FREQUENTLY ASKED QUESTIONS

BOTOX® Cosmetic is the gold-standard FDA-approved prescription product used to improve the appearance of facial aging lines in adult men and women.

A number of factors cause wrinkles, including cellular changes, collagen depletion, and damage caused by sun and free radicals. Also, the routine contraction of facial muscles when concentrating, frowning, or squinting can cause your skin to fold and furrow.

BOTOX is injected just beneath the skin’s surface, targeting muscle activity that causes the overlying wrinkle. When the muscle relaxes over time, the skin lines consequently soften and fade.

The safety and efficacy of BOTOX has been proven over more than fifty years, beginning with children treated for cervical dystonia, or neck spasms. In addition to cosmetic treatments, BOTOX is currently used to address numerous medical conditions including:

• Cervical dystonia (neck spasms)

• Lazy eye

• Muscle contractures

• Hyperhidrosis (excessive sweating)

• Tension and migraine headaches

• Bladder dysfunction

The effects of BOTOX have long been studied and championed by medical specialists ranging from plastic surgeons, dermatologists and otolaryngologists to neurologists, urologists and gastroenterologists. As with any product or procedure, however, it’s not for everyone. The best candidates for cosmetic treatment are physically healthy, without neuromuscular diseases, not pregnant or nursing, and are at least 18 years of age.

Some conditions that might exclude a patient from having BOTOX treatment include:

• Existing weakness in the targeted muscle

• Ptosis (drooping eyelids)

• Deep facial scars

• Very thick facial skin

• Facial asymmetry

• Skin rashes, skin disorders or infections near the affected area

You should inform Dr. Donaldson of any medications, vitamins, and herbal supplements you are taking prior to treatment. Make sure to discuss any questions or concerns, as well as your expectations with Dr. Donaldson during your consultation to alleviate confusion or dissatisfaction.

Your consultation with Dr. Reynolds is an opportunity to review your medical history and discuss your desired outcomes. Once you have communicated your vision, he will personally help you create a proactive plan. You are encouraged to ask any questions you may have at this point, and some patients even create lists in advance so they don’t forget their questions at the last moment!

Dr. Reynolds will explain how BOTOX works, warn of possible side effects, ask whether you are pregnant or breastfeeding, and show you the method he will use to achieve your goals.

Following your consultation, you may opt for treatment on the same day if that is most convenient, or schedule for another date.

Information and realistic expectations help to ensure a successful outcome. Once you have decided to move forward with your BOTOX appointment, some questions to ask Dr. Reynolds may include:

• How many injections have you performed?

• Do you perform the injections yourself?

• Am I too old or too young for Botox?

• What are the steps of the Botox procedure?

• Does it hurt?

• What can I expect after Botox treatment?

• When will I start to notice results?

• Will my friends and family see a big difference?

• How long does it last?

• What are my risks?

Complications following BOTOX injections are rare but possible. The most common side effect is swelling or bruising at the injection site. Others include minor headache, flu-like symptoms, mild eyelid drooping or asymmetry.

Contact Dr. Donaldson immediately if you notice any unpleasant signs or symptoms after your BOTOX treatment, as you may be a candidate for touch-up or closer observation.

The use of BOTOX is prohibited for patients who are pregnant or breast-feeding, because the risks are unknown.

A typical BOTOX® Cosmetic appointment lasts only a few minutes and does not require anesthesia. Using a super-fine needle, Dr. Reynolds will inject Botox into thin, specific muscles with little-to-no discomfort. The number of injection sites depends upon the size of the treatment area and the complexity of the anatomy.

What Can I Expect After Botox Treatment?

BOTOX is often considered a “lunchtime” procedure because of its minimal fuss and recovery. Most of our patients are able to visit our office during other routine errands without skipping a beat.

Results are usually visible within two to four days after treatment, but may take as long as two weeks to be fully evident. The effects typically last three to four months, although some patients report success even six months later or longer! Regularly scheduled follow-up injections are necessary to achieve consistent, long-lasting results.

