Introduction to BOTOX® What is BOTOX®? How does BOTOX® work? Does BOTOX® work for all kinds of wrinkles and skin folds? What is BOTOX® treatment like? Are there any special instructions for me to follow after treatment? How much do BOTOX® treatments cost? Am I “vain”? What are the possible side effects? Are there any people who should not use BOTOX®? BOTOX® for headaches. BOTOX® to control excessive sweating

1. Introduction to BOTOX®
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Many wrinkles are actually creases that have been worn into the skin by making the same expression thousands of times. These are called "expression lines" or “dynamic wrinkles”. Typical dynamic wrinkles include “frown lines” between the eyebrows, “crow’s feet” around the eyes, and forehead lines. The presence of these wrinkles can add years to our appearance, often making us look angry, tired or worried when we are not.

BOTOX® can help you to control your facial expressions so that you don't look angry or worried when you aren't. BOTOX® treatments can help to prevent the unintended display of negative feelings, and in this way help some people to express themselves more accurately.

While you may have earned every one of your worry lines, you don't have to show them if you don’t want to! If dynamic wrinkles are starting to make you look older or more “negative”, BOTOX® can help restore the rested, confident appearance you desire.

Please call (336) 659-2663 or Toll Free: 1-877-WE BOTOX (932-6869) if you have questions about BOTOX®,
or would like to arrange a confidential consultation and treatment.

No referral is needed for BOTOX® treatment.

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BOTOX® treatments also provide a safe, non-surgical alternative for the reduction of laugh lines, neck folds, and chin creases.

BOTOX® has been used safely and effectively for over fifteen years in adults and even in small children to treat many medical conditions where overactive muscles require relaxation. Each year tens of thousands of patients receive BOTOX® treatments for a variety of medical conditions, and BOTOX® has also become a leading treatment for reversing some of the visible signs of aging by relaxing the muscles which cause many of our wrinkles. BOTOX® is also becoming a leading treatment for excessive sweating, and for migraine and tension headaches.

What can BOTOX™ do for YOU? Reduction and softening of wrinkles and folds!   SEE what BOTOX™ can do in this collection of before and after photos

2. What is BOTOX®?
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BOTOX® is a highly purified, naturally occurring protein which has the ability to very precisely relax the muscles to which it is applied. This relaxation lasts for a number of months, and then the treated muscles gradually return to their original condition.

BOTOX® does not affect the nerves responsible for sensation, so there is no numbness in the treated .

You can stop BOTOX® treatments at any time and be confident that you will gradually return to your pre-treatment appearance.

3. How does BOTOX® work?
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The benefits of BOTOX® on wrinkles come from ability of BOTOX® to selectively and precisely relax the muscles which are causing wrinkles to occur. The skin over the treated muscles gradually becomes smoother and less wrinkled as the muscles relax.

A common use for BOTOX® is to reduce (often by 70-80% or more) the really deep furrows and lines that many people have between their eyebrows. These lines can make people look quite angry or concerned, even when they are happy. Crow’s feet around the eyes can also add years to your appearance, and make you look like you are squinting much of the time. Crow’s feet usually improve nicely when the muscles which cause the crow’s feet are treated with a bit of BOTOX®.

The treated muscles usually start to relax within a day or two, and reach their maximum degree of relaxation within a couple of weeks. About 3 or 4 months after the first treatment, the effects of the BOTOX® gradually start to wear off. If you liked the effect of your BOTOX® treatment (and almost everyone DOES like it), you will want to return for another treatment before the BOTOX® effect has completely worn off.

If you have a second treatment before the treated muscles have returned to their old bad habits, your second treatment will usually last longer (perhaps 4-5 months, instead of 3-4 months). Likewise, if you have your third BOTOX® treatment when you notice that the second treatment is starting to wear off, the third treatment may last 5-6 months instead of 4-5 months. It is common, after a couple of years, for people to go 6-12 months between treatments.

Untreated facial muscles continue to contract in their usual way, so that normal facial expression is unaffected. Because it relaxes the muscles that cause dynamic wrinkles, BOTOX® treatments can also prevent new lines from forming in the areas on your face, forehead and neck which are treated.

