botox info ver 1 - dr searles › uploads › files › documents › botox info ver 1.1.pdf ·...

BOTOX Treatments

Many wrinkles are actually creases that have been worn into the skin by making the same expression thousands of times. These are called "expression lines" or dy-namic wrinkles. Typical dynamic wrinkles include frown lines be-tween the eyebrows, crow’s feet around the eyes, and forehead lines. The presence of these wrin-kles can add years to our ap-pearance, often making us look angry, tired or worried when we are not.

BOTOX® Cosmetic™ injections is a remarkably safe and effective treatment which can help you to control your facial expressions so that you don't look angry or wor-ried when you aren't. BOTOX® Cosmetic™ injections treatments can help to prevent the unin-tended display of negative feel-ings, and in this way help some people to express themselves more accurately.

Dr. Searles is an Allergan BOTOX® Cosmetic™ and Therapeutic™ Injector.

While you may have earned every one of your worry lines, you don't have to show them if you don't want to! If dynamic wrinkles are starting to make you look older or more negative, BOTOX® Cos-metic™ injections can help restore the rested, confident appearance you desire.

Please call: 780/424-4464 if you have questions about BOTOX® Cosmetic™ injections, or to ar-range a prompt, confidential con-sultation and treatment.

No referral is needed for BOTOX® Cosmetic™ injections treatment.

BOTOX® Cosmetic™ injections treatments also provide a safe, non-surgical alternative for the reduction of laugh lines, neck

folds, and chin creases.

BOTOX® Cosmetic™ injections has been used safely and effectively for over fifteen years in adults and even in small children to treat many medical conditions where overactive muscles require relaxa-tion. Each year tens of thousands of patients receive BOTOX® Cos-metic™ injections treatments for a variety of medical conditions, and BOTOX® Cosmetic™ injections has also become a leading treatment for reversing some of the visible signs of aging by relaxing the muscles which cause many of our wrinkles. BOTOX® Cosmetic™ in-jections is also becoming a lead-ing treatment for excessive sweat-ing, and for migraine and tension headaches.

What is BOTOX® injec-tions?BOTOX® injections is a highly puri-fied, naturally occurring protein which has the ability to very pre-cisely relax the muscles to which it is applied. This relaxation lasts for a number of months, and then the treated muscles gradually return to their original condition.

BOTOX® injections does not affect the nerves responsible for sensa-tion, so there is no numbness in the

INFORMATION FOR PATIENTS ON AESTHETICS TECHNOLOGY VERSION 1.1

GORDON SEARLES, MD, FRCPC, FACP DERMATOLOGY AND INTERNAL MEDICINE PHONE: 780/424-4464 FAX: 780/424-2534 WWW.DRSEARLES.CA PAGE 1

This Information Package has been designed by Dr. Searles to answer your questions on this service.

Gordon E. Searles,OD, MD, MSc, FRCPC, FACP,

FAAD, FASDS, FASLMS

treated areas.

You can stop BOTOX® Cosmetic™ injections treatments at any time and be confident that you will gradually return to your pre-treatment appearance. If you have BOTOX® Cosmetic™ injec-tions treatments for several years, you may find that the clock will slow down or stop in the treated areas, in particular if you are care-ful to protect that skin from sun exposure and smoke.

What is the difference be-tween BOTOX® Cos-metic™ injections and fillers like Perlane™ and Artecoll® ?BOTOX® Cosmetic™ injections relaxes the muscles which cause many facial lines and unwanted facial expressions.Fillers like collagen (Zyplast™ and Zyderm™), Perlane™, Restylane™, Artecoll® and other products fill creases, lips, cheekbones, and also defects like acne scars. Sometimes BOTOX® Cosmetic™ injections is used in combination with fillers, for example when treat-ing frown lines on the lower fore-head or wrinkles around the lips.

How does BOTOX® injec-tions Work?The benefits of BOTOX® Cos-metic™ injections on wrinkles come from ability of BOTOX® Cosmetic™ injections to selec-tively and precisely relax the mus-cles which are causing wrinkles to occur. The skin over the treated muscles gradual ly becomes smoother and less wrinkled as the muscles relax.