Following treatment, Dr. Donaldson will provide you with complete after-care instructions. Be sure to discuss any concerns you may have with Dr. Donaldson regarding changes in your daily skin regimen or the use of other medications in conjunction with your BOTOX treatment.

Though recovery does not generally involve any downtime, patients are advised to wait for one hour before strenuous exercise.

Many types of dermal fillers can enhance your lips. Most contain hyaluronic acid, a natural substance found in your body. Hyaluronic acid helps your cells hold onto water, and thus enhances the volume of your lips when injected strategically.

The fillers improve your lips’ shape, volume, and structure. You can go from thin lips to plump lips in just a few injections. The injections do not change your lips’ sensation — they feel like your natural feature.

Everybody metabolizes the injections differently, but expect your lips to retain their new look for about four to six months. Results are not permanent. You then need a repeat procedure to maintain the look.

Set up a consultation to discuss your goals. Dr. Reynolds t and dosage that’s best for you. Most people don’t need more than one to two syringes of filler.

You can also have the fillers added gradually over several weeks until you achieve the look you want. It’s easier to add volume over time and makes for a less noticeable change to your features.

You will see the effects of the injections almost immediately, but schedule them several days before a big event in case you bruise.

The procedure takes only a few minutes. Most dermal fillers contain lidocaine, a numbing agent, but the team may apply ice or a topical anesthetic to the injection sites to ease discomfort. They use a thin needle to inject the agreed-upon areas. The sensation is like a pinprick or a strong pinch. You may feel a stinging as the filler enters your lips, too

Once the injections are complete, you can go on with your day. Lipstick and balms should be avoided immediately after the injections.

Any side effects are short-lived. You may have some redness and swelling at the injection sites. Bruising, tenderness, and activation of fever blisters are possible, too. If you have discomfort following lip injections, you can apply an ice pack to reduce discomfort.

Submental fullness is the medical term your doctor might use to describe the unwanted fullness beneath your chin, which can be the result of moderate to severe fat below the chin. This may be commonly known as a “double chin”

What causes submental fullness?

Submental fullness due to fat beneath the chin can impact a broad range of both male and female adults. Some possible causes are genetics, weight gain, and aging.

KYBELLA® is an individually tailored injectable treatment that permanently destroys fat cells in the treatment area under the chin for an improved profile.6 KYBELLA® is intended for adults with moderate to severe submental fat (double chin)6

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Multiple injections are given under the chin per treatment; up to 6 treatments may be given, at least 1 month apart6

The safe and effective use of KYBELLA® for the treatment of subcutaneous fat outside the submental region has not been established and is not recommended6

When injected into subcutaneous fat in the treatment area under the chin, KYBELLA® permanently destroys fat cells. Once destroyed, those cells cannot store or accumulate fat

Fat cleared from the treatment area is processed through natural metabolic mechanisms

Candidates who may not be appropriate for KYBELLA® treatment are those with excessive skin laxity and prominent platysmal bands.

Use caution in patients who have:

—A current or prior history of dysphagia

—Coagulation abnormalities or who are currently being treated with antiplatelet or anticoagulant therapy

—Had prior surgical or aesthetic procedures in the submental area

KYBELLA® is contraindicated in the presence of infection at the injection sites

Sometimes, even with diet or exercise, the unwanted fullness may not go away. Genetics, weight gain, or aging can be a cause of submental fullness due to fat beneath the chin.

Dr. Reynolds will help you determine how many treatment sessions you need based on the amount and distribution of your submental fat and your personal treatment goals. Up to 6 treatments may be administered, spaced no less than 1 month apart

KYBELLA can cause serious side effects, including nerve injury in the jaw (which can cause an uneven smile or facial weakness, as experienced by 4 out of every 100 people in clinical studies) and trouble swallowing (experienced by 2 out of every 100 people in clinical studies). The most common side effects include swelling, bruising, pain, numbness, redness and areas of hardness in the treatment area.

