Injectables
Botox
What is Botox?
A bacterium called Clostridia Botulinum produces a neurotoxin that affects the movement of muscles by blocking the nerve receptors in the muscle. Historically, improper canning of food would allow this bacterium to grow. An unfortunate person who ate the contaminated canned goods would become paralyzed from this neurotoxin within the Clostridia Botulinum and would perish from “Botulism.”
Today, with modern science and Research and Development by Pharmaceutical companies, this bacterium is grown in the laboratory, and the neurotoxin can be isolated as a drug medication. Used in very small and precise amounts, multiple medical uses for this neurotoxin are used today.
There are a number of companies that produce this neurotoxin from the Clostridia Botulinum bacterium commercially. The most common trade name is “Botox.”
Where is Botox used?
The most common use is in the face to decrease facial wrinkles in certain areas by temporarily paralyzing the muscle that produces the unwanted wrinkles.
Other uses include:
treatment for migraine headaches
excess sweating in the axilla: (arm pits) hyper-hydrosis
muscle spastic conditions
Where can it be used in the Face?
There are at least 42 facial muscles on each side of the face that are responsible for facial movement, both in response to emotional and non-emotional stimulation. Some of these muscles over time, and a lifetime of repeated use, produce wrinkling creases in the skin. We do not see these permanent etched creases in the face of a child. We regard the child’s face as youthful. By removing these etched-in lines, the face takes on a more youthful appearance like the child’s face.
Common areas where ‘Botox” is used in the face include:
Forehead and brow to decrease the horizontal furrowed lines
Glabella (area between the eyebrow above the nose) which produces the glabellar folds and a stern troubled look (angry brows)
Outside part of the eyelid area: “the laugh lines” when you close your eyes tightly
Nose: the horizontal crease at the top of the nose and the oblique crease on either side of the nose (bunny creases) produced when you smile hard or smell something bad and turn up your nose.
Lips: Upper lip to turn it up slightly; the lower lip to decrease the marionette and bitterness lines at the corner of the mouth.
Chin: to the transverse curved crease in the lower chin/lip area
Neck: to decrease the neck cords that develop with aging
How is the Botox injected and how long does it last?
The Botox comes refrigerated. A specific amount of non-preserved saline is injected into the vial of Botox to produce a solution. There are a measured number of units in the solution. A specific number of units are then injected into the muscles that are to be treated to reduce or eliminate the wrinkled area by paralyzing the muscle that produces the wrinkle.
To achieve the desired effect, the correct number of units must be injected into the muscle to produce paralysis. If paralysis does not occur, an inadequate number of units were used and the wrinkle will remain
The full effect of the paralysis of the muscle takes up to 7days following the Botox injection and the effect of the muscle paralysis and decreased wrinkling typically lasts 3 – 6 months. This varies from patient to patient.
Are there risks with Botox injection?
Botox injection is very operator dependant. An experienced medically trained practioner is advisable.
Dr. Giuffre has a highly trained Registered Nurse that treats patients with temporary filler and Botox in his surgical suite under supervision.
Please see www.pclsc.ca
An inadequate number of units or units placed incorrectly will not achieve the desired effect.
If the upper brow is over injected or injected too close to the upper eyelid, an eyelid ptosis (drooping upper eyelid) can occur until the effect of the Botox on the muscle that opens the eyelid disappears.
Headache may be experienced after Botox injection
There is a maximum dose that should not be exceeded. A massive overdose could have the same effect systemic effect as “Botulism”
Can Botox be used in conjunction with other temporary injectables?
The engine that drives the crease formation in the face is the repeated use of a facial muscle. When this muscle is paralyzed with Botox, the crease may soften but may not completely disappear.
Either at the same time or at 1 week post injection of Botox, further blunting or elimination of the crease may be done using temporary fillers which fills out and camouflage the crease.
Temporary Fillers
What are temporary fillers?
This is a product that is injected into facial wrinkles to blunt or camouflage the wrinkle and gives a more youthful appearance to the face. It can also be used to increase volume in certain areas of the face to give the appearance of a fuller more youthful face.
What are the types of fillers?
The original fillers were a form of collagen taken from cows (bovine collagen) or shark collagen. There was a significant allergic reaction risk with these products. Patients having collagen injections required a skin test and a waiting period for one week before undergoing treatment.
Today, collagen has been replaced by an injectable product called hyaluronic acid, which is a clear gel like substance. It comes in varying viscosities designed for different uses within the face (very fine wrinkles, deeper wrinkle, and volume filling).
There are a number of products available, each produced by different pharmaceutical companies. The more common product names are Resytlane and Juvéderm.
Allergic reaction to these products is rare and pre injection skin testing is not necessary.
How is the Filler injected and how long does it last?
Using a very fine needle, the desired crease being treated is injected, filling out the crease to blunt or eliminate it. Deeper creates require more filler.
Patients requesting a volume increase to certain areas of the face (like the cheeks or lips) will require more volume and a different viscosity of hyaluronic acid product to achieve this result.
The duration of the effect is very patient variable. Typically the effects are between 3- 6 months although some patients enjoy the effects for a year to 18 months.
Are there risks with temporary filler injections?
Hyaluronic acid filler injection is very operator dependant. An experienced medically trained practioner is advisable.
Dr. Giuffre has a highly trained Registered Nurse that treats patients with temporary filler and Botox in his surgical suite under supervision.
Please see www.pclsc.ca
Placing filler around or in the eyelid skin is inadvisable.
