that is used to inhibit specific muscular actions. Being a medication, it is required by Health Canada to be prescribed or purchased by a physician. It goes through rigid safety testing and purification processes. Other products may exist with a similar active ingredient, but Botox™ is a particular product with an unmatched safety profile.

Botox™ was first discovered in the treatment of eye muscle spasm and has been used for year in children. Its first uses were not cosmetic at all and have treated conditions such as spasticity, migraines, excessive sweating, spastic bladders, and others. Both hyperhidrosis (excessive sweating) and the treatment of migraines are covered by most drug plans when they are treated by a licenced physician.

Botox™ is a purified protein that is meant for the treatment of dynamic wrinkles. These wrinkles are caused by repeated expressions and movement of muscles, and can include frown lines, smoker's lines, crow's feet and forehead wrinkles. When Botox™ is injected into the muscle, it stops a chemical reaction that causes your muscle to contract, thereby relaxing the muscle itself. This leads to a lessening of the movement of the muscles that causes the formation of the lines, ultimately creating a less tired, softer, more youthful appearance to the face with less lines and wrinkles. Botox™ lasts between 3-6 months and, when used for cosmetic purposes, has minimal to no side effects as long as a qualified physician is injecting the medication. By choosing the right muscles to treat, you can have a person looking refreshed, softened, youthful and energetic. When injected improperly, one can see patients with the "plastic face". This non-movement is uncommon to see.

Botox™ can also be used as a complementary treatment with soft tissue or dermal fillers to restore the skin and recreate the youthfulness of the face. Both substances can be used to improve and diminish the appearance of wrinkles and fine lines. They are, however, used and injected very differently.

Soft tissue or dermal fillers are meant to fill up wrinkles or create enhancement of facial features. Temporary fillers, which are the most common, are typically made of Hyaluronic Acid (Hyaluronan) which is a natural substance found in all living tissue and is a substance already found in the human body. Hyaluronic Acid (Hyaluronan) is also produced synthetically to eliminate the risk of having any allergy to it. Dermal fillers can be injected into smoker's lines, the lins above the lips, nasolabial folds, the deep lines coming down from the sides of the nose and marionette lines, which are the lines coming from the edges of the mouth towards the chin. These fillers can also be used to to enhance the size or shape of the lips themselves. Many of the permanent fillers have some significant side effects and thus very long lasting materials tend to be used less and less.

Finally, fillers play a significant role in creating non-surgical enhancement for volume or tissue loss associated with aging. Many times, this would be in the areas of the hollows of the cheeks. Fillers typically last 6-8 months and more recently new advances have made the longevity of the results last up to 12-18 months.

Make sure you are being injected by a licenced and experienced physician. Botox™ cannot be injected into a patient without a physician prescribing the medication, which legally means that the physician must see you, even if a nurse or other injector is treating you. Your results, your care and your face deserve the best results.

Related resources:

Wrinkle (Skin) from Wikipedia, the free encyclopedia.

Botox Facts from BotoxFacts.ca.

Botox Injections from eMedicineHealth.

Face Institute: Facial Aesthetics Care and Education.

Dermal Fillers from eMedicine, WebMD.

How Botox Works - Video from HowStuffWorks, 2:46 min.

How Fillers Work - Video from HowStuffWorks, 2:26 min.

How Do Skin Wrinkles Work - Video from HowStuffWorks, 2:08 min.

Hyaluronan also called hyaluronic acid or hyaluronate, from Wikipedia, the free encyclopedia. "Hyaluronan is an important component of articular cartilage, where it is present as a coat around each cell (chondrocyte) . . . Hyaluronan is also a major component of skin, where it is involved in tissue repair."

Dermal Fillers: The Facts from FemaleFirst.co.uk.

Myth Busting: Dermal Fillers or Dermal Killers from Cosmetics Cop.com.

Panel: Toughen Dermal Filler Warnings. FDA Panel Wants Stronger Warning Labels on Treatment for Wrinkles by Kathleen Doheny, WebMD Health News. Reviewed by Louise Chang, MD.

Botox Side Effects by Reilly, eHow Contributing Writer. "... side effects are possible with Botox, most of which are temporary and rather mild."

Botox IM (Botulinum Toxin - Injection) from WebMD. Uses, Side Effects, Precautions, Interactions. View image of Botox IM - What does this medication look like?

Botox Cosmetic IM from WebMD.

User Reviews - Botox Cosmetic IM from WebMD.

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