Although results are noticeable, they are not immediate. KYBELLA works gradually to destroy fat cells. Once the aesthetic affect is achieved, further treatment with KYBELLA is not expected. Because there will be an inflammatory reaction, typically the skin tightens up as well as disappearance of the fat

Bioidentical hormones are compounds that exactly match the natural hormones your body makes when it is (or was) in balance. Intermittent testing is required to monitor the changes you need as menopause progresses.

Yes. We calculate the dosing of your bioidential hormone mixture based on your unique hormone levels. To be truly bioidentical, we want to check your levels to make sure they are in balance. Your insurance will typically pay for blood testing.

When hormones are absorbed rather than swallowed, they go directly to the tissues and are not altered by the liver. This is called the “first pass effect.” Bypassing the gastrointestinal system also avoids many possible side effects. We use pellets as a convenient and measurable way to provide your hormone replacement.

Certain women should not undergo hormone replacement therapy of any type until detailed studies on safety have been performed. You are not considered for bioidentical therapy if you have a personal history of breast cancer or stroke, or if you have a blood clot.

This therapy is a not a new approach to hormone replacement; it has been used since the 1930’s. Bioidentical hormones are legal to prescribe and use in the US, although the FDA has not given its specific approval. The lack of FDA approval is because there are no official placebo-controlled studies to prove whether bioidentical hormones are safer than standard hormone replacement therapy.

In the beginning of your therapy, you will need frequent testing to check that each hormone component is in proper balance. Once you are feeling well and tests show a proper balance, your visits can be less often – usually only once a year.

You will see improvement within the first 2 to 3 weeks of therapy, but it will take up to 8 weeks to feel the full effect. We want to achieve balance with the lowest dose of each hormone – the recommendation of the FDA and American College of OBGYN.

Fatigue, foggy mind, poor sleep, and weight gain are common symptoms of adrenal fatigue. The adrenal gland produces Cortisol, which controls our response to stress. During times of high stress, whether short or long-term, your ability to produce the proper levels of Cortisol can be affected. Sound nutrition, exercise, and short-term Cortisol supplementation can reverse this condition.

Platelet Rich Plasma Injections are used to stimulate healing using one’s own blood components. The physician will withdraw your blood, put the blood into a centrifuge where the platelets are extracted (platelets are now known to release healing proteins known as growth factors) and then inject that solution directly into the injured site using an ultrasound guided technique to ensure proper placement. These proteins then stimulate repair and regeneration at the site, offering the patient pain relief and quicker healing rates. In most cases, 1-3 injections are required.

Platelet injections are an alternative to surgery. Ideal candidates would be those who prefer a less invasive option to surgery or those who are unable to undergo a surgery. It also allows for a much quicker recovery period and is much less painful than a surgery.

It is important that patients considering this therapy find a doctor with experience in these types of injections. It is more likely to have a favorable outcome if the doctor administering the injections is experienced and skilled.

A large amount of growth factors are released at the site of injury upon injection. These platelets induce an inflammatory response to initiate healing. The platelets are able to restore tendons and ligamentous proteins as well as strengthen cartilage allowing it to become firmer and more resilient.

Patients usually tolerate the injection well. However, there can be soreness after the injection due to the PRP-induced inflammatory response. You can expect swelling and soreness during the first 48 hours post injection and are given pain medication to help alleviate the discomfort.

Most patients see some improvement within 2-6 weeks. The pain becomes less and less as the weeks pass with most clinical trials reporting improvement up to 6-9 months post injection.

Platelet injections are safe. Since you are using your body’s own blood components and there are no foreign substances being injected into your body, the injections are considered safe.

However there is some minimal risk involved. During research studies and clinical trials, the only risk noted was that the injection could cause an infection to develop. This is not unique to platelet injections, anytime a person undergoes an injection there is this risk. But because there are no foreign bodies being injected and there is no concern of disease transmission, this therapy is considered to be safe.

Using one’s own body as a healing mechanism is a relatively new concept in the world of medicine, and an exciting one at that. As therapies such as these begin to prove they are beneficial and effective, you will likely see similar therapies develop in other medical areas.

Schedule an appointment with Dr. Reynolds for more in-depth answers to the above questions or if you have questions you didn’t see answered here.