We get Questions…
Dear Dr. Hyland, please tell us:

Q. How safe is Botox - I heard it was a toxin - surely it can't be good to inject something like that into your face?

A. Many modern day drugs as discovered in nature are refined by science so as to render them safe to use in specific clinical situations.

• e.g. Digitoxin, a product of the foxglove flower, is a poisonous if ingested, but has been refined into digoxin, a life- saving drug for heart failure;
• Curare – a substance used by natives of the Amazon jungle for poison arrows, is widely used in anesthetics;
• Streptokinase, a toxin produced by streptococcal bacteria, is used as a clot dissolving drug in heart attacks;
• Penicillin, which is widely used to treat bacterial infections, is derived from mould Penicillium Chrysogenum.

Botox is derived from a protein produced by the Clostridium Botulinus bacteria which has the property of interrupting the transmission of nerve signals to the motor units of muscle fibers; like many modern medicines derived from botanical or bacteriological sources, which have toxic properties in nature. Botox like Digitoxin, Curare, Streptokinase and Penicillin is not only safe, but very beneficial for use in specific clinical conditions.

When we use Botox, we are NOT injecting the bacteria – but rather the purified protein produced by the bacteria… in the same way as when we prescribe penicillin, we are not giving you the mould that originally produced penicillin….

In actual fact, BoTox has been used in the treatment of a number of medical conditions since the early 90’s, when its potential use as a cosmetic agent was intuited and researched by a Canadian ophthalmologist, Dr. Jean Carruthers, who noted that adult patients having perioccular injections of Botox for strabismus, also exhibited diminution of perioccular wrinkles - crow’s feet.

She experimented with injecting the product into a volunteer’s frown lines; and with the erasure of the frown lines came the birth of the phenomenon later trademarked as BoTox Cosmetic. Prior to this discovery, the only way to erase frown lines was to surgically remove the corrugator muscle from the patient’ forehead.

Nowadays, Botox therapeutic is used in the treatment of cerebral palsy, motor tics, cervical dystonia, bruxism (tooth grinding), overactive bladder, excessive sweating (hyperhydrosis), as an adjunct in the treatment of migrane headaches, and even in some cases of prostatic hypertrophy.

Q. How exactly does it work, and where can you use it?

A. As mentioned above, it interrupts the transmission of nerve signals to the motor units of muscles; for cosmetic purposes, it can be used to diminish frown and forehead lines; wrinkles around the eyes; tight cords or lines in the neck; imbalances in the muscles of the lower face – such as downturned mouth, vertical lines above and below the mouth related to puckering, dimpling of the chin etc., it can even be used to give a slight lift to the brows…

Q. How long does it last?

A. The average duration is 4 months, although some people may get up to 6 months with repeated use over a period of a couple of years.

Q. Will I end up with a frozen face?

A. Not if your treatments are done by an experienced cosmetic physician who understands your desire to retain facial expressivity. “Frozen faces” are the result of overzealous and indiscriminate use of the product by inexperienced injectors.

Q. Does it hurt?

A. Only a teeny bit as we use teeny weeny fine little insulin needles to inject the product!

Seriously, the injections are barely perceptible, and if you have a needle phobia, we can use some topical anaesthetic gel to numb the area beforehand. If you have ever had a blood test, a needle to deaden pain, or a flu shot, you will find Botox injections hardly noticeable compared to these.

Q. What side effects could I expect?

A. There are no known long-term side effects. Perhaps a transitory redness or slight swelling at the site of injection; rarely a tiny bruise; extremely rarely a mild tenderness in the area or flu-like symptoms lasting for about an hour post procedure….

Q. How much does it cost?

A. We charge according to the specific procedure; one size does not fit all, and the dose will vary according to the number of areas treated, the depth/severity of the wrinkling; but as a rough guide, one could expect to pay between $200-300 for frown lines; $200-250 for a Botox brow lift; from $200-$400 for crow’s feet, and about $80- $100 per neck band.

