Patients with significant wrinkles in the forehead, between the eyes, and in the crow’s feet area in the upper third of the face, or who have deep furrows between the eyebrows which result in a stern or angry appearance may benefit from injections of neuromodulators such as Botox or Dysport.

These neuromodulators act by temporarily paralyzing muscles with which they come into contact. The paralytic effect usually lasts about 3 to 4 months.

Patients interested in Botox are seen in consultation with Dr. Casso. Any significant medical history is discussed. The patient’s concerns are carefully elicited.

Dr. Casso then makes a recommendation regarding the areas which may benefit from treatment, and the appropriate dose.

The patient undergoes prepping of the facial skin with alcohol. Often, an ice pack is applied to the area being treated to reduce the discomfort of injection. Treatment of the forehead involves a series of 8-10 injections placed at intervals to achieve the desired effects. Treatment of the vertical lines between the eyebrows requires two injections. Sometimes a horizontal wrinkle across the base of the nose between the eyes is treated with a third injection. The crow’s feet are treated with a single injection each. Generally, treatment of these three areas requires approximately 40 units of Botox, or 120 units of Dysport.

Although Dr. Casso makes an effort to avoid puncturing small blood vessels, sometimes bruising occurs, particularly in the crow’s feet area. Bruising can be minimized if patients refrain from taking aspirin or other anti-inflammatory medications for one week prior to injection.

Patients are advised to avoid any massage of the treated areas for 48 hours to prevent undesired migration of the injected material away from its intended target.

The maximal effect of paralysis is normally evident after about a week.

Over the ensuing months, as muscle activity is reduced, and folding of the skin is prevented, skin repair may proceed, and wrinkles become less evident.

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