A common use for BOTOX® Cos-metic™ injections is to reduce (of-ten by 70-80% or more) the really deep furrows and lines that many people have between their eye-brows. These lines can make peo-ple look quite angry or con-cerned, even when they are happy. Crow’s feet around the eyes can also add years to your appearance, and make you look like you are squinting much of the

time. Crow’s feet usually improve nicely when the muscles which cause the crow’s feet are treated with a bit of BOTOX® Cosmetic™ injections.

The treated muscles usually start to relax within a day or two, and reach their maximum degree of relaxation within a couple of weeks. About 2-4 months after the first treatment, the effects of the BOTOX® Cosmetic™ injections gradually start to wear off. If you liked the effect of your BOTOX® Cosmetic™ injections treatment (and almost everyone DOES like it), you will want to return for an-o t h e r t r e a t m e n t w h e n t h e BOTOX® Cosmetic™ injections effect starts to wear off.

If you have a second treatment before the treated muscles have returned to their old bad habits, your second treatment will usually last longer (perhaps 3-5 months, instead of 2-4 months). Likewise, if you have your third BOTOX® Cos-metic™ injections treatment when you notice that the second treat-ment is starting to wear off, the third treatment may last 5-6

months instead of 3-5 months. Some people who maintain their BOTOX® Cosmetic™ injections find after a couple of years that they can go 6-12 months between treatments.

Untreated facial muscles continue to contract in their usual way, so that normal facial expression is unaffected. Because it relaxes the muscles that cause dynamic wrin-kles, BOTOX® Cosmetic™ injec-tions treatments can also prevent new lines from forming in the ar-eas on your face, forehead and neck which are treated.

D o e s B O T O X ® C o s-metic™ injections work for all kinds of wrinkles and skin folds?Not all facial wrinkles are related only to activity of underlying mus-cles. These deep creases and skin folds (also known as static wrin-kles) are the ones that can still be seen when the skin is lightly stretched with your fingers. Static wrinkles are made worse by sun exposure, by the natural maturing



process, and in particular by smoking. Many static wrinkles re-sult from a combination of muscle activity and aging, and can be greatly improved when BOTOX® Cosmetic™ injections (to relax the underlying muscles) is used in combination with f i l l ing sub-stances like Perlane™, Restylane™ or Artecoll® .

Fo r peop le who have had chemical/laser peels and injec-tions of collagen, Perlane™ Resty-lane™ and Artecoll® , BOTOX® Cosmetic™ injections can prevent or delay the development of new wrinkles and furrows, and so can reduce the long-term need for additional laser resurfacing and for injection of filling substances.

In some cases, BOTOX® Cos-metic™ injections can be used to delay or eliminate the need for a surgical procedure like a facelift, browlift or necklift; and BOTOX® Cosmetic™ injections (by reduc-ing muscle activity which might undo the surgeon’s fine work) can be used to prolong and enhance the effects of those procedures if you have already had them done.

What is BOTOX® Cos-metic™ injections treat-ment like?BOTOX® Cosmetic™ injections treatments are gentle and quick. No sedation or local anesthetic is required, so you will be able to continue with all of your usual ac-tivities immediately after your treatment. You can certainly drive yourself home or back to the of-fice.

BOTOX® Cosmetic™ injections treatments take only a few min-utes, and performed personally by Dr. Searles, using the finest 31 gauge needles to maximize your comfort.

A small amount of discomfort may be felt when the needle is inserted and a few drops of BOTOX® Cos-metic™ injections are applied to exactly the muscles which need relaxation. This sensation lasts ap-proximately 5 seconds. Many pa-

tients are pleasantly surprised by the lack of discomfort, in particu-lar when they are treated with the very fine and smooth 31 gauge needles.

Occasional patients experience a slight temporary bruising, perhaps the size of their baby fingernail, at an injection site. This can be hid-den with cover up, and fades away in a few days.

Are there any special in-structions for me to follow after treatment?1. Exercise the treated muscles during the two hours after your BOTOX® Cosmetic™ injections treatment.

To ensure the best possible uptake of BOTOX® Cosmetic™ injections by the treated muscles, Dr. Searles will encourage you to exercise the treated muscles using normal fa-cial movements during the first 2 hours after your BOTOX® Cos-metic™ injections treatment.

For example, so that your BOTOX® Cosmetic™ injections will work to maximum advantage:

o frown to exercise the muscles above and between the eyebrows which frown lines,

o raise the eyebrows to exercise the muscles which cause forehead wrinkles, and

o squint and smile to exercise the muscles which cause crow's feet.