Rare allergic reactions are treated with an injection of a product called hyaluronidase, an enzyme, which eliminates the local filler.
These fillers are temporary and their effects are short lived.
Patients can trial the temporary product to see the cosmetic effect before proceeding to more permanent fillers (fat grafting). This has application to patients considering a permanent increase in facial volume around the temple, cheek bones, cheek and upper and lower lips.
Risks for temporary filler enhancement for facial creases:
Scarring
Infection
Pigmentation change which can be darker or lighter pigmentation to the area treated
Prolonged redness (erythema)
Early Recurrence of the wrinkling (under filling)
Overfilling leaving a contour deformity
Prolonged irregular surface of the skin (seen with filling of the eyelids -this is not recommended)
Skin damage (necrosis)
Allergic reaction
Asymmetry
Expense
Permanent filler: FAT GRAFTING
What is fat grafting?
This surgical technique takes fat from one part of a patient’s body using a form of liposuction. This fat is then prepared and then injected into another part of the patient’s body that requires filling or correction of a contour abnormality or increased tissue volume. Only the patient’s own fat can be used (a friend or relative cannot donate some of their fat).
How is it done?
The procedure can be done under local anaesthesia (freezing) if the area of fat grating is small or under general anaesthesia if the area is too large to freeze properly.
Fat is removed from an area in the body (tummy, thighs, hips or a heavy neck) using a liposuction technique.
The fat is then prepared and then loaded into small syringes for injection into the desired area using a very small cannula (this is like a small injection needle with a blunt end)
The desired amount of fat is then injected into the area to be treated.
There are minimal if any sutures and virtually no scarring
The patient is allowed to shower the following day and often can return to work the next day unless a large area of fat harvesting and grafting was done. A week off work would be advisable if there is significant bruising.
Strenuous exercise should be avoided for 3 weeks
RISKS:
What are the risks of Fat grafting to the face?
With any surgery there are surgical and anesthetic risks.
Aside from the rare risks of an anesthetic event, some of the general and specific surgical risks for this procedure would include:
Infection
Bruising
Bleeding (hematoma)
Swelling
Sensation change
Discomfort
Rejection:
when fat is removed as a fat graft, it no longer has a blood supply and is essentially dead. If it does not get a new blood supply, the fat cells will die and turn to oil. Your body will remove the oil as waste. When the fat graft is injected in to the donor area, it must survive by being nourished by a new blood supply from the donor site. A donor site that is healthy and minimally scarred will grow blood vessels into the fat graft and keep the fat alive. Only the fat graft that has a blood supply will remain and provide the contour fill correction desired.
Symmetry:
if more fat graft survives on one side of the face compared to the other side, then some degree of asymmetry may result.
The donor site where the fat is taken from with liposuction will be reduced in size. If a large amount of fat is removed, some degree of skin looseness may result. This area may be bruised and swollen after surgery for a number of weeks
Time off work and exercise
*This list is not complete.
During the consultation with the patient, Dr. Giuffre will outline and explain each of the risks in detail.
THE FOLLOWUP:
How often do I need to come back for a checkup after the surgery?
Postoperative visits include:
A 1 week post operative visit.
A 6 week visit in the office to review the preoperative photograph and the surgical result.
The patient is allowed to shower the following day.
Aggressive sports activity should be avoided for 3-4 weeks.
If there are any patient concerns, Dr. Giuffre provides his home phone number for patient's direct access.
After the 6 week visit, if there are any future requests for an appointment, they are made directly with Dr. Giuffre’s office and an expedited visit is arranged.
FINANCING:
Will AHS (Alberta Health Services) cover Fat Graft surgery?
Fat graft surgery for Facial cosmetics surgery is not covered by Alberta Health Services.
Can I finance the costs of the surgery? How do I do this?
Dr. Giuffre does not provide in house financing for cosmetic procedures.
There are a number of companies across Canada that will finance cosmetic surgery, similar to car financing or mortgages.
Please refer to the links provided for this information. Dr. Giuffre has no financial or business relationship or affiliation with any of these companies..
What about having my Cosmetic Surgery in another country where it is cheaper?
There is a current trend to have surgery out of your country where the surgery may be cheaper.
We call this tourist surgery.
There are a number of additional risks associated with tourist surgery, which include:
The surgical skill, experience, licensing and education of an unknown surgeon.
Canada has very strict rules and requirements to be a licensed Plastic Surgeon (FRCS(C)) in our country. Your Plastic Surgeon has completed an undergraduate degree (4 years), an MD degree (4 years), a Fellowship Degree in Plastic Surgery (5 years) and often a post Fellowship (1-2 years).
A “friend” is not a good reference, nor is glitzy advertising.
The safety, sterility and equipment quality, including anaesthesia machines in the hospital or private surgical suite could be questionable; this may lead to increased risk of infection and anaesthetic risks.
Post operative care is limited to the time you spend in their country.
If you have a complication, to see your original surgeon, you will have to fly back to where your procedure took place, or see a new surgeon in your own Country.
If you have an unsatisfactory result, you will have to fly back to see your original surgeon or find a new Surgeon.
The cost of the repair may exceed what you originally paid, and the final result, fixing a mistake, is often not as good as it could have been had the surgery been done correctly the first time.
After accounting for the accumulated costs of the air travel, hotel, surgery and postoperative care, the perceived cost savings may not be significant.
If you have a severe, life threatening complication, Alberta Health Care will cover the medical costs for your care.
Correcting the reconstructive problem, as a result of the complication, would be the patient’s financial responsibility.