Botox Cosmetic Injections

When considering treatment options for facial wrinkling and signs of aging many people focus on the area around the eyes. A more rested and youthful look in the periorbital (eye) region can have a tremendous impact on your appearance.

Botox Cosmetic is a purified protein that is injected in minute amounts to weaken specific muscles causing unwanted lines to soften. The most notable wrinkles in the eye area occur between the eyebrows in an area known as the glabella. These vertical furrows are due to the action of several muscles most notably the corrugators and the procerus. This is the area for which the injection of Botox Cosmetic received its FDA approval. Another common group of wrinkles around the eyes are known as "crow's feet". These are often the result of smiling or squinting. A third area in the upper face where wrinkling may develop is the forehead. These horizontal furrows are the result of the action of the frontalis muscle. These three areas are the most typical areas patients will chose to soften with Botox. Other areas where Botox may be effectively used are around the mouth, softening the lines caused by pursing the lips or turning down the corners of the mouth, and the neck, reducing the vertical banding.

Effects from Botox Cosmetic are seen within several days following treatment and last for three to four months. The results are always temporary, but after several treatments, the muscles causing the wrinkles may atrophy, prolonging the effect of the Botox. However, it is never permanent.

Botox has been used safely for more than two decades for neurologic conditions such as strabismus ("lazy eye") and blepharospasm (uncontrolled blinking). It was first used for facial wrinkling in 1989. A very small amount of Botox causes a significant effect. Botox works by selectively and temporarily weakening the muscles into which it is injected. By weakening the muscles, the associated lines are softened.

Potential risks with the proper use of Botox Cosmetic are rare and temporary. Mild bruising may occur that can be covered with make-up, or asymmetry may occur that can be corrected. Quite rare complications include drooping of an eyelid or double vision; again, the effects are temporary and treatable. The Florida botulinum toxin scare early in 2005 involved the use of an unapproved and extremely potent toxin that was not Botox Cosmetic.

Soft Tissue Augmentation

Soft tissue augmentation involves the injection of fillers to plump up lines and scars due to aging, acne and trauma. Dr. Washburn offers injections with the FDA approved products Zyderm, Zyplast, Cosmoderm, and Restylane. These substances are composed of either collagen or hyaluronic acid which are two of the most abundant substances normally found in the deep layers of healthy youthful skin.

Zyderm, Zyplast and Cosmoderm are all injectable collagens. They have been used for many years to treat fine lines, wrinkles and scars of the face. Zyderm and Zyplast are derived from bovine (cow) collagen and have the longest track record of use. They work beautifully at filling in the lines around the nose, mouth, and between the eyebrows. The results are immediate and last for three to four months. Repeated treatments several times a year are necessary to maintain your results. About 3% of people are allergic to bovine Collagen and therefore two skin tests are performed to determine if you are allergic prior to treatment. Cosmoderm is a newer product that is derived from human collagen and therefore does not carry the risk of allergy. Therefore, treatment with Cosmoderm may be carried out without allergy testing. Side effects of all type of injectable collagen are rare but include bruising, scabbing, infection and bumps in the skin. There has been no proven relationship between the use of injectable collagen and the development of autoimmune diseases.

Restylane was developed in response to the desire to find a safe and longer lasting injectable for soft tissue augmentation. Restylane is a nonanimal based hyaluronic acid gel. Restylane differs from bovine Collagen in that there is little risk of allergy, so no skin test is required, and it lasts about twice as long as Collagen. We have also been impressed with how much softer and more natural it feels. Injections with Restylane are a little more painful than with Collagen and therefore local numbing with nerve blocks are used. Restylane commonly causes swelling for a day and therefore is best not done the day of a big event.

Soft tissue augmentation differs from Botox Cosmetic injections in that Botox relaxes the muscles that cause facial wrinkling and soft tissue augmentation plumps up lines and furrows with a temporary filler. A terrific combination is Botox Cosmetic for the forehead and eye area and fillers for the area around the mouth.

Be sure to tell us if you have a history of cold sores around the mouth, are pregnant or nursing, or are taking any medications or supplements that could increase your risk of bleeding including aspirin, ibuprofen, coumadin, Vitamin E, alcohol, ginko, garlic, or St. Johns Wort.

Sclerotherapy

Sclerotherapy has been used for decades for the treatment of unwanted spider and varicose veins of the legs. It involves the use of a tiny needle to inject an irritating solution into a vein obliterating it under the surface of the skin. The vein then dissolves and the work of carrying the blood is shifted to other healthy blood vessels nearby, improving circulation

Spider veins are tiny dilated blood vessels located close to the surface of the skin. They generally pose no health hazard, but may produce a dull aching after prolonged standing. Varicose veins are abnormally dilated blood vessels caused by a weakening in a vein’s wall. They can be harmful to your health because they may be associated with the development of phlebitis, blood clots, swollen ankles or leg ulcers.