2. Do not touch or rub the treated areas until two hours after your BOTOX® Cosmetic™ injections treatment.

It is also important for you to avoid rubbing or pressing on the in-jected areas for 2 hours to avoid spreading BOTOX® Cosmetic™ injections out of the treated mus-cles and into non-targeted mus-cles.

If your BOTOX® Cosmetic™ injec-tions was moved out of the mus-cles it is injected into, there might less effect on those muscles, and unwanted temporary relaxation of nearby facial muscles, which

could be a nuisance for a week or two. In rare cases (perhaps one case in a hundred), this unwanted relaxation of muscles could cause temporary drooping of an eyelid or slight asymmetry of facial ex-pression. Because the effects of BOTOX® Cosmetic™ injections are completely reversible, these rare side effects are temporary, and resolve after a few weeks.

After two hours, there are no re-strictions at all.

How much do BOTOX® Cosmetic™ injections treatments cost?In Canada, BOTOX Cosmetic™ is not expensive; however there is a cost involved. Many cosmetic treatments were once considered a luxury item only for those who had a high disposable income. BOTOX Cosmetic™ is very afford-able even for those with modest incomes, but some people need to budget for it just as they would for buying accessories like shoes and having their hair styled.

Having successful cosmetic treatments for your face is not ex-pensive, it is priceless.

BOTOX® Cosmetic™ injections is priced at $10 per unit.

BOTOX® injections treatments may be a tax-deductible medical expense (similar to dental, ortho-dontic and cosmetic surgery bills), so save your receipts!

Typical BOTOX® Cosmetic™ injec-tions treatments use:

o Glabellar frown lines: (between and just above the eyebrows) 25-40 units of BOTOX® injec-tions

o Upper forehead lines: 15-20 units of BOTOX® injections

o Crow’s feet: (wrinkles and squint lines radiating outwards from the outer corners of the eyes) 20-40 units of BOTOX® injec-tions

o Anterior neck: (to reduce jowls, and to reduce vertical and horizontal lines on the anterior neck ) 30 - 40 units of BOTOX®



injections

If your drug plan covers the cost of Botox Therapeutic™ for sweat-ing or headache, your only cost for treatment of the following will be Dr. Searles's fee. Otherwise, Botox Therapeutic™ will cost you $4 per unit.

o Excessive sweating of the hands or feet: $300 per session for either or both hands, or either or both feet, plus $4 per unit of BOTOX® injections

o Excessive sweating of the arm-pits: $250 fee for either or both armpits, plus $4 per unit of BOTOX® injections

o Migraine and muscle tension headache: $250 fee, plus $4 per unit of BOTOX® injections

Some people (in particular some men) get best results with high doses (for example: 60-80 units of BOTOX® injections for glabellar frown lines, 40-50 units for crow’s feet, 40-80 units for the neck. To make it easier for you to get the best possible treatment Dr. Searles provides a price reduction ($150 + $4 per unit) for areas which require large amounts of BOTOX® injec-tions.

Am I vain?Many people at some time before BOTOX® injections treatment for wrinkles or excessive sweating have fears and doubts. A com-mon concern is that they are be-ing vain. My experience has been that just about all patients who have BOTOX® injections treat-ment, laser hair removal, and other procedures to maintain their appearance and comfort are no more vain than anyone else. What does distinguish these individuals is a desire to get the most out of life, and to look as good as they feel.

Looking after your appearance is not a fault. After all, would you leave your house with broken gut-ters or peeling paint? Why do less for your body? I think you should feel proud of yourself for having the will and the ability to change something that you find unac-ceptable. I emphasize that you

should only have BOTOX® injec-tions treatment, laser hair removal, and other treatments if it is for you. It is a big mistake to do these things if it is just for somebody else.

As Dr. Richard Glogau of San Francisco has noted: the same self-esteem that makes our pa-tients successful in their chosen fields, precise in their consultation questions, well groomed and well dressed, and often careful in their diet, exercise, and other aspects of health maintenance lead our patients to seek help for their wrin-kles and frown lines.

These individuals are normal healthy people, and the same degree of se l f - interest that prompts them to exercise, be se-lective in what they eat and drink, and protect themselves from sun damage leads them to explore the benefits of BOTOX® injections. Our patients simply want to look their best.

