Botox® Cosmetic, Dysport® and Xeomin®

Restore a Balanced and Soft Look to Your Appearance with Injectable Facial Relaxants
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John Q. Cook, M.D.

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Successful Botox® Cosmetic, Dysport® and Xeomin® therapy requires in-depth knowledge of the facial anatomy and precise technique. Dr. Cook has carefully studied the patterns of facial expression, and this leads to a highly individualized approach to Botox® Cosmetic or Dysport®therapy at our Chicago and Winnetka centers. We believe that all patients benefit from our diligent attention to detail.

Over activity of the muscles in this region may have several undesirable consequences. Deep furrows or “frown lines” may develop and give the face an angry, or distressed, look. Repeated and prolonged contraction of these muscles pulls the inner brows downward and can set the facial attitude into a permanent frown. Patients with these habits report that friends and co-workers ask them why they are always “angry” or “tired.” Excess contraction of these muscles may also contribute to a sense of heaviness in the region by the end of the day. This over activity may even trigger tension or migraine headaches.

For some patients surgery may represent the best solution to this problem, but many of our patients have achieved a wonderful softening of the facial attitude with relaxants such as Botox® Cosmetic, Dysport® and Xeomin®. This remarkable substance works by interrupting the message that tells the frown muscles to contract.

A subtle but distinct elevation of the inner brows restores a calm and refreshed facial attitude. The habitual creases between the brows are softened. Patients are delighted by the change in their appearance after treatment with relaxants.

Habits of expression in other facial regions may also respond well to injectible relaxants. These include the “crow’s feet” at the outer corners of the eyes, the horizontal creases of the forehead, and the vertical lines of the neck.

Treatment consists of precise micro-injections along the path of the overactive muscles. Practically all patients are able to resume work and social interaction immediately. Most of our patients return every three to six months for additional treatments, since the Botox® Cosmetic, Dysport® and Xeomin® loses its control of the muscle over time.

Muscle Relaxant Injection Treatments require in-depth knowledge of facial anatomy and precise technique. Do not buy these products online. You must go to a skilled certified clinician.

  1. Botox® Cosmetic and Dysport® have FDA approval for use in treating frown lines between the eyes. Botox® also been approved by the FDA for a number of years for the treatment of medical conditions such as hyperhydrosis, blepharospasm and extraocular muscle balance.
  2. Injectable relaxants work by hindering the connection between nerves and muscles and preventing the transmission of the message for the muscle to contract. This alters habitual expressions that we often adopt subconsciously. These expressions can make us look tired or angry when we really are not feeling this way.
  3. Most patients in our practice return every three to six months for repeat injections. Usually the effect has only partially worn off, but most people prefer to seek re-treatment before there is a complete return of muscle function. This helps the patient to retrain his or her habits of facial expression.
  4. Part of the success of relaxant therapy comes from the retraining of facial habits. It is also our impression that the facial expression muscles treated by Botox® Cosmetic, Dysport® and Xeomin® become weaker over time when a patient undergoes several injections. In our opinion, the main reason for this is that the muscles are used less so they become smaller. This is similar to the difference between the arm muscles when an individual works out regularly at a gym versus the smaller less toned muscles that occur when an individual gets out of the habit of working out.
  5. A precise understanding of the intricate anatomy of the muscles of expression is essential with injectable relaxants. There is a significant variety in facial expression patterns in different people. This must be recognized and incorporated into the treatment plan if a nuanced approach to the therapy is desired.
  6. The goal is not the complete elimination of facial expression. This looks weird. The goal is to soften and retrain the patterns of facial expressions. Overdone Botox® looks no better than overdone facial surgery.
  7. Don’t settle for Botox® Cosmetic, Dysport® or Xeomin® therapy in anything less than a medical office environment. Beauty Salons and hotel suites are not good settings for this. There are important issues of cleanliness and safety. Alcoholic beverages and Botox® Cosmetic or Dysport® can be a dangerous mix. Herding a group of people into a “Botox® Cosmetic or Dysport® party” compromises individualized and nuanced therapy.
  8. Don’t settle for treatment unless the individuals in the practice are highly experienced and have a serious commitment to artistic principles of facial rejuvenation.
  9. Relaxants may be only part of the answer. “Memory creases,” folds and creases in the skin that persist even in the absence of muscle contraction, will not be eliminated by Botox® Cosmetic, Dysport® or Xeomin® alone. They do sometimes soften over time, especially after several injections. A variety of treatment options exist for the critical zones around the eyes, and the person who evaluates you should have the experience and knowledge base to be able to address all available treatment options to you. Relaxants, helpful as they are, can be misapplied, and this will only lead to disappointment. On the other hand, the proper selection of Botox® Cosmetic, Dysport® or Xeomin® from the portfolio of treatment options has provided a wonderful benefit for many patients.

