Introduction

Welcome. I am Dr. Mimi Lee and I would like to take a few minutes to go over how Botox and Dermal Fillers work and their general applications. Then I will meet with you to see what treatment or products will work best for you and answer your questions.

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How Botox WorksBotox is a prescriptive medication that has been used in the medical field for 20 years. And it has been used for cosmetic treatment since 2002 with proven safety and reliable results. It is a potent medication that is precisely placed at the muscle to relax it, which in turn relaxes the wrinkles. There is more than one formula available but we only use Botox Cosmetic which is made by Allergan and is by far the safest and most reliable. Botox works best at the “dynamic” lines created by our moving expressive muscles; which cause the tired, mad, worried look. If the lines are already very noticeable without facial expression or movement, then they are static lines; and Botox may only be able to soften but may not eliminate them. Dermal filler can be added for further correction. Botox treatment should be performed by someone knowledgeable of the anatomy and

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various muscle interactions in order to achieve safe and desirable aesthetic results. I personally perform all aesthetic injections in my practice. Additionally, it is important for me to know if you have had facial surgery because your muscle anatomy may be altered and treatment effect may differ.

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Areas For UseBotox is approved to treat frown lines between the brows, but is also commonly used in the forehead and crows feet area. Botox can also give a gentle lift to the brows when strategically placed at the brows and crows feet area. Of course it cannot achieve the significant amount of lift that a surgical brow lift can achieve, which some patients may need. Overall Botox is best used in the upper face area for lines created by our animated expressions. I do not typically use Botox at the lower face, as the smile muscles are very close to each other, so there is a slightly higher risk of asymmetry influence to the smile. The only exception is, we can use a very small amount to treat fine lines around the mouth, or so called “smoker’s lines.” Most grooves and lines around the mouth are actually caused by volume loss, so

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replacing the volume loss with dermal fillers can naturally deliver better and safer results in the lower face.

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Treatment and CareBotox injection treatment is quick and literally painless. It only takes 10 minutes and is performed with very fine needles that are hardly noticeable. I am also a very experienced and skilled injector, and patient comfort is always a top priority. So I like to apply ice to the area for a little numbing effect, so our treatment experience is never unpleasant. Bruising is rare but you should avoid blood thinner such as aspirin, ibuprofen products, vitamin E, and fish oil for 2 days before treatment. Mild temporary redness is expected, that looks like a mosquito bite, and they will be gone in 15 minutes. I also recommend avoiding high impact exercise for, 24 hours after treatment. And you may apply make-up the next day. There is NO special need to massage, or exercise the muscles treated, because we do not want the medication to migrate.

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What results to expectIt may take 3 to 10 days for Botox to take full effect. If results are not satisfactory, you need to notify us within 1 month, so we can determine why and take appropriate action. Additional treatments may sometimes be needed. Results usually last 3 months, but there can be slight variation. Some patients may last 2 ½ months, some may last 4 months.

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RisksUndesirable effects are rare when treatment is performed by a qualified physician, but minor bruising, headache, asymmetry, lowering of brows, drooping eyelids can rarely occur. You should notify us if you have any undesirable results so we can identify the cause and appropriate action.

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CostsWe charge $ 13 dollar per unit of Botox. The area between the brows can require 12.5 -17.5 units. The crows feet can use 15-20 units, and this amount covers both sides. The forehead is a large muscle and can take 10-20 units. If I have not done Botox for you before, I may prefer a conservative approach, so I may use the lower dose range to see your response and will add more if needed. This allows us to achieve desired results, without over treating, which may cause the unnatural frozen look. This can also help you save money in a long run, since treatment is needed every 3-4 months. But we want to make sure you are happy with your results. If results are not adequate, you need to let us know so I can add more if needed. Once we know what works best for you, then we can follow that regimen.

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Option 1 (botox/ filler):

I hope you find this overview of Botox helpful. Now let me tell you more about dermal filler.

Option 2 (botox only):

I hope you find this overview helpful. I will be with your shortly, to make specific recommendation for you and answer your questions. Thank you.

