Dear GG Dianne: 35 units of Dysport to treat both the glabellar area and forehead is insufficient. There is not a direct correlation between Botox and Dysport, it varies slightly from patient to patient. Typically, it takes between 3 and 5 units of Dysport to get the same effect of 1 unit of Botox, so you received the equivalent of 7-12 units of Botox which is simply inadequate to treat either of these areas. I evaluate the amount of muscle contraction of the area I am treating and base the dosage on the size of the area and the muscle action. Typically, I use between 20-25 units of Botox initially to the glabella and 30+ units to the forehead. I have found that Asian patients can require & respond to lesser amounts. I have been injecting Botox for over 30 years and am one of Allergan's trainers and member of their National Education Foundation. I find Botox more comfortable to inject for my patients than Dysport, but you should get the same result with either one with the proper dosage. It is recommended to wait about 3 months between treatments. The doses are not additive, which means that if you go back in, your doctor will not be able to count the 35 units they initially injected, you start from ground zero. Too frequent injections pose the possibility of developing an immune response to the neurotoxin and losing the effect of the agent. It is also normal to gradually require increasing doses as we get older.
These lines look like "bunny lines" developing from scrunching your nose. Low dose Botox will relax these. This type of facial movement responds well to biofeedback, in that, if you can't do it, you tend to stop doing the 'scrunching'. Due to blood flow in this area, I agree that this is a danger zone for injecting fillers requiring long time expertise, and would only consider if the Botox does not adequately address your problem. I have been injecting Botox since the 1980's and fillers since the 1990's, and there are certain areas where, for safety reasons, I will not inject fillers.
Kudos to you for checking on safety of these during your pregnancy. As the other doctors indicated, such safety tests are not conducted on pregnant women. Any chemical substance, such as in a peel, or the anesthetic in the Restylane, are unknowns as far as fetal safety. The hyaluronic acid in Restylane and Juvederm actually occurs in the body, but no testing is available as to safety in injecting it during pregnancy. The microdermabrasion should be safe if the crystals used are sodium bicarbonate (antacid), rather than aluminum based. We don't know the effect of pounding aluminum into the body, and whether it would cross the placenta.
Dear Bob F, All outpatient surgery facilities I work at in Houston have a protocol in place for elective outpatient surgical procedures regarding EKG's and lab work. Your surgeon typically does not have a say in this unless the surgery is performed in their office. This is performed for safety reasons for the patient. If any abnormalities show up on lab work or EKG, evaluation prior to surgery may be required. If you just recently had lab work and EKG from your primary care physician, those can be provided to the facility. All surgeons have had patients who had normal vitals in the office, but had irregular heart rhythms or abnormality on their lab work at pre-registration at the facility. In healthy patients, with authorization from their primary care physician, I will perform blepharoplasty in office, without IV or sedation, under topical anesthetic cream placement, followed 10-15 minutes later with local anesthetic. Other than that injection, the procedure is comfortable. Discuss this option with your surgeon.
Your information requires more detail. Age is important in these procedures. Are you a child or adult? Children tolerate the frontalis sling better than adults with the night-time exposure from the incomplete lid closure. When you say poor levator function, how many millimeters of function exist? A sling is necessary when there is no levator function. If there is some, then a levator advancement combined with a tarsoconjunctival resection can give a very nice functional result and allow you to close your eyes while you sleep. More levator function may allow just a levator advancement procedure.When a frontalis sling is performed, scar tissue developes along the tract of the passage of the sling material, especially dependent on the type of material used. Reversal of the sling is not necessarily 100% if removed. If you previously had a sling, how long ago? If years, the surgeon can attempt to reverse, and there may still be the option of levator advancement or resection surgery. I usually tell my patients to be prepared for a permanent correction after ptosis, but if other conditions occur in the subsequent years, like trauma to the lids or bouts of lid swelling, ptosis can recur. Find a good oculoplastic surgeon to evaluate and perform your surgery.