Let’s be honest, skin wrinkles and fine lines on the face don’t help our image at all. If skin wrinkles are progressively getting worse and are bothering you, then Botox® , such as Botox®, may be the right treatment for you. Neuromodulator is an anti-aging treatment that helps soften those age-related facial skin lines. Its ability to not only soften skin wrinkles, but also to prevent or delay these unwanted facial skin lines has made Botox® a popular treatment across all age groups. No wonder Botox® is the most common non-surgical cosmetic procedure performed worldwide.
Dr. Couto is a board-certified, Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
Dr. Couto specializes in both surgical and non-surgical aesthetic treatments. Therefore, an objective and unbiased recommendation will always be provided during your consultation. The ability to know firsthand what can be accomplished non-surgically and when a surgical intervention is required is a unique and essential quality in the field of aesthetic surgery and aesthetic medicine.
Botox® or neurotoxin is the name we give to botulinum toxin. There are numerous brands, such as Botox®, Dysport®, Xeomin®, Jeaveau®. Botox® is the most recognized brand, because they were the first Botox® to obtain FDA-approval for skin wrinkles in the face.
Although there are numerous medical indications for Botox , it is most commonly used for the treatment and prevention of facial skin lines. Botox work by selectively weakening those facial muscles producing excessive skin wrinkles. The most common treated areas are usually the forehead, between the eyebrows, and on the lateral corner of the eyes, also known as the lateral crow’s feet. After its administration it usually takes 5-12 days to start seeing the effects. Botox ® approximately last 3-4 months. It is important to note that 5% of the population may develop antibodies to certain Botox brand; thus, making the treatment ineffective. In those cases, the patient is treated with a different neuromodulator brand, one that has a lower risk of developing antibody resistance.
The real question is, who is not? Botox® can benefit, both young and older patients. In the young population, Botox® help smoothen facial expression lines, but most importantly, it prevents or delays the development of unwanted facial skin lines. Dr. Couto has written on this topic in scientific journals. The benefit of Botox® in older individuals is that it actively softens facial skin wrinkles and prevents existing skin lines to worsen. In addition to its rejuvenative effect on the skin, Botox® can provide a cosmetic and functional benefit on patients suffering from teeth grinding during their sleep. Also, it helps reduce or eliminate excessive sweating of the axilla, hands, or feet.
Botox® are commonly referred to as Botox®; however, Botox® is just one of many brands available in the market. Each brand has a specific type of botulinum toxin, and a unique effect. It is for that reason that selecting the type of neuromodulator to be used should be tailored to the patients needs and aesthetic goals.
Unfortunately, the number of commercially available neuromBotox® dulators has increased dramatically worldwide over the past decade. However, there are just a handful of neuromodulator brands that are approved by the US Food & Drug Administration (FDA). Knowing the type and brand of neuromodulator being used is crucial, since a non-medical grade neuromodulator can produce suboptimal results and potentially produce complications. In our practice, we only offer FDA approved Botox® , this includes:
Botox®
Dysport®
Xeomin®
Jeaveau®
The consultation is divided into five parts:
1) Health and Medical History Evaluation
A comprehensive evaluation of your medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the treatment. It is important to tell Dr. Couto if you have recently taken blood thinning medications such as aspirin, ibuprofen, or anti-coagulants, as this can lead to greater bruising. Furthermore, it is important to specify if you have experienced any allergic reactions or complications to Botox in the past.
2) Discuss with the Patient About Surgical Goals
Dr. Couto has a deep discussion with the patient to learn about their concerns and goals. Listening to our patient’s interest is crucial, since it is our priority to determine if we can meet their expectations.
3) Physical Exam
A complete systematic analysis of the face is performed. Dr. Couto treats the face and neck as whole, not by areas. A youthful appearance is marked by smooth transitions between different areas of the face and neck. Consequently, Dr. Couto not only examines the regions the patient is mainly concerned with, but also those surrounding areas and structures of the face that could help achieve a balanced and refreshing look.
4) Recommendations & Treatment Plan
Following the physical exam, Dr. Couto develops a personalized plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient if the desired aesthetic look by the patient can be achieved with the use of Botox or if a surgical intervention is required.
5) Treatment
Once the treatment plan has been determined, we proceed to do the injection treatment. It usually takes 3 minutes complete the treatment.
Neuromodulator treatment is a straightforward and painless procedure that is usually performed in the office following your consultation. First, we examine and determine the areas where the neuromodulator will produce the highest benefit. Then we proceed to perform the injections, it usually takes a few minutes.When performing the injections, we use the thinnest needles Afterward, the nurse will apply cold compression to the site and help scheduling any follow-up appointments or treatments, as necessary.
In order to minimize bruising, we recommend our patients to avoid taking blood thinning medications such as aspirin, ibuprofen, or anti-coagulants, as this can lead to greater bruising.
Recovery time is not required! You can continue with your normal daily living activities following neuromodulator injection. After your treatment, we do recommend applying cold compression to the area to minimize swelling and bruising. We also encourage patients to use Arnica products, as this may help resolve unwanted bruising much faster.
Neurmodulator is only safe treatments when an experienced and certified injector is performing the procedure. With the increasing worldwide demand of injectables, we are observing a significant amount of uncredentialed personnel performing this procedure. As a result, every week we have patients showing up to our clinic with complications. Some patients have a bad aesthetic result, while others have complications, such as eyelid droopiness, descent of the brow, or smile deformities. The problem with these uncertified injectors is that they lack proper training. This lack of experience not only increases your risk of complications, but they are less likely to know what it needs to immediately do to treat these adverse events. Furthermore, many of these non-certified injectors do not have access to FDA-approved Botox® ;instead, they commonly use non-medical grade botulinum toxin acquired through the black market.
We recommend to our patient to always do your research before undergoing a neuromodulator treatment. Enquire about the injector’s credentialing and experience doing neuromodulator. Also, ask about the origin of the product and ensure that FDA-approved Botox® are being used.
Botox® are typically used to restore the shape by raising the tail of the eyebrows. Although it works beautifully to the great majority of patients, its brow lifting effect may be limited to individuals with advanced brow descent. In these cases, a browlift may be the indicated procedure.
The effect of Botox® usually last 3-4 months. That been said, everyone is different.
This could be due to several reasons. One reason maybe that the product that injecting you with is expired or is poor quality. The other reason may be that the injector is not treating the areas adequately or administering enough product. Alternatively, you may have developed resistance to a neuromodulator. Approximately, 5% of the population may develop antibodies to certain types of botulinum toxin. Thus affecting the effectivity of the treatment. The most common scenario for this is a patient that had a good response the first time she got treated, but minimal to no effect the following treatment sessions. When that occurs, the patient needs to be treated with an specific neuromodulator that is designed to lower the risk of developing antibody resistance.
