Frequently asked questions - FAQ`s
The following questions have been answered by Dr. B. Peter MiraMed / Salzburg.
Botox can be used to relax specific muscles that are responsible for wrinkles. This method is ideally suited to treat glabellar furrows, laughter lines, wrinkles on the forehead, crow's feet, or platysma bands. The treatment involves the injection of Botulinum Toxin Type A (Botox, Dysport) into the muscles. The dosage is so low that any degree of poisoning is completely impossible. The effect starts to show after one to three days and wears off after four to six months. The treatment can be repeated indefinitely. It can be observed that long-term use has a certain lasting effect as the pull of the muscles becomes less and wrinkles flatten. The only contraindication can be an overdosage which leads to a temporary weakening of neighbouring muscles (e.g. lifting the eyelids, neck muscles). The smallest quantities sold are 100 units (Botox) and 500 units (Dysport), of which a fifth is needed for one treatment.
The greatest risk is a partial paralysis of neighbouring muscles. A treatment of glabellar furrows may affect the muscles that raise the eyelids. The same can happen to the sip musculature when wrinkles in the neck area are treated. These side effects are annoying, but they wear off after three to six months. In very rare cases the body may develop antibodies after a number of treatments, which diminish the results. Symptoms of poisoning are practically impossible, since they would require a much higher dosage.
FAQ: Are there any dangers to an unborn child? What happens if a woman conceives a child, e.g. a month after the injection, when Botox is still active?
The risk is zero. All we know about the (side) effects of Botox indicates that there is no danger.
FAQ: Are Botox and Dysport officially registered medications for the cosmetic treatment of wrinkles as they are in the US?
Although Dysport is nowhere officially licensed for the treatment of wrinkles, it is used anyway. This is known as an Off-Label-Use. Compared to Botox, Dsyport is a third less potent. Botox is licensed in Switzerland, France, Poland, the USA, and Canada, but not here which makes it another Off-Label-Use.
The use of Botox/Dysport as a supportive measure can be very helpful in the case of skin treatments and for surgery to relax and immobilise the treatment area.
Wrinkles develop automatically under the influence of gravitation which causes a sagging of soft tissue. These can be smoothed out through lifting. Sleeping on one's preferred side can lead to the development of so-called 'sleep lines'. These become visible as vertical lines across the lateral forehead and the cheekbones. These wrinkles can be successfully treated with injectables/fillers (augmentation). Wrinkles caused by the pull of muscles can be diminished through augmentation or the injection of Botox (Botolinum Toxin Type A).
As a general rule, only substances that are well tolerated should be used. Almost all of them dissolve after six to nine months and are resorbed by the body, which means that the treatment has to be repeated. Nowadays, Collagen has lost its importance as the main filler. Artecoll represents a peculiarity, as it mixes microscopically small synthetic globules with Collagen. The synthetic components do not dissolve and in some cases may provoke a rejection reaction. Moreover, half and fully synthetic fillers have been developed, which are either based on hyaluronic acid (e.g. Hylan) or polylactide (e.g. New Fill, Restylane). These substances do not bear a risk of allergic reactions and can be used without prior testing.
This really depends on the individual person's sensation of pain and the area to be treated. Very sensitive parts, such as the lips, can be anaesthetised.
The treated area is immediately and visibly filled up which is also amplified by the swelling for a couple of hours.
Swellings and, less frequently, oedemas may form temporarily. Very rare are palpable nodules and other side effects, especially if resorbable fillers are used.
The most common transplants are either natural (e.g. the patient's own dermis), synthetic (tubular synthetics such as Softform or Goretex), or metallic (e.g. gold threads), which are placed under the sagging skin to smooth it out. These materials do not dissolve and are usually well tolerated.
There are several methods which should be combined to achieve a successful treatment. First, there is the subcutaneous dissolving of wrinkles, then a surface treatment with dermabrasion, and finally a chemical peeling. Also the use of injectables/fillers can lead to the desired results.
For skin refreshment and revitalization we can recommend a mesotherapy. The initial three to four sessions take about 30 minutes each. The treatment should then be repeated every three to five months to succeed. Vitalizing substances are superficially injected into the skin, which leads to a local reddening for a few hours.
Thermage is a new technique among the many skin treatment procedures. It uses high frequency radio waves that stimulate collagen growth in the connective tissue. Some clinical trials show actual changes in the tissue. However, the possible results should not be exaggerated as they are nowhere near a face lift. For the rejuvenation of the skin there are other, better known, and very successful treatments that are less expensive. From our point of view, it is too early to offer this treatment without sufficient evidence for its benefits. Thermage is surely not the best, the only, or the most effective method.
Wrinkles can be treated through smoothing or the removal of excess skin. Among these operations we count the face lift and all similar procedures for the tummy, the buttocks, the upper arms, the hands, and the thighs.
There is no definite age for any aesthetic corrections. Only the initial diagnostic findings and the realistic expectations of the patient determine how to proceed. In younger adults excess skin is very rarely to be found. What may cause dissatisfaction are sagging cheeks or similar phenomena. Here a face lift is possible, though minimal surgery is often sufficient.
The therapy depends on the question which factors caused the double chin in the first place. This may range from a simple liposuction to skin smoothing operations.