What are the possible side effects?There have been no long-term side effects, allergic reactions or health hazards related to BOTOX® injections use thus far. Some pa-tients have been getting BOTOX® injections treatments for more than 10 years, with no problems.

Are there people who should not use BOTOX® injections?People who are pregnant, breast feeding, have rare neurological disorders like Eaton-Lambert syn-drome or myasthenia gravis, or who are allergic to albumin should generally not be treated with BOTOX® injections.

Botox Therapeutic™ for headaches.A number of patients treated with BOTOX® injections for lines on the forehead, frown lines between the eyebrows, and for crow’s feet have reported that a pleasant side effect of BOTOX® injections treatment was reduction or elimi-nation of headaches. BOTOX®

injections used for headaches and for excessive sweating sweating is marketed as Botox Therapeutic™, DIN 01981501. This is the same medication as BOTOX® injections, but has a different DIN# so that some drug plans will pay for it when it is being used to treat medical rather than cosmetic in-dications.

Formal studies of patients with headaches have confirmed that BOTOX Therapeutic™ treatment often reduces the frequency and intensity of both muscle tension headaches and also some mi-graine headaches. Patients who respond well to BOTOX Therapeu-tic™ generally experience im-provement within a few days, sometimes enjoy several months of relief from headaches, and are able to greatly reduce (and in some cases eliminate) headache medications. Many drug plans pay for BOTOX Therapeutic™ for headache, because this can be very cost effective when it re-duces consumption of medica-tions, and allows patients to avoid missing work. An increasing dura-tion of effect is often noted in headache patients who repeat their BOTOX Therapeutic™ treat-ments as soon as they notice that the BOTOX Therapeutic™ effect is declining.

In some cases, each point which you can identify as being associ-ated with your headaches will be



injected with BOTOX Therapeu-tic™, usually starting at 5 to 10 units of BOTOX Therapeutic™ in each point. In other cases, it is more effective to treat larger ar-eas (for example, the forehead and sides of the scalp) with a total of 75-100 units of BOTOX Thera-peutic™, or as much as 150 units if the posterior scalp and neck are also treated.

Botox Therapeutic™ is also used for the treatment of temporo-mandibular joint (TMJ) discomfort, and bruxism. In these cases, BOTOX Therapeutic™ is injected into the masseter muscles.

Some questions to ask yourself when consider-ing BOTOX Therapeutic™ for headache:o On how many days in the last 3

months did you miss work or school because of your headaches?

o How many days in the last 3 months was your productivity at work or school reduced by half or more because of your headaches? (Do not include days you counted in question 1 were you missed work or school).

For the next two questions, house-hold work means general house-work, home repairs, shopping, car-ing for family or other activities around the home.

o On how many days in the last 3 months did you not do house-hold work because of your headaches?

o How many days in the last 3 months was your productivity in household work reduced by half or more because of your headaches?

o On how many days in the last 3 months did you miss family, social or leisure activities be-cause of your headaches?

o On how many days in the last 3

months did you have a head-ache? (If a headache lasted more than one day, count each day).

o On how many days in the last 3 months did you have to take medications for headache?

o On a scale of 1-10, on average how painfu l were these headaches?(Where 0 = no pain at all, 10 = pain as bad as it can be).

o When you have headaches, how often is the pain severe

o How often do headaches limit

your ability to do usual daily activities including household work, employment, school, or social activities.

o When you have a headache, how often do you wish you could lie downIn the past 4 weeks, how often have you felt fed up or irritated because of your headaches

o In the past 4 weeks, how often have you felt too tired to do work or daily activities be-cause of your headaches

o In the past 4 weeks, how often did headaches limit your abil-ity to concentrate on work or daily activities

BOTOX Therapeutic™ to control excessive sweat-ing.The facts about hyperhidrosis: BOTOX Therapeutic™ is frequently used to control hyperhidrosis (ex-cessive sweating) of the armpits and palms, and occasionally other parts of the body. About one person in 100 has a serious problem with excessive sweating in these areas. This usually starts in childhood or adolescence, and sometimes other family members have a similar problem. This kind of excess sweating is caused by a reflex reaction of the nervous sys-tem and is beyond voluntary con-trol. Excessive sweating is some-times brought on by stress or heat, but often there is no cause, which can be identified.

