Amazingly, despite the drumbeat of negative business news about the economy, record numbers of people are requesting Botox treatments from Maine Laser Skin Care this year, definitely outpacing our previous record pace from last year.  Although I have written extensively about Botox in prior newsletters and blog entries,  several questions come up recently and frequently enough to warrant further attention here.

“How do you (Dr. Burke) decide how much Botox to use?”

As many of you may know, Botox is measured in units as opposed to milligrams which most other medications are measured in.  The amount of Botox units that I recommend depends on the area of the face involved, whether the person has had Botox in that area before, and finally how strong the muscles are in that area.  In general, facial muscles in younger people are stronger.  The muscles are also stronger if Botox has not been used in that area before.

The glabellar area (between the eyebrows and just above the nose) possesses the strongest muscles of the upper face and therefore requires the most Botox, especially for the initial treatment.  I generally start with 20 units spread in 3-5 injections, although some younger and first treatment patients may require up to 30 units in that area.

The forehead area wrinkles are formed by a much weaker and thinner muscle called the frontalis.  In this area, I start with 12 units in 4-6 injections and I generally don’t have to go above 15 units.

The “crow’s feet” areas around the eyes are formed by the orbicularis oculi muscle, which is also a weaker muscle compared to the glabellar area.  It is also a circular muscle and very shallow below the skin close to the eye. I use 12-15 units in 6 injections divided between the two sides.

My philosophy is that in this area of medicine, there is a lot of art involved.  Before the operations, I always have people smile, scowl and squint to show me how their muscles function to form their individual wrinkles or lines and how strong these muscles are.  This gives me a good idea of how much Botox to start off with, especially in this initial evaluation and treatment.

“How do you decide where to inject the Botox?”

When I was initially trained in the use of Botox a number of years ago, I reviewed the anatomy of the facial muscles and learned about the recommended sites of injection.  Since the upper face is the most common site for Botox injection, it is important not to inject Botox too close to the eyes.  In those initial courses, precise measurements are made and marks are made on the face to designate the sites of injection.

As anyone can tell by looking at different people’s faces, everybody’s face is slightly different. Some people have high or narrow foreheads; some have high cheekbones or narrow eyes.  As a doctor, I have to analyze each individual person’s face and decide the best sites for Botox injection.  Just as a surgeon does not mark the abdomen when he/she performs an appendectomy or a hair stylist does not have to measure the length of hair that he/she cuts, I no longer mark the person’s face.  Having injected Botox for over 5 years and having treated over 200 people with Botox in 2008 alone, writing on a person’s face is thankfully no longer necessary for me.

I have found that for each individual person’s face, my adjustment of injection sites and the dosage of Botox creates the best results.  By using this method, my patient satisfaction is very high and most patients want repeat treatments when their previous Botox wears off.

I hope that the information above answers some of your questions.  If you have any other questions concerning this article and any other skin issues, please leave a comment on this blog or call our office directly at (207) 873-2158 or email through our website.

This entry was originally written as an e-newsletter exclusively for our subscribers on May 12, 2008.  The following information has been edited to illiminate dated references, but the main points of the article remain unchanged.  As always, feel free to contact us with any questions, or post any comments (within reason) you may have:

Technology Advancements Part II

I am writing this blog to give you more information that I couldn’t quite fit into my last posting.  While I was at the conference in Orlando, I heard another interesting report from the Lupo Center for Aesthetic and General Dermatology, located in New Orleans.  Researchers from that institute were there discussing their studies on the treatment of severe nasolabial folds.  Nasolabial folds are the lines from your nose to the area down around your mouth that form especially as we all grow older.  Some people call them “parentheses lines” because they form into that semicircular line around your mouth.  
 
During this study, 87 patients were treated with with Juvederm Ultra Plus on one side of the face and collagen on the other, similar to demonstrations on television commercials.  The patients had a mean age of 49 years, and they were evaluated every 4 weeks for about six months using a 0-4 scale (with 4 indicating the most severe lines).  Before treatment, the average folds were rated as 3 in the study group.
 
Over the study period, the collagen-treated folds improved to an average of 2.5 while the Juvederm treated areas improved to an average of 1.3 (which is equivalent to a mild wrinkle).  96% of the Juvederm-treated wrinkles were considered clinically significant improvements, and 81% of the patients maintained the improvement for one year or longer. No serious treatment-related adverse side effects were noted.  This report adds to the growing and accepted evidence that Juvederm provides improvements in treatments from previous available products and also provides durable correction of severe nasolabial folds.
 
I have been using Juvaderm for nasolabial folds and other facial wrinkles since it was approved by the FDA in the past several years.  I too have had excellent results with high patient satisfaction, and this study further confirms my experience with this product.  If you have any questions concerning dermal fillers including Juvaderm, give us a call or send us an e-mail and I would be glad to discuss this information further.
 
In upcoming posts, I will provide you with plenty of information from the national laser meeting that I will share with you in the near future.  Summer is coming if it’s not here already.  And even though I stress that sunblock is necessary for every time of year (including winter), you will especially need it during the summer.  Hence, now is the time to stock up on it while it’s hot, particularly now since our brand of SPF-36 replenishing sunblock is on sale.

Thanks again for reading this, and for your consistent support!  You’ll be hearing from me again soon.

This entry was originally written as an e-newsletter exclusively for our subscribers on March 28, 2008.  The following information has been edited to illiminate dated references, but the main points of the article remain unchanged.  As always, feel free to contact us with any questions, or post any comments (within reason) you may have:

The Basics of Botox

I’m sure all my patients have heard about Botox from various sources ranging from newspapers to late night monologues.  However, I still get a lot of questions from patients wondering about side effects, long term damage or lack thereof, and perhaps most importantly, if Botox is right for them.
 
To make it simple for everyone, I have compiled a Top Ten list of every basic thing one should know about Botox:

1.)  Botox, by definition, is a simple injectable treatment that creates a temporary smoothed and improved appearance in areas of wrinkle-causing muscles of the upper face.

2.)  The wrinkle smoothing effect lasts for 3 months with initial treatments, but can last longer in future treatments.

3.)  Botox was approved by the FDA in 2002 for treatment of moderate to severe “frown lines”. 

4.)  Botox is safely approved for use around the world in more than 75 countries.

5.)  Since 2002, more than 13 million Botox cosmetic procedures have been performed in the world.

6.)  Surveys show that 97% of Botox patients are definitely satisfied with their treatments.

7.)  Botox is becoming increasingly popular each year with more than 3 million treatments in 2006 alone.  This means it’s not just for celebrities and millionaires anymore.

8.)  Botox is also used for other medical conditions such as hyperhidrosis (excessive sweating), blepharospasm (eyelid spasm), migraines and muscle spasms associated with strokes.

9.)  Botox is only approved for use by licensed doctors who have been fully trained in its use and in the anatomy of the facial muscles.

10.)  I, Dr. Burke, have been injecting Botox since 2004 and am one of the most frequent practitioners in its use in Maine.  I have treated hundreds of patients over that time frame and the patients treated literally double every year.  I am certified in both cosmetic and hyperhidrosis (one of two doctors in Maine who use Botox for this purpose) uses of Botox.

The above list is, of course, a basic rundown of what Botox treatments are all about.  I am always available to answer any questions you may have which the list did not cover. 

Thanks again for reading this and for your overall support, and more pertinent information will be coming to you soon.