Guilford Botox doctors
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Robert C. Langdon, MD
Guilford Dermatologic Surgeon
5 Durham Road, Guilford |
3 answers |
Recent Answers
8 weeks ago I had my 1st treatment.Botox with a tiny bit of Juvederm for the "11s" between my brows.Also fillers at the corners of my mouth, chin fold and a touch in my lower lip to lift some moderate lines and sinking with a touch of Botox at the corners of my mouth. I bruised heavily! Bruising cleared in 2 weeks.Now I am left with the whole treated areas being slightly darker & a bit red compared to the rest of my face and complexion. Is this normal&how long til it goes away?Safe to do again?
I always apply a topical anesthetic cream (which includes a medication that causes blood vessels to constrict) before injecting "fillers" such as Juvederm and Restylane). The skin is numbed for the injection and is also much less likely to bruise. Bruising is usually minimal to nonexistent.
I usually do not use anesthetic cream prior to Botox injections; the key to preventing bruising is for the physician to immediately apply pressure to the injection site if any bleeding is noted. Again, bruising is usually minimal to nonexistent.
It is also a good idea for patients who are scheduled for injections to avoid any elective "blood thinning" medications such as aspirin for two weeks prior to the procedure.
Botox relaxes the facial muscles that are the cause of wrinkles, but it has no direct effect on the skin. Wrinkles that are visible when the underlying muscles are fully at rest are "etched in the skin" and will not improve unless the skin is directly treated by other modalities. Injection of a filler substance such as hyaluronic acid (Restylane, Juvederm) into the skin will temporarily smooth the wrinkles, but long-lasting improvement requires skin resurfacing, which is best done by a laser.
Laser resurfacing can be achieved through a series of fractional laser treatments (most often Fraxel laser at 1550 nm wavelength or Fractional CO2 laser at 10,600 nm wavelength), or through a single treatment of "traditional" (non-fractional) laser resurfacing (either erbium laser at 2940 nm or CO2 laser). The "traditional" approach is the most effective and can result in complete smoothing of the wrinkles.
The best strategy of all is combining Botox and laser resurfacing. Continued use of Botox can prevent the wrinkles from recurring after the resurfacing. I have personal experience with this combo, having had laser resurfacing of my frown lines in 1995 followed by continual injections of Botox (3-4 times a year). After 15 years, my frown lines have not returned, and should never return as long as I prevent them with Botox.
I keep hearing more and more cases of eyelid ptosis or "droopy" or closed eye from Botox. Is there a way to decrease the chances of this happening? Does it happen as often with Dysport as well?
"Droopy eyelid" after Botox or Dysport injection is the result of an inadvertent paralysis effect on the levator palpabrae muscle, a small muscle that serves to elevate the upper eyelid. This problem is very rare when experienced physicians administer the injection (the last time this happened in one of my patients was in 1999). It usually occurs after Botox injection in the frown line area (glabella). The levator palpabrae muscle is located somewhat deep below the surface of the lid; if a small amount of Botox diffuses in this area it may weaken the muscle. The key to avoiding this unwanted side effect is for the physician to keep any injections near the middle portion of the eyebrow at least a few millimeters above the brow.
If weakness of the levator muscle does occur, it can be alleviated by the use of eye drops (Apraclonidine) that stimulate another small muscle that can also lift the lid. The effect of the Botox will wear off after 3-4 months.
"Droopy eyelid" should not be confused with a sagging eyebrow, which can result if too much Botox is used in the forehead, weakening the muscle that lifts the brows (frontalis muscle).