BOTOX Therapeutic™ for exces-sive sweating is covered by many drug plans – we will do all the necessary paperwork for you.

Many patients who are treated with BOTOX Therapeutic™ in the axillae are also please to note that there is a great improvement in body odor – "bromhidrosis" – from the axillae!

Considerable emotional and so-cial stigma can be attached to excessive sweating of the hands and armpits, and this can lead to a loss of confidence and self-esteem. For example, those af-flicted with excessive sweating often feel that -- when people see big sweat marks under their arms or feel their sweaty palms -- they may decide that the individual is nervous or insincere, even when that is not the case.

Social engagements and simple things like physical contact with other people may be avoided because of uncontrollable sweat-ing.

Patients afflicted with excessive sweating can routinely soak through clothing in a matter of minutes, and some patients have to use Kotex™ pads in their arm-pits, shields, absorbent tissues and



frequent changes of clothing to cope with the disorder. Shirts and jackets can be quickly stained and ruined, and dry cleaning and replacement of clothing is some-times a substantial expense.

BOTOX Therapeutic™ -— hyperhi-drosis treatment that works…Unlike antiperspirants and other topical treatments for excessive sweating, BOTOX Therapeutic™ targets sweating at its source. BOTOX Therapeutic™ enters the specific glands which are respon-sible for excessive sweating and blocks the release of a chemical which causes the production of excess perspiration. In clinical studies, 95% of patients with hy-perhidros i s that was severe enough to interfere with their daily lives experienced the benefits of BOTOX Therapeutic™ after just one week, with sweating reduced by an average of 83%.

...and keeps on workingHalf of patients report that after one BOTOX Therapeutic™ treat-ment they are free of excessive sweating for more than 7 months, and more than one third of pa-tients are still free of excess sweat-ing after one year. Because you continue to sweat normally in other areas, there is noconcern about overheating.

Questions to ask yourself when deciding whether or not to invest igate BOTOX Therapeut ic™ treatment for excessive sweating include:o Over the past week, how em-

barrassed or self-conscious have you been because of your sweating?

o Over the past week, how much has your sweating interfered with normal activities like shopping or looking after your home?

o Over the past week, how much has your sweating influenced the clothes you wear?

o Over the past week, how much has sweating affected any

social or leisure activities?

o Over the past week, how much has sweating made it difficult for you to enjoy any sport?

o Over the past week, has your sweating interfered with work-ing or studying?

o Over the past week, has your sweating created problems with your partner, friends or relatives?

o Over the past week, how much has your sweating created sexual difficulties or interfered with intimacy?

Individuals troubled by excessive sweating often do not respond adequately to antiperspirants, and they may not respond to (or be willing to tolerate) systemic medications, electrical treatments on the areas of excessive sweat-ing, permanent destruction of the nerves which control sweating, or surgery (in the armpits) to either scrape away the sweat glands or to cut out the areas of excessive sweating.

BOTOX Therapeutic™ treatment, by contrast with the above, is a simple office procedure with little discomfort or risk; and can be much less expensive than surgery. Some people wil l only want BOTOX Therapeutic™ treatment before an important event (for example, a wedding). Others, whose sweating is mainly a prob-lem during hot weather, may have BOTOX Therapeutic™ treatment at the start of every summer. BOTOX Therapeutic™ treatments can be safely continued year-round if necessary to maintain

control of your sweating.

Before your BOTOX Therapeutic™ treatment, a simple iodine solution may be applied to the area of excessive sweating. This solution is allowed to dry, and then pow-dered starch (of the sort found in most kitchens) is sprinkled on the area. Where there is excess sweat-ing, the moisture of the sweat al-lows starch to combine with io-dine, producing a dark blue color. This starch-iodine test indicates the precise areas of excess sweating, and allows us to concentrate the BOTOX Therapeutic™ treatment where it is needed -- reducing both the number of injections and your costs. The blue marks from the starch-iodine test will be wiped off after your BOTOX Therapeutic™ treatment.

When it is used to control exces-sive sweating, BOTOX Therapeu-tic™ is injected (using ultra-fine needles) into the top layer of the skin (where the sweat glands are) rather than into the muscles under the skin (as is the case when we are treating dynamic wrinkles, muscle tension headaches and some migraine headaches).

