Botox And It's Effects On The Brain

Does paralizing the muscles used to frown actually effect the brain?

Here's some completely antecdotal findings that preventing people from physically frowning might actually have effects that make them happier. (Not scientifically validated of course.)

The facial feedback hypothesis states that facial movement can influence emotional experience. Charles Darwin was among the first to suggest that physiological changes caused by an emotion had a direct impact on, rather than being just the consequence of that emotion. Recently, strong experimental support for a facial feedback mechanism is provided through the use of Botox to temporarily paralyze facial muscles.

In a functional neuroimaging study, Andreas Hennenlotter and colleagues, Botox decreased activation of brain regions implicated in emotional processing and emotional experience (namely, the amygdala and the brainstem). These studies suggest that botox can dampen the ability to understand another's emotions, and they lend considerable support to Darwin's original notion.

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What Post-Neuromodulator Instructions Are Really Needed For Your Botox Patients

The most common instructions given to Neuromodulator injection patients post-treatment seems to be to avoid exercise, aspirin, and laying down for 4 hours. Every physician seems to have their own recommendatations, and none of them are the same.

Don't tie your shoes. Don't go bowling. Don't work out. Don't wear a hat. What?

I've heard physicians tell patients 4 hours, 12 hours, no sex tonight and everything in between. But it seems that if the Botox or Dysport has been injected correctly the outcomes are pretty much the same. In general you're probably well served by waiting a few minutes before you lie down or constirct the treatment area (wearing a hat) since the Botox very rapidly moves into the tissues. The window is proably quite short where the patient could affect the treatment in a negative way.

The one benefit of listing a whole slew of dont's is something of a CYA tactic (understandably) that gives you a little air-cover if the patient is unhappy in some way.

Happy to listen to opposing views.

Brotox...Botox For Men? Don't Bet Your Clinic On It.

Brotox Botox for MenYet more stories about men getting Botox... now it's "Brotox", but don't bet your medical spa on your male clientele.

Plumbers and wall street bankers alike are increasingly turning to Botox to turn back the years? There's more on what's touted as a growing population of men that are turning to cosmetic medicine, Botox in particular.

It Britain, they call it the “Simon Cowell” effect. What do Simon Cowell, Gordon Ramsay and David Hasselhoff have in common? They’ve all confessed to having Botox. Turn out, men care about their appearance just as much as women do, they just haven’t wanted to talk about it.

Once relegated to the female population, Botox has gained popularity among men today – particularly those with what are considered “stressful” careers. Dermatologist Dendy Engleman said that Wall Street men are “the fastest growing segment of my patient population,” because they’re looking to smooth out the stress lines caused by the European crisis abroad and weak economy at home. 

Men feel pressured to maintain a more youthful and attractive appearance to compete in the job market. There’s also less of a stigma now for men to turn to cosmetic procedures. Think of it as a continuation of the metrosexual movement. Guys taking charge of their appearance, and owning it.

And it’s not just Botox. Injectable dermal fillers have now become the second most popular nonsurgical treatment for men. Evidently 29% of men get manicures, 24% have facials, and 13% get eyebrow waxing appointments.

Tom Ford and Marc Jacobs have both launched men’s cosmetic lines. With guyliner and murses out there, it’s no real surprise this is a growing trend. 

Most of the above is complete bullshit. 29% of men get manicures? Bullshit. 13% have eybrow waxing? Bullshit.

Don't listen to what you hear in the press about stuff like this. It's written by a twenty something who's just rewriting a press release that's designed to get attention.

My opinion is that the number of males who look at some form of cosmetic medicine is going to vary somewhere around 5-5% of your clinic, a little more in some areas but that's pretty much it. It's generally a waste of time to try to cater to men in the same way that you cater to your female patients unless you're just doing it for some sort of marketing. There may be some growth, but that just represents the growth of the market in general, and since males make up such a small percentage, it's not hard to see those numbers as skewed. Don't take the bait.

