Buffalo Dermatologists

I Have Dermatomyositis, Scleroderma & Reynauds. Is Botox Safe? Also Have Spinal Injury.

I have undifferentiated connective tissue disease and though dermatomyositis (gottrons papules on hands, muscle & joint pain, no muscle wasting) has been confirmed, reynauds and scleroderma are also suspected on hands and elbows. Is it safe for me to have botox on my forehead, crows feet and between eyebrows? I have also had 3 spinal operations on my neck and take 40mg omeprazole, 8 x paracetamol, 600mg pre gabalin, 25mg nortriptline daily for nerve pain.

BOTOX® will be fine for you, should help relax overactive muscles causing forehead lines, crows feet and frown lines between you eyebrows.

Some of my patients who have serious medical problems really appreciate aesthetic treatments, which help them to look and feel as good as possible.

Did you know that BOTOX® can also be used to treat Raynaud's in the hands and other areas? Some colleagues and I recently published a book chapter on this:

Botulinum toxin type A (BoNT-A) treatment for Raynaud’s and other novel dermatologic therapeutic applications
Irèn Kossintseva, Benjamin Barankin, and Kevin C. Smith.
in: BOTULINUM TOXINS IN CLINICAL AESTHETIC PRACTICE
Second Edition
Edited by Anthony V. Benedetto  ISBN: 9780415476362 • December 2010

Kevin C. Smith, MD

Niagara Falls Dermatologic Surgeon

Is the Orbicularis Oculi Muscle Ever Frozen with Botox Injections?

I read the paragraph below on an Oprah.com article, and was wondering if this muscle is commonly or ever frozen by botox injections? "When someone smiles out of genuine delight, a facial muscle called the orbicularis oculi involuntarily contracts, crinkling the skin around the eyes. Most of us are incapable of deliberately moving this muscle, which means that when a person fakes a smile, her orbicularis oculi likely won't budge."

In particular when used in aesthetic medicine, BOTOX® is mainly used to relax muscles, seldom to freeze them.

Almost all of my patients want a natural, wholesome, relaxed appearance. This can usually be achieved by simple treatment with moderate doses of BOTOX®.

In subsequent treatment sessions the dose of BOTOX® can be adjusted up or down [as the patient wishes] to adjust the degree of relaxation of the orbicularis or other muscles of facial expression. For example, in the spring and summer when patients are squinting more in the bright sunshine, some prefer to have an increased dose of BOTOX®, then drop back a bit to a lower dose in the autumn.

Some patients have remarked that they feel that they can express themselves more accurately after they have had treatment with BOTOX®, because after BOTOX® they are not making unwanted or excessive facial expressions.

Kevin C. Smith, MD

Niagara Falls Dermatologic Surgeon

I Have Always Used but Botox but Tried Xeomin Recently and Haven't Had Great Results. Am I Resistant?

I have always love botox but my doctor stopped offering it and said xeomin would work better. I've waited three weeks with still no results, just some twitching near my right brow. Could I be resistant? I had the same amount/units as normal, if I switch back to botox will it still work. I have heard that it isn't recommended to go back and forth. I also take olive leaf extract and read that sometimes it is a natural antitoxin( use it for acne) Thanks!

Marion Moers-Carpi, MD et al recently presented the results of an experiment comparing 20 units of BOTOX®  to 30 units of XEOMIN® for forehead lines. It was a large, double blind study, with 112 patients in each treatment group.

Multicentre, Randomised, Double-Blind Study to Evaluate the Efficacy of OnabotulinumtoxinA (20 units -- BOTOX®) in the Treatment of Glabellar Lines, When Compared to IncobotulinumtoxinA (30 units XEOMIN®)

Bottom line: This clinical study found that 20 units of onabotulinumtoxinA [BOTOX®] are as effective as 30 units of incobotulinumtoxinA [XEOMIN®] in reducing the severity of glabellar lines 28 days post injection, and demonstrated a trend in favour of onabotulinumtoxinA at days 84, 98 and 112. These results were obtained despite a 50% higher dose of incobotulinumtoxinA than onabotulinumtoxinA.

Kevin C. Smith, MD

Niagara Falls Dermatologic Surgeon