younger
rejuvenated
New Technologies for Facial
refreshed Enhancement
Microdermabrasion 1,023,931
BOTOX® 3,294,782
Physician satisfaction
- VISTABEL® provides the cornerstone of rejuvenation treatments
of the ageing face
Cosmetic Maintenance
“Context” Research 2004 Paris, France
Impact Of Wrinkles On Client’s
Life
Just under 50% of the clients considered that wrinkles had a
considerable impact on their life
Having wrinkles is just part of growing older and nothing to be too worried about 2.5
Recommend Strongly
Neither Against Recommend
Recommend 0% Against
for nor against 0%
10%
Strongly
Recomment
38%
Recommend
52%
Under 18 0.05
18 - 24 0.16
25 - 34 32%
35 - 44 23%
45 - 54 17%
55 - 64 7%
65 + 1%
N=1335
Vivid Interface Ltd. Market Research Body Beautiful 2005
It is very important
®
to learn that BOTOX
is both an
art and a science
before you become a user
your practice?
Starting BOTOX®
Starting BOTOX®
collecting patients,
promoting it in the practice,
consent forms…
Starting BOTOX®
Before offering BOTOX® to patients
Starting BOTOX®
Launching it in your Practice
– consider the following:
• Train reception staff to discuss the
procedure
• Do some initial free treatments on
staff and best patients for word of
mouth advertising
• Build a before and after photo library
to show prospective patients
Starting BOTOX®
Launching it in your Practice –
consider the following:
• Schedule “BOTOX® days”
• Get local media exposure
• Inform patients with practice
newsletter
Starting BOTOX®
Neurotoxin
Pharmacology
Indicated for*;
-Blepharospasm
-Strabismus (USA)
-Hemifacial spasm
-Cervical dystonia
-Cerebral Palsy
-Axillary hyperhidrosis
-Glabellar lines
*Approvals and product names vary from country to country – consult specific
prescribing information
BOTOX®
Photos © J Jankovic
Other Clinical Conditions Treated with
BOTOX® (Un-licensed)
•Migraine
•Tension Type Head-Ache
•Back Ache
•Hypersalivation
•Myofacial Pain Syndrome
Neurotoxin Pharmacology
Botulinum Neurotoxin Serotypes
• 1982 Jean Carruthers to San Francisco to
work with Alan Scott – one of early co-
investigators in FDA study
Neurotoxin Pharmacology
Botulinum Neurotoxin Serotypes
COOH NH2
• Seven serotypes
S-S
- A, B, C1, D, E, F, G
Light
- Type A has longest duration Chain Heavy
Chain
of action
• Intracellular target varies
NH2 S
- SNAP-25 S
Neurotoxin Pharmacology
BOTOX® - Mode of Action
Neurotoxin Pharmacology
BOTOX® - Mode of Action
- Digitalis 1:2
- Insulin 1:3
•Neuromuscular transmission
disorders.(Myasthenia Gravis)
•Unrealistic expectations
•Dysmorphophobia
Type II (Wrinkles in
Motion)
BOTOX® plus topicals
Technique Tips
General Injection Technique Tips
Technique Tips
CHECK LIST
• Med history
• Assess expectations
• Explain 2 to 3 days before visible signs, 14 days
for maximum effect
• History,Skin status
Cont’
• Explain likely results discuss alternatives
• Peels,microdermabrasion,Laser resurfacing
• Sign consent form
• Photograph, Inject, Record
• Follow up instructions recall
Cosmetic Indications
• Glabellar Frown Lines
• Forehead Lines
• Crow’s Feet
• Eyebrow lift
Glabellar
Frown Lines
• Convey negative emotions such as anger,
depression,fatigue,biterness,disappointment
and envy
• Consider utilising in younger individuals as
habit breaker.Muscle group may atrophy in time
allowing longer duration of action
• Women require 20 to 30U, Men 30 to 40U assess
individually
Target Muscles for Frown Lines
Procerus
Corrugators
Cosmetic Indications
Muscles of the Glabellar Complex
Muscles Function
Corrugator Brow adductor (depressor)
• Moves eyebrow downward and
medially
Injecting down
toward the globe
Patient supine
No gloves!
30 Days
120 Days
Glabellar Frown Lines - Follow Up
• Patients to return in 2 weeks to:
- assess results/technique
- photograph patient
- touch up (if necessary)
• Re-injection schedule
- Patient dependent
- 3 - 4 month intervals for first year
- Less frequent after repeated treatments
Cosmetic Indications - Glabellar Frown Lines
Horizontal
Forehead Lines
Anatomy - Frontalis Muscle
Frontalis muscle
30 Days
120 Days
Horizontal Forehead Lines
Before After
Before After
Note enhancement of brow
shape to soft flare
Orbicularis oculi
30 Days
120 Days
Crow’s Feet
Before After
Managing complications
Potential complications
Bruising
Headache
Eyelid ptosis
Brow ptosis
Brow repositioning
Diplopia
Managing complications
Treating ptosis
Alpha-1 adrenergic
stimulation of Müller’s
muscle
Managing complications
Treating ptosis
Usually resolves in 1-6 weeks
Iopidine (Alcon) eyedrops 1 drop q.i.d. will
temporarily resolve
Managing complications
Brow repositioning
Excessive brow
elevation
• “Quizzical” or “Mr
Spock” brows
• Correct with 1 to
®
2units of BOTOX
injected into the
frontalis above the
lateral brow
Managing complications
If after glabella treatment
“cruella” / mephisto
inject 0.5-1.5U only
‘Mephisto’
Photo © Ph LEVY
Advanced techniques require a
degree of judgement gained from
approximately 3-6 months BOTOX®
cosmetic experience
Advanced Cosmetic Techniques
• Suborbital region
• Upper lip wrinkles
• Nasal scrunch (“bunny lines”)
• Nasolabial folds & marionette
lines
• Platysmal bands
Perioral Rhytides
Photos © K De Boulle
Chin: Peau D’orange, Mental
Crease
Before After
Photos © NJ Lowe
Marionnette Lines Or Sad
Corners Of The Mouth
Uplifts corners of the
mouth
Technique: 1.5–3U into
each depressor anguli oris
muscle
Injection site
-7mm lateral , 8mm
caudal OR mandib.
border
© Ph LEVY
Before After
Frozen Smooth
Weaken Relax
Customer service
• Prompt service availability is essential
•Offer free consultation
• The wait time for BOTOX® is best kept short
• Try and arrange BOTOX® days for efficient
use of material
• Always have material available!!!!!!!!
BOTOX
100 units per vial
Reconstitute 2.5 mls Bacteriostatic saline
100 units in 2.5mls
20units in 0.5 mls
2 units in 0.05 mls (marked 5)
4 units in 0.1 mls (marked 10)
VISTABEL
50 units per vial(half of Botox vial)
dilute with1.25mls Bacteriostatic saline and use unit measurements as
above.
CONSENT FORM