And while we're at it, let's take a moment to share a story about my brother-in-law. Last week he had a business meeting out of town. He packed his bags, han an uneventful flight, checked into his hotel and slept well. In the morning, while dressing for his meeting, he realized that the black pants he had packed to wear with his black suit jacket were actually, his wife's skinny black pants. Ever the problem solver, he decided to give them a quick try on anyway. Surprisingly, they fit... poorly, but still. He even claims they perfectly matched his suit jacket. So, the point I make, perhaps I'm wrong.

Botox For Plantar Fasciitis

I've seen Botox used for stress headaches, but until now I was unfamiliar with the fact that Botox can also be used to treat Plantar Fasciitis.

The article below detalis some of the new reasearch, but I'm wondering if anyone is using / has used Botox in this way and what the results were? (Leave a comment.)

Botulinum toxin (BTX)A may be more effective than steroids for the treatment of plantar fasciitis.

The 19 patients given a total of 250 U of BTX-A split between two medial and lateral calf muscle sites and the soleus had significantly faster and greater improvement than the 17 patients treated with intralesional dexamethasone (8 mg) plus 2% lidocaine (2 mL).

Although there was no significant difference between the BTX-A and steroid treatment groups at baseline for the visual analog scale (VAS) for pain (7.1 vs 7.7), patients given BTX-A had a significantly lower average score than steroid-treated patients at the 1-month check up (1.9 vs 3.4 points). Scores were also significantly lower at 2 (1.6 vs 3.6 ), 4 (1.5 vs 3.7 ), and 6 (1.1 vs 3.8) months.

Similarly, despite comparable Maryland Foot and Ankle scores at baseline, the BTX-A-treated patients had significantly greater improvement over the whole study than steroid-treated patients.

Although both patient groups experienced significant improvements of American Orthopaedic Foot and Ankle Society scores and Foot and Ankle Disability Index scores at 15 days after treatment, BTX-A was associated with a faster and more sustained treatment response than steroids.

The researchers note that all patients were shown dorsiflexion and plantarflexion stretching exercises to begin within a week of treatment.

“It is important to note that patients must perform plantar fascia stretching exercises to obtain a rapid and sustained improvement of plantar fasciitis,” say Carlos Acosta-Olivo (Hospital Universitario “Dr Jose E Gonzalez,” Universidad Autonomade Nuevo Leon, Monterrey, Mexico) and co-workers.

Read the entire article here.

Additional articles on the same subject:

The Power Of The Botox Birthday Coupon

For the past 5 years, our plastic surgery office has been offering patients birthday coupons worth $50 off their Botox injections.  

I've been impressed with the power of this Birthday Coupon. Basically this is a letter sent out via a group email with birthdays identified one month at a time. Our EMR is able to identify birthdays which are coming up. Of course we take advantage of the blind cc: email function soin order to protect patient privacy. We also let our patients use it for fillers instead of Botox, and because all patients are getting this email who have a birthday coming up, some patients aren't appropriate for Botox or fillers, and thus we allow them to pass it along as a "regift."

It brings back patients whom I haven't seen in while.  It also brings back patients who have wandered off to other Botox places.  I've also seen new patients who have never received Botox before because they got a the coupon tactfully passed along from one of our existing patients.  And best outcome is when a patient is converted over from an unrelated plastic surgery procedure such as breast augmentation or tummy tuck (already happy and familiar with our office), and now he or she is armed with coupon in hand ready to try Botox!  And in general, our patients seem very grateful for the gift - especially the ones who have already used our services every 3-5 months.  Another benefit of the Birthday Letter is that it makes patients eager to give us their email addresses to stay in touch.

For our office, it's Botox that we use, but I think this concept could be converted to another product or service which helps patients look younger.

The Birthday, itself, of course is a great event, however it does remind all of us that we are getting older, and getting Botox is one of the ways to help us age more gracefully.  I think using a cosmetic injection coupon is a great marketing tool and I've seen a good return on the investment for our own plastic surgical practice.  Best of all, patients seem to really like it and it is a "win-win."

Using Artefill

Are you using Artefill? How do you like it?

There have been a few chapters in the story of this filler, and I know that many doctors are not using it due to fears of permanent fillers and fears of longterm complications. Also, it went off the market for a while as Artes Medical went bankrupt, but came back from a new company called Suneva.