Spider and varicose veins are common. Almost 40% of women develop them at some point. They are four times more common in women, but occur in men too. Heredity, pregnancy, hormonal changes, obesity and a sedentary lifestyle are just some of the known causes.

Dr. Washburn uses either a concentrated saline solution or a specially developed FDA approved chemical solution (Sotradecol) for injections. While injections with Sotradecol are less painful than with saline, there is a small risk of an allergic reaction. Prior to treatment, the solution that is best for you will be determined.

Sclerotherapy requires multiple treatment sessions. One to three injection sessions per leg are often required to significantly clear unwanted veins. The same leg should not be retreated more often than every six weeks to allow for healing between sessions.

After treatment you must wear compression stockings for one to two weeks depending on the size of the blood vessels treated. Walking and moderate exercise help speed recovery. High impact exercise such as running is discouraged. Taking medications or supplements which thin the blood such as aspirin, ibuprofen, coumadin, vitamin E, alcohol, garlic, St. Johns Wort and ginko may decrease the effectiveness of treatment. Temporary reactions such as slight swelling of the leg or foot, bruising, itching, or brownish discoloration of the treated area may occur. If swelling is painful or persistent, call us immediately.

Alternatives to sclerotherapy include surgical ligation and stripping, ambulatory phlebectomy and laser treatment. These options will be discussed with you at the time of your consultation. Sometimes Dr. Washburn will request a noninvasive vascular ultrasound prior to your treatment to determine if sclerotherapy will be safe and effective for you. She will also refer you to a vascular surgeon if she feels surgery is your best option.

Dr. Washburn has had extensive training in sclerotherapy, having received a Women’s Dermatologic Society Scholarship for a mentorship with international expert Dr. Mitchel Goldman in San Diego, California and pioneering the Vein Center at New England Medical Center along with members of the Department of Vascular Surgery.

Photorejuvenation with Intense Pulsed Light

Photorejuvenation with Intense Pulsed Light (IPL) uses light energy to improve or eradicate brown spots, broken blood vessels, and blotchy redness. These discolorations may be due to sun exposure, aging, pregnancy, past trauma or rosacea. IPL also improves the skin’s texture by stimulating collagen production deep within the skin. This makes pores appear smaller and fine lines less noticeable. Light of multiple wavelengths passes through a rectangular crystal into the skin while the skin is cooled and protected by a layer of clear gel.

The entire face may be treated in one 20 minute session. The neck, chest and back of the hands may also be treated safely. There is a slight stinging sensation with each pulse of light. Most patients do not find this painful. For those who wish to be as comfortable as possible, a topical anesthetic such as LMX or EMLA may be applied one hour before the procedure.

The change in your skin will be gradual and cumulative over a series of approximately five monthly treatments. While there may be slight temporary redness or darkening of brown spots after the procedure, make-up may be applied right away and you may resume normal activities.

In order to maintain your results it is essential that you protect yourself from the sun and continue any recommended treatments for rosacea or other underlying skin conditions. A maintenance IPL treatment is recommended every three to six months.

Photodynamic Therapy

Photodynamic Therapy (PDT) is a relatively new treatment using laser with the additional application of a naturally occurring photosensitizing liquid chemical called Levulan (20% aminolevulinic acid). This enhances the results of photorejuvenation. PDT was initially used experimentally in the treatment of nonmelanoma skin cancers but was recently FDA approved to treat precancerous skin lesions called actinic keratoses. Levulan is applied to the skin in the office; after 30-90 minutes the Levulan is “activated” with IPL. PDT can improve the appearance of sun damaged skin, rosacea, acne, and sebaceous hyperplasia. It can also decrease the oiliness of skin and improve skin’s texture and decrease pore size. The use of Levulan for any skin condition other than actinic keratoses is “off-label”. Adding Levulan to IPL makes the entire experience more intense. The results are more rapid and are generally seen after three treatments rather than five. The side effects are also more intense. After PDT you must absolutely avoid any sun exposure (even through window glass) for 24 hours. The Levulan has been absorbed into your skin and may be activated even by ambient light. There may be some discomfort, burning sensation, swelling, redness and possible peeling of the skin for several days. Tylenol may be taken for discomfort and Aquaphor may be applied to any crusted areas.

With either type of photorejuvenation, IPL or PDT, it is imperative to protect the treated skin from the sun for a full four weeks prior to treatment. This is best accomplished by the daily use of an SPF 30 broad spectrum sunscreen containing zinc or titanium daily and wearing a hat. Any tan or “color” from the sun can increase the risk of side effects and decrease the effectiveness of treatment. Likewise, self tanners should not be used within two weeks of treatment. Retin A or Renova should be discontinued two days prior to treatment. Medications that make you more sensitive to sunlight, such as tetracycline, should be discontinued three days prior to treatment if possible. Medications that thin the blood such as aspirin, ibuprofen, coumadin, vitamin E, alcohol, ginko, garlic, and St. John’s Wort all increase your risk of bruising and are best avoided for one week before treatment.