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Dermal Filler is mostly an inactive medication that is placed under the tissue to replace the volume loss from aging. And they can be placed virtually anywhere but we will go over some common applications. Our practice offer fillers that are well proven and they do not require skin testing because of low risk of allergy.Juvederm and Restylane are made with hyaluronic acid which is natural substance found in our body. They last about 6 months to 1 year. Their very soft gel consistency is versatile for many applications including treating thin tissue and lips.Radiesse is made of calcium hydroxyapetite which is found next to our bone. Because of the calcium, this product may show on dental x-ray . Radiesse has additional benefit of stimulating collagen to rebuild itself. And it lasts about 10-14 months. I prefer this product for patients with more volume need because

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of it is more robust. Radiesse pricing is also more competitive because it does not advertise as much as the other brands.

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Dermal fillers products are in general selected based on:

Treatment locations, Amount of volume replacement needed, And patient skin or tissue thickness.

Let’s go over some of the commonly treated areas:

Dark circles under the eyes caused by hollowness:Restylane is the only product I would recommend in this area because it gives the most refreshing natural look. Other products can cause more swelling that can look puffy. Most patients need 1 syringe.

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Nasolabial folds/ Marionette lines/ Oral commissures/ Mental crease:Restylane, Radiesse, Juvederm can all work in these areas. I like using Radiesse in patients with larger volume need because it is more robust and better priced.

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(show photo of 3 syringes used: This patient has deep folds that took 3 syringes to correct but most patients usually need 1 or 2 syringes)

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Lip augmentation:Juvederm brings very attractive yet natural enhancement when placed in lips. It is ideal for lips because of its soft consistency. Most patient need 1 syringe

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Other applications:Dermal fillers can also be placed in temporal area, cheeks, and jowls for lifting effect. They can also be used to improve scars.

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During treatment:I perform all aesthetic injections in my practice and patient comfort is a top priority. Our treatment is performed with topical numbing anesthetic that is placed for 15-30 minutes in advance. We need the face clean without any make up or lotion, to allow adequate penetration of the numbing cream, and to avoid infection risk. After the area is numbed, the actual treatment may take about 1 hour. Some products also come with additional local anesthetic, for improved comfort. For lip treatment, I will perform a mini-dental block, which will give complete comfort without long downtime, like the full dental-block. Dermal filler treatment is never painful at our practice.

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Before and After CareSome bruising and swelling is expected. So please give 10-14 days to allow full healing prior to special commitment. To minimize bruising we recommend avoiding blood thinning products such as aspirin, ibuprofen products, vitamin E, fish oil, Plavix, or Coumadin for 7 days. If lip treatment is planned and you are prone to cold sores or fever blister, please let us know, so I can write a prescription to minimize or prevent this. If you have acne problem near your treatment area, please call so I can prescribe oral antibiotics to treat the acne, prior to your treatment. This is very important, because acne harbors bacteria, and can increase risk of infection. It may take 2-3 days of antibiotic, for the skin to improve, before we can safely perform filler treatment.

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You may ice the treatment area for first 24 hours to reduce swelling. I do not recommend massaging the area because it can disturb the product. You may gently cleanse. And you may apply make-up the following day. I recommend using new make-up to avoid infection. You can also use concealer to cover minor bruising. There is a special make up that you can purchase at Dillards, called “Derma Blend”, that will cover darker bruising.

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What to expectMost swelling and bruising will resolve after 1-2 weeks. Our goal is for patient to achieve natural rejuvenated look without overfilling. With our conservative approach, we can add more volume, if you do not feel you have adequate correction. Be sure to notify us of your concerns, so we can evaluate for the cause and need for further correction.

Results in the lips usually last 6 months, other areas near the mouth may last 6-10 months. Treatment near the mouth is not, as long lasting, because of amount of movement associated. The under eyes area can last 1-2 year, especially when treated together with Botox.

Risks

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There is very little risk to dermal filler treatment, although some bruising and swelling is expected. If there is swelling during treatment, it can influence symmetry result, but it can be corrected. Very rarely, nodules, bumps, infection, allergic reaction may occur. However, good meticulous technique and conservative approach can virtually eliminate these undesirable results.

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CostsOur dermal filler charges range from $ 450 to $ 650 per syringe. Most patients need 1 to 4 syringes to achieve desired results.

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In conclusion, Botox Cosmetic and Dermal fillers are excellent non-surgical treatment, to unwanted wrinkles and folds. They can provide amazing natural looking results, with little to no downtime.

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I hope you find this overview helpful. I will be with your shortly, to make specific recommendation for you. Thank you.

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