I am a fan of the product and have used it quite a bit in my practice for the last 6 years. I have seen no concerning longterm issues. No granulomas, no migration, no product lumps. In Europe it sounds like doctors encountered quite a few serious problems with the Artecoll and Arteplast iterations of the product, including granulomas and lumps. It was so much so that a fairly strident call went out to never use permanent fillers. This boycott was enthusiastically supported here in the states by many plastic surgeons and dermatologists (most notably Arnie Klein). Even now, it seems that doctors who use Artefill are considered somewhat fringe by the core group of physicians.

I think that this is a shame. I have used the product on over 1000 patients without a single adverse event and I find it to be soft, natural appearing and forgiving. My main issue is that when the collagen component gets absorbed it is often not fully replaced by the patient's tissue. The result is that I frequently have to do several sessions in order to get good results and this can get costly. I inject in the deep as well as the superficial planes, but i try to have most of the product stay superficial. Because the product is so soft, I have found that if I inject it deep I do not see great results.

What is your experience?

Interview With Certified Allergan Botox Cosmetic Trainer Marc S. Scheiner MD: Part 1

Certified Allergan Botox Cosmetic Trainer Marc S. Scheiner MDPart 1 of our interview with Marc Scheiner MD, an Allergan Certified Botox Cosmetic Trainer and the physician instructor on Botox Training MD.

Name: Marc S. Scheiner, MD
Clinic: O'Leigh Aesthetic Surgery Center
Location: Elkton, MD
Clinic Website:
Training Website: Botox Training MD

I this three part series we're discussing Botox and fillers with Marc Scheiner MD who trains clinicians through 14 credit CME two-day hand's on seminars with the American Society of Aesthetic Medical Professionals and Botox Training MD, an online botox training site for clinicians. 

Part 1: Botox injections
Part 2: Filler Injections
Part 3: Complications of Botox and Filler Injections

In part 1 we discuss Botox indications, complications and some treatment techniques.

Let's talk a little bit about differentiation between Botox and fillers. Can you give me a kind of a overarching framework of how it is that you decide which is going to be better treatment for an individual patient?

Well, certainly, to determine whether or not you're going to treat someone with Botox versus fillers really requires that you have an understanding of facial ageing right from the beginning. So typically when you evaluate the face

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Interview With Certified Allergan Botox Cosmetic Trainer Marc S. Scheiner MD: Part 2

Allergan Certified Botox Cosmetic Trainer and the physician instructor on Botox Training MDPart 2: Filler Injections

Name: Marc S. Scheiner, MD
Clinic: O'Leigh Aesthetic Surgery Center
Location: Elkton, MD
Clinic Website:
Training Website: Botox Training MD

I this three part series we're discussing Botox and fillers with Marc Scheiner MD who trains clinicians through 14 credit CME two-day hand's on seminars with the American Society of Aesthetic Medical Professionals and Botox Training MD, an online Botox training site for clinicians.

Part 1: Botox injections
Part 2: Filler Injections
Part 3: Complications of Botox and Filler Injections

And how about for filler injections? Are there different levels of expertise in treating different areas?

Filler injections also have this kind of heirarchy of possible complications. If we just review briefly where the fillers are used commonly, and then we can kind of discuss which is the most elementary to the advanced techniques

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Interview With Certified Allergan Botox Cosmetic Trainer Marc S. Scheiner MD: Part 3

Botox TrainingPart 3: Complications with Botox & Filler Injections

Name: Marc S. Scheiner, MD
Clinic: O'Leigh Aesthetic Surgery Center
Location: Elkton, MD
Clinic Website:
Training Website: Botox Training MD

I this three part series we're discussing Botox and fillers with Marc Scheiner MD who trains clinicians through 14 credit CME two-day hand's on seminars with the American Society of Aesthetic Medical Professionals and Botox Training MD, an online botox training site for clinicians.

Part 1: Botox injections
Part 2: Filler Injections
Part 3: Complications of Botox and Filler Injections

So Dr. Scheiner, tell me about some of the typical complications you've seen and how you deal with them?

