Putting BOTOX Facial Fillers Into Practice

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    Putting Botulinum Toxins and

    Sirtaz S. Sibia, D.O., FAOCO

    Orlando, Florida May 2013

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    Anatomic areas of concern to the patient

    History of previous treatment

    ocumen pa en s ana omy

    Educate the patient about treatment options

    Botox Cosmetic, Dysport, Xeomin, Restylane,

    Perlane, Juvederm, Radiesse, etc.

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    Basic Physician Knowledge of

    Botulinum toxins Indications Administering physicians

    Temporary improvementin the appearance of

    moderate to severeglabellar lines

    Be well trained

    Have knowledge of

    Corrugator and/orprocerus activity

    Adults 65 ears

    expression

    Understand the dynamicsof a in

    Be qualified to evaluateand determine individualtreatment

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    Botulinum Toxin Overview

    BOTOX Cosmetic, Xeomin and Dysport are,

    bacterium Clostridium botulinum.

    Botulinum toxins works by blocking

    acetylcholine impulses that trigger hyperactive

    musc e contract ons.

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    Aging Face

    Glabellar frown lines

    or zon a ore ea nes

    Periorbital lines (Crows feet) Lateral brow lift

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    Store vacuum-dried product .

    Administer within 4 hours

    after reconstituting product.

    2C to 8C.

    BOTOX Cosmetic should beclear, colorless and free of

    particulate matter. Supplied in a single patient

    use vial.

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    Store vacuum-dried product .

    Administer within 4 hours

    after reconstituting product.

    2C to 8C.

    Dysport should be clear,colorless and free of

    particulate matter. Supplied in a single patient

    use vial.

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    Rare

    Generalized weakness

    u- e symp oms

    Diffuse skin rash

    Headache

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    Pregnancy and breast feeding

    sor ers o e neuromuscu ar unc on

    Myasthenia gravisyopa es

    Aminoglycoside therapy

    ay mpa r neuromuscu ar ransm ss on an are a eore cacontraindication

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    Botox/D s ort Pre aration

    1 cc syringes Insulin s rin e with re-

    attached 30 guage needle vs.

    separate syringe and needle

    Digital camera

    Postop instructions

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    None

    ce, e y c or e

    Emla, ELA-Max,

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    Botulinum toxin needs

    with sterile,

    preservative freesaline

    Refer to Botulinum

    toxin by units notvolume

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    Botox: Vial Dilutions

    Saline U/ml U/0.1 ml

    2.0 ml 50 5.0

    2.5 ml 40 4.0

    4.0 ml 25 2.5

    5.0 ml 20 2.0

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    D s ort: Vial Dilutions

    Saline U/ml U/0.1 ml

    1.5 ml 200 20.0

    2.0 ml 150 15.0

    2.5 ml 120 12.0

    3.0 ml 100 10.0

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    Documentation of Botox treatments

    Botulinum toxin injection worksheet

    e ore an a er p o ograp s

    Make good notes on how many unitsinjected for each site to help improve results

    for future Botox/Dysport / Xeomin

    treatments

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    BOTOXRInjection Worksheet

    Patient Name: _______________________________ DOB: _________ Date: _________

    Treatment Areas: glabella forehead periorbital perioral other

    BOTOXR: Lot __________ Expiration ___________ Concn ___________

    The risks, benefits, and alternatives of Botox injections were discussed with patient.

    BotoxRwas administered after alcohol skin prep and topical anesthesia placement.

    Patient tolerated procedure well and there were no complications.

    Return appointment: ___________________

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    Key Muscles of the Upper Face

    Superciliiron a s

    Procerus Orbicularis

    Oculi

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    Discussing BOTOX Cosmetic,

    Patients

    ,protein thatrelaxes wrinkle-causing muscles, creating asmoothed and improved appearance.

    BOTOX Cosmetic/ Dysport/ Xeomin is administered via afewtiny injections of purified protein into the muscle to block nerveimpulses that trigger wrinkle-causing muscle contractions.

    BOTOX Cosmetic/ Dysport/ Xeomin is asimple and quick,minimally invasive treatment that delivers dramatic results with

    .

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    Discussing BOTOX Cosmetic, Xeomin,

    an yport w t your at ents

    Dont

    , , , ,

    needles

    Do

    smoo , re ax , re res , nyinjection, soften

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    Botulinum Toxin Marketin

    Internal marketing

    Treat office staff with left over Botox/Dysport

    External marketin Traditional advertising

    Spas, salons, gyms, health clubs

    Pricing Botox Days

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    Rhytids (wrinkles)

    Produced by

    corru ator

    procerus

    orbicularis oculi

    depressor supercilli

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    1 in procerus

    2 in each corru ator

    Total dose:

    Botox/Xeomin: 20 U

    (4U/injection site)

    Dysport: 50 U

    (10 U/injection site)

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    Decrease in Glabellar Lines after

    Treatment with BOTOX Cosmetic

    Baseline Day 30

    Unretouched clinical trial photos taken while frowning before

    BOTOX Cosmetic and after BOTOX Cosmetic. Individual

    resu s may vary.

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    Potential com lications of labellartreatments

    Bruising

    row os s

    Diplopia Eyelid Ptosis Treat with Naphcon A or Iopidine, the alpha agonistic activity

    s mu a es ue er s musc e w c s e an compensa es or eloss of the levator

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    Why use Botulinum in glabella vs. fillers

    Occlusion of cutaneous vessels (Zyplast)

    n ness o agen, a , r amc no one

    Cerebrovascular occlusion (fat)

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    Rhytids (wrinkles)

    across the forehead

    Produced by frontalis muscle

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    Before and After:Forehead

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    Forehead line treatment

    Botox/Xeomin: 2 U/

    site

    Dyport: 5U/ site to prevent eyelid ptosis,

    injections should be at least 1

    cm above the supraorbital rim

    and away from the area abovethe lateral eyebrow

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    Potential com lications of foreheadtreatments

    Bruising

    row os s

    Eyelid Ptosis

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    Rhytids (wrinkles)

    radiating from the

    lateral canthus,

    person smiles

    orbicularis oculi

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    Before and After: eriorbital lines

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    Botox/Xeomin:

    Dysport: 8 U per site

    rim

    To prevent bruising in this area

    injections

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    Potential com lications of eriorbitaltreatments

    Diplopia

    era s

    Ectropion Epiphora

    Weakness of z omaticus muscle

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    Lateral Brow Lift

    Performed mainly for

    Treat the lateral brow

    de ressors so the browelevators work

    unopposed

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    Before and After:lateral brow lift

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    Lateral Brow Lift Treatment

    4 units Botox/Xeomin

    2 units Botox/Xeomin

    glabellar lines

    add an additional 2 units into

    -

    lateral to the orbital rim and atthe tip of the eyebrow

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    Posto Instructions

    Do not lie down for the next 4 hours

    o no ean over or e nex ours

    Do not touch or massage the treated areas inany fashion for at least 4 hours

    Immediately after