Treatment of the armpits is easy, and no anesthetic is needed. Both armpits can be treated at the same time.

In most cases excessive sweating of the hands and feet can be treated without anesthesia. Dr. Searles has pioneered the use of ice to prevent discomfort when treating the palms and soles with BOTOX® injections, and has taught this technique to other physicians at meetings across Canada, and in the United States and Mexico. Your BOTOX® injec-tions treatment will be done in a way that greatly reduces sweat-ing with little or no effect on the muscles.

If small areas of troublesome sweating persist, they can be identified with a starch-iodine test and then treated at relatively low cost with BOTOX Therapeutic™ when you return for follow up sev-eral weeks later.



After BOTOX Therapeutic™ treat-ment, excess sweating starts to decrease within a couple of days, and the full effect in reached in a week or two. The goal of BOTOX Therapeutic™ is reduction of sweating to a normal level, but not total elimination of sweating to the point where the treated area becomes abnormally dry.

Patients usually report very high satisfaction with BOTOX Therapeu-tic™ treatments, return for addi-tional treatments, and would rec-ommend BOTOX Therapeutic™ treatments to their friends.

Consultations about treatment with BOTOX® injections or with BOTOX Therapeutic™ can usually be arranged within two or three weeks simply by calling our book-ing line: (780) 424-4464. Treatment can be done the same day as the consultation, if you wish.

Our staff can take the time to dis-cuss your wishes and options, and answer your questions.No referral is required.



Getting to Know your Options through the Con-sultation ProcessAesthetic dermatology, laser serv-ices and healthy skincare are the most effective ways to enhance your natural beauty and to pre-vent further skin damage. Dr. Sear-les and his team of trained nursing staff offers consultations for all cosmetic and laser procedures and skincare offered at our office.

A consultation includes a com-plete evaluation of your skin his-tory, depicting your skin care concerns and goals, and a treat-ment and skincare regimen based on those areas evaluated. The treatment and skincare options will be described in-depth to you so that you understand all of the necessary information for begin-ning the recommended regimen. This information includes, but is not limited to, description of the treatment, pre- and post- treat-ment protocols, risks and side ef-fects, costs, and before and after examples. If an area of concern is not treat-able with the technology and therapies available at Keystone Dermatology, we will refer you to a qualified professional in that field.The consultation is designed to provide you with all of the infor-mation necessary for you to feel most comfortable in receiving the benefits of these treatments and skincare programs.

About Dr. Searles…

Dr. Searles is dually certified by the Royal College of Physicians of Canada in both Internal Medicine and Dermatology. He has been honoured to be elected as a Fel-low of the prestigious American College of Physicians. He is a member of numerous National and International medical organi-zations devoted to the discovery and application of new ideas and techniques for treating medical and esthetic skin conditions.

Dr. Searles is a Clinical Professor in Medicine at the University of Al-berta, and is the Director of Resi-dent Training for Dermatology.

Dr. Gordon Searles’ primary mis-sion is to deliver the best care pos-sible through the use of the latest advances in medical research and new technologies.

A Fellow of the ASLMS

A Fellow of the ASDS

Peer-Elected to Best Doctors in Canada, 2008

A Fellow of the CDA

Mem- ber of the CDA



Gordon Searles Professional Corporation

atKeystone Dermatology

Institute

Suite 303, 2377 - 111 StreetEdmonton, Alberta T6J 5E5Canada

Phone: 780-424-4464

Fax: 780-424-2534

E-Mail: [email protected]

Hours:Monday, Tuesday, Thursday7:30 am - 11:30 am12:30 pm - 4:30 pmWednesday12:30 pm - 4:30 pmFriday7:30 am - 11:30 am

We’re on the Web! See us at:

www.keystonedermatology.com

This Information Package is prepared

for you by:

Suite 303, 2377 - 111 StreetEdmonton, Alberta T6J 5E5Canada

Phone: 780-424-4464

Fax: 780-424-2534

E-Mail: [email protected]

Hours:Monday - Thursday7:30 am - 11:30 am12:30 pm - 4:30 pm

Friday7:30 am - 11:30 am

We’re on the Web! See us at:

www.drsearles.ca

mailto:[email protected]

mailto:[email protected]

http://www.keystonedermatology.com

http://www.keystonedermatology.com

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