In general, the complications are separated with regard to what product we're using. There are different complications with each filler within the filler class. We're going to see different complications from one filler to the next, but in general all the fillers are going to... Well, let me rephrase that. All the nonpermanent fillers are going to result in similar complications. That is to say that I believe you may experience a different set of complications with

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Botox & The "Spock" Look

Botox + fillers that make your patients look like Vulcans?

The clinical and cosmetic uses of neurotoxins continue to grow. Botox, perhaps after aesthetician visits, are often the first procedure consumers consider. It is very common for patients to tell me that they have been considering Botox treatments for 3 to 5 years. We frequently see these patients pleased with there Botox treatments and then very interested in fillers, non-invasive body contouring, and often surgical procedures. However, what quickly interrupts this transition to other services is a result from neurotoxins that looks unnatural.

In our practice, we have increased patient retention and satisfaction after their initial Botox treatment by reviewing with them possible outcomes. Patients will often complain about a quizzical or "Spock" look after glabellar and sometimes forehead injections. I am still surprised that patients are not told of this and that there is a simple remedy. As most practioners know, 2-4 units additional neurotoxin at or just above the over arched area will soften the arch of the eyebrow.  A follow-up call/visit or just good instructions to the patient can turn a dissatisfied patient into a lifelong member and proponent of your practice.

Botox Training MD: Online Botox & Filler Injection Training Course

Getting started with Botox and filler injections through Botox Training MD, a comprehensive online video training course.

Botox Training MD is an online course for clinicians that teaches you everything you need to know to begin offering Botox and filler injections inside your medical practice. It's exactly the same course and content that is taught in Dr. Marc Sheiner's two day course but comes packed with extra information and bonuses. Best of all, better than trying to remember everything you saw and learned during an in-person course, this course is taught via video and delivered online so you can review each module as many times as you want or need to.

Oh, and by the way, you'll save more than $1,400 off of the two day course tuition.

Botox Training Online Video Course

Botox Training MD Membership is for clinicians who…

  • want to add an additional high-profit revenue stream to their practice
  • want access to the highest quality training and learn the secrets of successful experts
  • want to avoid the costly mistakes that all new cosmetic practices make
  • want to know how to start, manage, and grow their new business
  • want to have 24/7/365 access or don't have local access to training
  • are done thinking about going big and are ready to take action!

Here's a welcome message from Marc Scheiner MD, the Botox Training MD online course instructor.

We’re here to help you start learning how you can add Botox and fillers to your practice. There are a lot of tabs, options and videos inside of the coursebut there’s no need to to feel overwhelmed.

Botox Training MD Video Modules: This is where you'll probably want to start. You’ll want to watch these videos in order since they build on each other and we often refer to previous modules. These videos will walk you, step-by-step, through the individual treatments.

  • Module 1: Introduction to Botox & Fillers
  • Module 2: Infra-orbital & Mental Nerve Blocks
  • Module 3: Lip Augmentation, Nasolabial Folds & Peri-Orbital Rejuvenation
  • Module 4: Glabellar Frown Lines
  • Module 5: Periorbital Rhytids (Crows Feet)
  • Module 6: Forehead & Frown Lines
  • Module 7: Liquid Face Lift (Cheek & Jaw Augmentation)
  • Module 8: Marionette Lines & Fillers
  • Module 9: Axillary Hyperhydrosis
  • Module 10: Advanced Botox Techniques (Lower Face, Platysmal Bands, Depressor Anguli Oris & Browlift)
  • Module 11: Advanced Dermal Filler Techniques

Here are two very short excerpts from Botox Training MD's online video training modules from module 5 on using Botox for periorbital rhytids (crows feet) and another excerpt from module 11 on advanced filler techniques.

Module 5: Periorbital Rhytids (Crows Feet)

Illustrated PDF Treatment Guides detailing exactly how each treatment is performed,  how it can be modified for best results, and how to avoid complications.

Resource Guides show you where to find the best deals on products and services to grow your practice without breaking the bank, from managing your legal structure to adding marketing resources.

Consent & Follow-up Forms: Use the same forms that I use for my own patients! Informed consent, follow-up, treatment records and more. Best of all, they’re delivered as Word documents so you’ll be able to modify them with your own logo, address and any other information you may want.

