Botulinium Toxin
& Dr Di Saia's Philosophy

BOTOX® and MYOBLOC® are therapeutic muscle-relaxing agents that work at nerve endings that control muscles. BOTOX® is a registered trademark of Allergan pharmaceuticals. MYOBLOC® is a registered trademark of Solstice Neurosciences.

"What is Dr Di Saia's Philosophy on Botulinium Toxin?"
These toxins when used conservatively can improve facial wrinkles. They can be used by those with little experience to make you look pretty silly. To avoid this in the practice, Dr Di Saia administers these treatments personally (no nurses or assistants) and limits the areas of treatment to limit problems. He will not treat "whole foreheads" as the risk of "dropping the eyebrows" is real. The best areas for treatment are at the base of the nose (where it meets the forehead) and the "Crow's Feet" near the lower eyelids. Please note that Dr Di Saia offers Botulinum toxin treatments primarily to existing clients as a support service. He is not always in the position to accept new clients interested in primarily Botulinum toxin treatments. You may of course call the office for availability.

"What are BOTOX® and MYOBLOC®?"
These therapeutic agents are derived from the bacterium, Clostridium Botulinum. Also known as Botulinum Toxin Types A and B respectively they are produced in the laboratory and provided in extremely small doses. 

They are used in the treatment of several conditions associated with overactive muscle activity. Some of these have been found to be of benefit cosmetically. Botulinum Toxin Types A & B are the most studied of the seven different serotypes of botulinum toxin (A, B, C1, D, E, F, G). Each serotype has different properties and actions. No two are exactly alike.  
 

"How does this stuff work?"
Normally your brain sends electrical messages to your muscles to tell them to move. The electrical message is transmitted to the muscle by a substance called acetylcholine. BOTOX® and MYOBLOC® work to block the release of acetylcholine and, as a result, the muscles treated don't receive the message to contract. This means that the muscle activity is decreased after injecting these agents providing a decrease in certain facial wrinkles 

"Who is a Good candidate?"
Patients looking to diminish certain facial expressions such as the "Look of Consternation" in the patient below. Notice that her forehead muscles still work. Only her vertical nasal root wrinkles were treated.

Treatment of the entire forehead has been shown to contribute to forehead droop and is therefore not advised.The wrinkles at the base of the nose are fair game though :).  

Injections such as these are probably best suited to decreasing wrinkles at the root of the nose and at the lower sides of the eyelids or "Crow's feet". Patients looking to diminish facial expressions such as the "Look of Consternation" seen at the base of the nose in the patient below are good candidates. Notice that her forehead muscles still work after treatment. Only her vertical nasal root wrinkles were treated.

BOTOX® & MYOBLOC® are not a cure. For many patients, however, their effects have been dramatic - the injections take effect within a few days and the effects can last for approximately two to three months.
 

"How is it administered?"
They are injected into the muscle. Dr Di Saia can determine the muscle(s) in need of treatment. Not all muscles respond similarly to treatment and certain muscles should not be treated. 
 

"Does the treatment hurt?"
A very fine needle is used for the few injections that are usually given per muscle. Some patients report minor and temporary discomfort from treatment. A burning sensation or a headache can follow a treatment. 

"How long does it take to work?"
Usually, you will see the effects within three days. The maximum benefit is reached in one to two weeks. 
 

"How long does it last?"
These agents seem to offer sustained relief, dose after dose over the course of long-term treatment. The relief you will feel from a single treatment will normally be sustained for approximately two to three months. You will notice a gradual fading of its effects. At this point you may return to your doctor for another treatment. You may notice a slightly decreased effect over the long term as your body "adjusts" to the medication. 

Usually, BOTOX® treatment is required only three or four times a year. Symptoms may vary throughout the course of the condition, and so the degree of relief and duration of effect varies from person to person. 
 

"How long can I be treated with these agents?"
Treatment may typically be repeated indefinitely. Acceptable safety in long-term treatment has been experienced. 

There are a number of factors that can impact your long term experience: 

• Having realistic expectations - Changes occurring with each injection can be variable. Some physicians dilute the material which can make the treatment less long lasting. Patients can also form antibodies to the material that can decrease its effectiveness.
• Proper muscle selection - Identifying and injecting the affected muscle requires the proper knowledge of facial anatomy. This is why some practitioners seem to be better at the use of these medications than others.

"Does insurance cover this?"
When used for cosmetic purposes, these treatments are not covered by insurance.

"Are there any alternatives?"
Newer Botulinium components are under study. We will just have to wait and see.

"Why are you offering MYOBLOC®?"
MYOBLOC is much more stable for storage, so I don't need to charge as much for each injection. My patients have liked it eventhough some have said it burns a bit more with injection. BOTOX is available as well, but it is more expensive with a higher minimum charge.

"Do you have any MYOBLOC® pictures?"
This patient had a small horizontal line at her nasal root. This is the Procerus muscle which was treated alone to preserve her normal appearance. We have all seen people who have had too much of these medications. Below she appears before and 6 days after MYOBLOC treatment.