Q. Are there any people who can't have Botox?

A. We do not advise treatment for pregnant women, those with neuromuscular disorders such as Myasthenia Gravis, ALS (Lou Gehrig’s disease); Muscular dystrophy, Lambert-Eaton syndrome, and for persons currently taking certain antibiotics

Q. I heard there were creams that were just as good - is that true?

A. Certain serums claim to be able to relax facial muscles - we stock one product - Linurase, which contains Argeline, which can partly relax (17-30% of the effect that can be achieved by Botox) forehead lines or shallow crinkling around the eyes; but all topical serums lack the degree of relaxation and specificity of action on specific portions of the muscle that can be achieved with the accurate intra muscular placement of Botox; also the duration of action of the serum is hours vs months for Botox.

Q. Facial anatomy is quite complex, and you cautioned about using inexperienced injectors to produce the desired outcome, just how important is it to have an experienced injector, and what qualifications should we be looking for?

A. Achieving a naturally looking attractive result is an art as well as a science. It takes a very detailed understanding of facial anatomy, normally acquired through Medical School, and then additional Medical training in specific applications of Botox and fillers. Ideally you should look for an experienced cosmetic physician, and ask to see examples of the procedures in question. Experienced practitioners usually have pictures of patients who have given permission to use their photos.

The fact is that treatments such as skin resurfacing, Botox and the injection of Dermal Fillers into the deep layers of the face are medical procedures that need appropriate training and qualified judgment in order to ensure the desired outcome and safety. Procedures should be performed in appropriate facilities by a properly qualified physician who has received the specific training in the particular procedure.

Juvederm is a cross –linked hyaluronic acid product used for softening deep lines such as nasolabial creases, (lines from the nose to either side of the mouth), marionette lines (deep creases extending down from the corners of the mouth), tear troughs (hollows under the eyes), fine lines between the brows, above and below the mouth, and for enhancing lips, chin and cheeks. It can also be used to refine nasal profiles, fill in dimples or scars, raise the brows, and lift midface sagging leading to jowls.

Hyaluronic acid is a substance present naturally in skin, responsible for its moisture retaining properties; the cross linkage of the hyaluronic acid molecules is responsible for its prolonged duration of effect 12-15 months in deep injection sites, 12 months average in skin folds, 6 months in lips. It has a very smooth texture, and integrates well into the tissue i.e. doesn’t feel lumpy. Effects are noticeable immediately after injection.

Sculptra is a Poly-L-Lactic acid compound, commonly used in surgical sutures for its property of stimulating collagen formation. It is mostly used to replace volume loss in the face – such as for extreme sagging of the midface due to fat & muscle shrinkage and to replenish subcutaneous tissue loss in the lower face and temples, around the eyes etc. One of the interesting benefits of this product is its phenomenal ability to rejuvenate the texture of the skin, rendering it baby-soft, smooth and glowing, due to its powerfully stimulating effect on collagen production.

Sculptra differs in its onset of action to Juvederm: there is an immediate volumizing effect, followed by a lag period in which the initial effect seems to diminish, then by a phase in which natural collagen formation is stimulated with regaining of lost volume. Because of this 3 stage process, a full Sculptra treatment is usually administered over 2-4 sessions , spread over a 2-6 month period; but the end result will last well in excess of 2 years. It is commonly referred to as the Liquid Facelift in France, where it was developed.

St. John's man - another happy Sculptra patient

This gentleman presented after losing more than 40 lbs on an exercise and healthy eating regimen; unfortunately he had lost a lot of volume in the mid face region, making him appear older than his stated age, and giving him a sad appearance.

"People keep telling me I look sad - and in reality, I'm a very happy person."

He received a series of Sculptra treatments to the midface and periorbital regions, also a microdermabrasion session to freshen up the skin, and had one Accent laser skin tightening treatment to the forehead region - to reduce forehead wrinkling and elevate brows slightly - (a little Sculptra was also used under the brow to enhance this effect)...and the result... a happier, rejuvenated appearance.

Another satisfied Sculptra patient

For discussion of her treatment - see "St John's Woman tells her Story" section.