Discover the secrets that only the real insiders know. Learn from physician experts that have been performing Botox and dermal fillers for years. These experts take you inside and share their secrets with you. What works. What doesn’t. What to look for and what to avoid. You’ll have insider information that you can’t get anywhere else on marketing, consultations, staff training, up-selling, pricing and every other aspect of cosmetic medicine.

Bonus Courses, Guides, Special Offers and Resources.

Cosmetic services are unlike traditional medical services and demand an understanding of new techniques as well as getting a handle on marketing and advertising. Our free bonuses will teach you how to sell without being ‘salesy’ or turning clients off, how successful physicians are marketing these treatments, and you'll be able to access some special offers that will save you money on products and services that you'll actually use.

NOTICE: This course is offered exclusively to physicians and clinicians who are licensed to perform these treatments in their geographic location.

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Pioneer Of Non-Surgical Rhinoplasty, Dr. Alexander Rivkin In LA

Dr. Alexander Rivkin is an international authority on non-surgical cosmetic treatments who provides non-invasive and non-ablative treatments in Southern California.

Name: Alexander Rivkin, MD
Clinic: Westside Aesthetics
Location: Los Angeles, CA 
Website: Westside Aesthetics

That's Interesting: After several years of being an Allergan Clinical Educator, Dr. Rivkin was recently honored with Diamond level status: recognition that he is among the top 1% of Botox providers in the nation

He is a prominent member of the national teaching faculties for Allergan, Contura, Johnson and Johnson, Medicis and Bioform. He is also a member of the physician advisory board for Contura and serves on the boards of a number of charities including the Lynne Cohen Foundation for Breast and Ovarian Cancer Research.

I first met Dr. Rivkin somewhere around 2002 when I was attending a "medical spa conference" and Westside Aesthetics was on the tour. At the time, Westside Aesthetics was located above a salon but now Westside Medical Spa is tucked away on Gayley Avenue near UCLA. 

Dr. Rivkin is renowned for non-surgical alternatives to commonly performed cosmetic procedures. He was the first physician in the country to offer the Non-Surgical Nose Job, his signature method for non-invasive correction of cosmetic nasal irregularities.

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Stem Cells & The Vampire Facelift

If you attend medical conferences, or read the trade journals, you’ve no doubt heard about stem cells and their incredible potential in the healthcare industry. These cells have the ability to repair or replace damaged cells, reduce inflammation, and possibly even have a role in disease prevention and cure.

Lately, these cells have been the target of much interest in the cosmetic field. Platelet-rich plasma (PRP) is the portion of the blood that remains after centrifugation has separated out the red cells. This fraction is unusually rich in growth factors and stem cells, that have the ability to repair damaged skin, and act as a long-lasting filler to volumize the face. The PRP is activated using calcium, and then is immediately injected into the donor’s face.

At Canyon Lake MedSpa, we have been using the patented “Vampire Facelift” technique (Regen Labs) in conjunction with standard HA or CHA fillers. We inject the filler using standard technique and then layer the PRP on top. Although still very new to this technique, we believe we are seeing the early effects including improved skin tone and color. Research has documented significant prolongation of filler effect, but we have not been doing this procedure long enough to attest to that yet.

Since we are only minimally manipulating the blood (centrifuging and decanting off the PRP) in a completely closed system, and re-injecting it into the same patient, there is virtually no risk.

In our next article we will discuss, in greater detail, tips on collecting and injecting PRP, how to educate patients and the outcome of our patients’ results.

There has been tremendous interest in the very-well marketed “Vampire Face Lift” and we have experienced an increase in our Med Spa new-patient visits as a result of this interest.

5 Years Of Good Experiences With Artefill (PolyMethylMethacrylate)

I've been using Artefill for volume with good results for the last 5 years.

On a recent chart and procedure review, I looked critically at the use of fillers in my practice over the past 5 years. I use HA's (Hyaluronic Acids) mainly for lips; some Sculptra (activator) for volume in thicker facial tissues; lots of Radiesse-everywhere except the lips; some PRP and an increasing amount of Artefill (except for lips) to take care of patients suffering from both "filler injection fatigue" and significant volume loss.