One possibility to treat these symptoms is the so-called midface lift. The necessary incision to lift the area around the cheeks can be made in the lower eyelid. At the same time the tear sacs could be treated. Depending on the actual problem, other operations, such as a cheek lift, are also conceivable.
The pain that results from a local anaesthesia depends significantly on the technique, especially on how fast and where the needles are injected. Experience has shown that patients tolerate the local anaesthesia necessary for an operation on the eyelids pretty well. There are quite a few patients who say later on that they did not feel anything. Often a consultation before the operation can clarify most of these issues.
There is no typical face lift. It always depends on what kind of changes the patient wants. Tightening the skin on the forehead can lift the eyebrows and smooth out the glabellar furrows. A temple lift leads to a smoother skin around the eyes. Not only does a cheek lift remove wrinkles in this particular area, but pushes the fatty tissue which slipped over the zygoma back into its original position. During a skin smoothing procedure on the neck, a small incision just under the chin allows the surgeon to perform a liposuction in the same area. A so-called mini lift is advisable, if the intended corrections are rather small. In most cases, temples, cheeks, and the neck are lifted at the same time and combined with a relocation of the superficial musculature. The lifting of one or more facial areas can be supplemented with further treatments, such as a lid correction. It is also quite common nowadays to treat subtle wrinkles around the mouth and the eyelids with non-invasive procedures. Before you decide in favour of a face lift, you should consult with your surgeon. Thus you can learn more about the various methods and determine together with the surgeon how the desired results can best be achieved.
Surgery is performed under twilight or general anaesthesia. Additionally, tumescent anaesthetics are infiltrated. It is not required that the head is shaved prior to the operation. The incision starts at the temples within the hairline, passes the ears, and ends behind them. In the case of a forehead lift (brow lift) the incision is also made within the hairline. Along this incision the skin is lifted from the underlying connective tissue, which is then corrected along with the musculature that controls facial expressions and the sunken fatty tissue. Extremely thin threads fix the connective tissue and the muscles in their original locations. In the area of the forehead, the cheeks and the eyes, many of these corrections can now be performed using endoscopy. This method has the great advantage that the incisions are much smaller. The facelift wounds are first sutured with resorbable stitches before the skin is tightened and fixed. The whole procedure may last between three and five hours. During this time the surgeon has to work like a sculptor, only in a much more detailed way. His skill, experience, and sense of aesthetics determine the final result of the lifting.
After surgery the skin will feel tight and swollen. Oedemas in the cheek area and under the chin as much as a slight numbness across the whole face are perfectly normal. The most pronounced swellings appear one or two days after the operation and may change the look of your face significantly for a certain period of time. These swellings recede and disappear within the following one to three weeks. Depending on the complexity of the face lift, the final result starts to take shape after a few weeks or months.
After a face or forehead lift the sensibility in and feeling of the skin can be permanently impaired in the affected areas. A postoperative oedema which may appear after surgery can significantly delay the healing process and should be removed surgically. In a few cases, the tightness of the skin may lead to a partial hair loss around the temples. However, the hair grows back within the next few months. A reduced blood circulation caused by heavy smoking can lead to wound necrosis and prominent scars. These may have to be treated separately. If bacterial infections set in, they may not only delay the healing process but cause wider scars. These can also be corrected through additional surgery. Damaged facial nerves which are highly unlikely in the hands of experienced surgeons regenerate after three to six months. In rare cases lesions of skin and muscle nerves may appear which then regenerate automatically within weeks or months. A permanent damage to the face musculature caused by the surgical procedure itself is a very uncommon occurrence.
Full recovery time may vary from patient to patient depending on his or her physical disposition and the complexity of the operation. The first five to seven days should be exclusively dedicated to rest and recovery. During that period you should not burden the skin with creams and ointments. Your skin can take care of the healing itself. On the eighth day you can have a shower and put on make-up as usual. For the first month you should avoid nicotine and pain relievers, such as aspirin. The same is true of direct sunlight. If you do want to spend time in the sun after that, a very high sun protection factor is advisable. You can do your favourite sports again without any restrictions after four weeks.
Through an effective face lift time is turned back by ten years. The rejuvenation effect lasts for a lifetime and natural aging is deferred by the same number of years. The face lift can be repeated after some time if the patient wishes to rejuvenate his or her outer appearance again.
The effect can be lessened or completely neutralised by taking specific medicine (i.e. high dosage Vitamin C and various antibiotics). After the injection you should avoid any extensive physical strain for twelve hours as well as putting your fingers on the injection marks. You should often tense the muscles treated with botulinum toxin to ensure that the substance is well-dispersed. For three to five days you should avoid all activities that could result in increased blood circulation (i.e. sauna, sun, solarium, sports).
After a pre-treatment with botulinum toxin, the regrowth of collagen and elastic fibres can take place in an undisturbed manner and parallel to the skin surface, since the relaxed muscles prevent a reformation of the old wrinkle pattern.
Slight wrinkles, blotchy pigmentations, aged skin, slight acne vulgaris, rosacea and hyperceratosis (broadening of the corneal layer of the skin) can be treated with a superficial peeling. The medium peeling is used for fine wrinkles, aged skin, pigmentations, sun damage and, in the case of shallow acne scars, as an additional treatment. Deeper wrinkles, acne scars and stronger sun damage are treated with deep peelings.