Chemical Peels

We offer both mild Glycolic Acid and slightly more aggressive Salicylic Acid Chemical Peels. With a chemical peel the skin is not actually “peeled off” in layers, but is irritated so that the dead layer almost imperceptibly flakes off over a period of days. Glycolic acid is a naturally derived fruit acid that belongs to the alpha hydroxy acid (AHA) family. Salicylic acid is a beta hydroxy acid (BHA). Both peels are considered superficial and therefore cause very minimal discomfort or downtime.

Improvement is gradual and cumulative; therefore a series of multiple peels is required. Each peel takes less than 15 minutes. You may have mild redness, but can return to normal activities immediately. This lack of downtime has earned these peels the nickname the “lunch time peel”.

Fine wrinkling, brown spots from the sun or the “mask of pregnancy”, sallow skin from sun damage, acne, and clogged pores can all be addressed with chemical peels.

Be sure to discontinue the use of Retin-A or Renova the night before a peel and tell us if you have a history of cold sores, recently took Accutane, or are pregnant or nursing.

Pulsed Dye Laser for Redness

Pulsed Dye Laser (PDL) has been used safely for nearly two decades to treat benign facial redness due to dilated or excess blood vessels. Angiomas, hemangiomas, spider veins, rosacea, and portwine birth marks can all be treated with PDL.

We use the Candela V-Beam laser which emits a yellow light that is absorbed by red blood cells. Because red skin lesions have excess amounts of blood, they will absorb a lot of laser light and be destroyed preferentially over other skin structures. This makes the risk of scarring extremely low.

The laser is coupled to a cooling device rendering the treatment virtually painless. Patients have compared the sensation to the snapping of a rubber band against the skin. In particularly sensitive patients or children topical anesthetic cream may be applied.

The number of treatments necessary to clear an area varies depending on the darkness, thickness, or location of a lesion, and the age of the patient. After treatment the area may appear bruised for a few days.

Usually this treatment is for cosmetic reasons and is therefore not covered by insurance. Whether or not your treatment is covered by your insurance depends on your policy. Many carriers will cover treatment of red birthmarks in children but almost none will cover treatment of spider veins or angiomas in adults.

Thermage

Thermacool TC from Thermage is a revolutionary FDA approved skin tightening device. It has been successfully used in over half a million people worldwide since 1997 to reduce jowls and neck laxity, lift the brows, tighten and lift skin around the eyes and tighten skin on the abdomen, thighs and upper arms. It is a quick, safe in office procedure with no downtime. Results gradually occur over 4-6 months and may last a couple of years. This radiofrequency device has been popularized on Oprah and in women’s magazines as a “non-surgical facelift”, and while we feel the results are not nearly as extreme as those of surgery, Thermage will continue to play a major role in noninvasive tightening of aging skin. For more information, go to www.Thermage.com.

Laser Hair Removal

Laser hair removal has been a welcome option for the permanent reduction of unwanted hair. As opposed to shaving, waxing and depilatories which must be repeated indefinitely, laser actually destroys the hair follicles and is best compared to electrolysis. While electrolysis uses a needle to deliver an electrical current into each individual hair follicle, laser treats larger areas at one time and is much less painful with less risk of inflammation, scabbing and scarring.

Lasers work via the principle of selective destruction of a specific target. In the case of laser hair removal the target is dark (melanin) pigment within the hair follicle. One of the challenges is that melanin is also found in the skin. The ideal candidate for laser hair removal has very dark hair and very light skin.

Individual hairs go through a predictable life cycle: first growing, then resting, then falling out. Only hairs in the active growing phase have pigment in their follicles and are therefore the only hairs destroyed by laser. In any area of your body only some of the hairs will be in the active growing phase at any one time. Therefore, several treatments are necessary in order to catch hairs in the growing phase. Usually at least five treatments are necessary to see significant (greater than 80%) reduction in body hair, however, the hair will be less coarse with each treatment.

Many lasers are available for laser hair removal. We use the Intense Pulsed Light (IPL) system from Lumenis. The IPL is an extremely safe, comfortable and effective way to remove unwanted hair smoothly and in many skin types.

If you feel laser hair removal may be right for you, please call us to set up a free consultation with our medical assistant. Remember not to wax, pluck, bleach or use a depilatory on you hair for at least 4 weeks before your treatment. Let us know if you have a history of herpes cold sores. You cannot be treated if you have a tan or are pregnant.

Skin Care Products

The products we carry are clinically tested and scientifically based skin care products that have been proven to perform. We look for products that contain a minimum of potentially irritating or allergenic chemicals such as MD Forte, Lumiere Eye Cream, Skin Medica, Person & Covey, Prevage MD (1% idebenone) antioxidant cream. We are also pleased to offer Wallaroo UPF 50 (SPF 30) hats and Truform support stockings. Stop by to meet with one of our medical assistants who will help you choose products that are right for you.

To order:

If you have any questions, please call Dr. Washburn's office for assistance 781-235-1533.