As part of a regieme of (re)creating Beauty using the CT3+V=Beauty, Color Correction, Texture, Tightness, Tone + Volume, VOLUME is a key player for rejuvenating the facial shape and contours, putting the skin on stretch-which restores texture, tone and luster, and is often more economical (social down time and real money) for patients with less risk. When coupled with smaller lifts, blephs and various resurfacing, the overall result is synergystic, less traumatic, equally dramatic and probably more rejuvenating than any other single element taken to it's maximal benefit alone.

It is illegal to inject silicon for aesthetic use in Nevada, so Artefill is my only choice for "permanent" revolumization. Interestingly, when I discovered how well my early Artefill patients were doing, I started using even more of the product and pricing it aggressively so that patients could afford to get significant corrections with 6 to 12 syringes. Overall, it ends up being less expensive for the patient than what they spend on restoring volume with temporary gels.

We have patients out nearly 5 years, who have maintained good correction from their initial injections with this FDA approved version of poly-methyl methacrylate. While the FDA approval of this filler is for correction of nasolabial folds, I have used it off label all over the face, the dorsal hands, for horizontal necklace lines and depressed scars.  I have learned from other talented physicians, the techniques of deeper, comfortable injections that lead to significant permanent correction of temple, peri-orbital, glabellar, zygomatic, malar and "tear trough" volume. More deflated patients have avoided rhytidectomy by using up to 20 syringes. My own 56 year old, jolly cheeks enjoy 6 syringes of this material done over a year ago. My wife, though a Grandma, appears more than a decade younger than her stated age. She is a walking example of combining modalities without major surgery and a great educator for my patients.

Perhaps physicians are rightfully afraid of long lasting/permanent fillers considering the horror stories of previous products. However, any laser or scalpel carries the risk of permanent poor aesthetic outcome. And this ain't your traditional, poorly tested filler. It's got data approaching 10 years outside the US which is devoid of serious complication. The risks that do show up with this filler are generally avoided with good technique. Last year, I shot nearly 600 syringes of Artefill without any unexpected issues-just some bruising and discomfort. No granulomas, lasting nodules, sloughs, Tyndell Effect or infections... ever, so far.

So maybe the well trained hand, wielded by an artful and educated physician in the service of the well educated patient is a mitzvah (a good and honorable deed). After all, what patient enjoys quarterly mammograms or DRE's, anymore than the patient who comes to the office every 3 to 6 months to maintain their lip and tear trough filler?

Lasting corrections, done conservatively, with safe, evidence based products, should be more widely offered and utilized. They benefit select patients by allowing them the chance to (re)build their volume once and maintain it, rather than recreate it over and over. They still top off the small volume we all continue to lose, but they now find other services in the practice to utilize because they are so happy with their Artefill results.

I know I am.

Top 5 Medical Spa Treatments In 2011

The top nonsurgical treatments in 2011?

  1. Botox: 5.7 million treatments (up 5% from 2010)
  2. Filler Injections (Juvederm, Restylane, Perlane, etc) 1.9 million treatments (up 5% from 2010)
  3. Laser Hair Removal: 1.1 million (up 15% from 2010)
  4. Chemical Peels: 1.1 million (down 3% from 2010)
  5. Microderm: 900,000 (up 9% from 2010)
Source: American Society of Plastic Surgeons

Botox Industry Register Launched In UK

Back in September of 2010 the UK launched a government-backed registry for providers of injectable cosmetic treatments such as botox and dermal fillers.

It seems to be something of a simple list rather that any kind of licensure since those who meet the standards for the Independent Healthcare Advisory Services' voluntary register, will receive a "quality assurance mark" that they can use to help promote their services.

The IHAS hopes people will be steered away from "Botox parties" or treatments offered in inappropriate locations and that if enough providers are using this mark that they can influence the market and get patients to actively look for it.

Of course such self regulation in the guies of some sort of association will not stop bad practice and the register has had limited success with the growing demand for Botox and dermal fillers.

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