10 Questions You Should Ask Before You Are Treated with Botox® / Dysport® / Xeomin

  • How many patients have you treated with relaxants in this practice?

  • This is an important indicator of the experience of the practice. If you desire a nuanced and artistic result, it is important that the person treating you has considerable experience with proper diagnosis and treatment. There is a distinct learning curve, so the more patients that have been treated the better. Therefore, it’s best to go to a practice that has experience with at least several hundred treatments.
  • How did you learn about the anatomy of the muscles in this area?

  • Do not settle for a vague answer to this question. A precise understanding of the anatomy of the muscles in this region is essential if one is to obtain an appropriate response to the injection. Botox® therapy should be highly specific and precise. Injections without this knowledge can lead to over treatment or a bad result.
  • What is the exact setting where Botox® will be administered to me?

  • Overall, it is unwise to settle for anything less than a physician’s office. Unfortunately, there are situations where Botox® is administered in many inappropriate settings, from hotel conference rooms to beauty salons. Botox® and other relaxants, although very safe, can occasionally produce reactions that must be treated appropriately. Further, if proper lighting and equipment are not available, a minor problem could turn into something quite serious.
  • How will you balance my brow?

  • If they don’t understand this question, it probably means you are not speaking to someone who is serious in their understanding of Botox® therapy. A common mistake is to inject into forehead frown lines without understanding the competing muscle groups. This can cause an undesirable settling of the brow. The forehead creases may be softened but the downward position of the brow can give the patient an angry or downright strange expression.
  • Will all of my wrinkles be gone?

  • Admittedly this is a bit of a trick question, but it provides a good indication of the level of experience and truthfulness of the person you are speaking to. In general, it is impossible (and perhaps not even desirable), to remove every trace of an expression crease. This should be forthrightly communicated to the patient.
  • What other treatments do you offer for this area?

  • Botox® is indeed a wonderful treatment for patterns of overactive muscles, especially in the region between the brows and in the crow’s feet area. It is not, however, the only solution. Often the best results come from combined therapy. For example, if there has been a very strong pattern of habitual expression, there may be significant memory creases that persist even when the muscles don’t contract. These can be treated with other techniques. Sometimes the result that Botox® would provide would be disappointing, and a surgical procedure would be better. We believe strongly that patients’ interests are best served if they are evaluated by individuals who have an understanding of the complete range of options available. Otherwise, a very useful tool, such as Botox®, may be forced into a situation where it really won’t work very well. Under these circumstances, it is really not the fault of the Botox®, but the fault of the individual who misused it.
  • What is your goal in treating this area?

  • In almost every field of human activity, the person who can clearly articulate his or her goals will get a better result than someone who cannot. I would suggest that if someone is not able to explain what they are trying to accomplish with the Botox®, then perhaps you might seek someone with a greater level of knowledge and finesse.
  • What do you think looks good? What is your artistic concept?

  • This is perhaps the key question that should be asked by anyone considering either skin care treatment or plastic surgery of any sort. The concept of beauty is very subjective for each individual. Perhaps the person who is about to treat you has a concept of beauty that is very different from your own. It is better to define these issues in advance, so that you can avoid the disappointment that comes from miscommunication.
  • Are you truly interested in me as a patient or merely as a source of revenue?

  • This is, of course, a question that you should not ask directly. The answer to this question will be revealed to you by the manner in which you are treated. I would strongly suggest that if you find yourself in a facility where the staff does not pay attention to your medical history and general health, you should not seek treatment. If you are not asked questions about medications, medical allergies, your general level of health, and your goals for the treatment, then you are subjecting yourself to the care of individuals who do not care much about your well being.

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