4. Does BOTOX® work for all kinds of wrinkles and skin folds?
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Not all facial wrinkles are related only to the activity of underlying muscles. These deep creases and skin folds (also known as “static wrinkles”) are the ones that can still be seen when the skin is lightly stretched with your fingers. “Static wrinkles” are made worse by sun exposure, by the natural maturing process, and in particular by smoking. Many “static wrinkles” result from a combination of muscle activity and aging, and can be greatly improved when BOTOX® (to relax the underlying muscles) is used in combination with filling substances like Perlane™, Restylane™ Zyderm or Zyplastl™.

For people who have had chemical/laser peels and injections of collagen, Perlane™ Restylane™ Zyderm or Zyplast™, BOTOX® can prevent or delay the development of new wrinkles and furrows, and so can reduce the long-term need for additional laser resurfacing and for injection of filling substances.

In some cases, BOTOX® can be used to delay or eliminate the need for a surgical procedure like a facelift, browlift or necklift; and BOTOX® (by reducing muscle activity which might undo the surgeon’s fine work) can be used to prolong and enhance the effects of those procedures if you have already had them done.

5. What is BOTOX® treatment like?
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BOTOX® treatments are gentle and quick. No sedation or local anesthetic is required, so you will be able to continue with all of your usual activities immediately after your treatment. You can certainly drive yourself home or back to the office.

BOTOX® treatments take only a few minutes, and performed personally by Dr. White, using the finest Becton-Dickinson II 30 gauge needles to maximize your comfort.

Dr. White uses the highest concentration of BOTOX® (100 units per ml) in order to minimize injection volumes -- further enhancing your comfort and safety.

Dr. White is an Allergan Certified BOTOX® Instructor, and teaches other physicians the art and science of BOTOX® treatment.

A small amount of discomfort may be felt when the needle is inserted and a few drops of BOTOX® are applied to exactly the muscles which need relaxation. This sensation lasts approximately 5 seconds. Many patients are pleasantly surprised by the lack of discomfort

Occasional patients experience a slight temporary bruising, perhaps the size of their baby fingernail, at an injection site. This can be hidden with coverup, and fades away in a few days.

6. Are there any special instructions for me to follow after treatment?
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1. Exercise the treated muscles during the two hours after your BOTOX® treatment.

To ensure the best possible uptake of BOTOX® by the treated muscles, Dr. White will encourage you to exercise the treated muscles using normal facial movements during the first 2 hours after your BOTOX® treatment.

For example, so that your BOTOX® will work to maximum advantage:
a. frown to exercise the muscles above and between the eyebrows which frown lines,
b. raise the eyebrows to exercise the muscles which cause forehead wrinkles, and
c. squint and smile to exercise the muscles which cause crow's feet.

2. Do not touch or rub the treated areas until two hours after your BOTOX® treatment.

It is also important for you to avoid rubbing or pressing on the injected areas for 2 hours to avoid spreading BOTOX® out of the treated muscles and into non-targeted muscles. It is also a good idea not to lie down in bed for a couple of hours after the injection, to reduce the chance that you will accidentally move BOTOX® to an area where you do not want it.

If your BOTOX® was moved out of the muscles it is injected into, there might less effect on those muscles, and unwanted temporary relaxation of nearby facial muscles, which could be a nuisance for a week or two. In rare cases (perhaps one case in a hundred), this unwanted relaxation of muscles could cause temporary drooping of an eyelid or slight asymmetry of facial expression. Because the effects of BOTOX® are completely reversible, these rare side effects are temporary, and resolve after a few weeks.

After two hours, there are no restrictions at all.

7. How much do BOTOX® treatments cost?
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BOTOX® is priced at $16 per unit.

The $100 cost of your consultation is credited toward the cost of your first BOTOX® treatment.

BOTOX® treatments may be a tax deductible medical expense (similar to dental, orthodontic and cosmetic surgery bills), so save your receipts!

8. Am I “vain”?
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Many people at some time before BOTOX® treatment for wrinkles or excessive sweating have fears and doubts. A common concern is that they are being vain. My experience has been that just about all patients who have BOTOX® treatment, laser hair removal, and other procedures to maintain their appearance and comfort are no more vain than anyone else. What does distinguish these individuals is a desire to get the most out of life, and to look as good as they feel.

Looking after your appearance is not a fault. After all, would you leave your house with broken gutters or peeling paint? Why do less for your body? I think you should feel proud of yourself for having the will and the ability to change something that you find unacceptable. I emphasize that you should only have BOTOX® treatment, laser hair removal, and other treatments if it is for you. It is a big mistake to do these things if it is just for somebody else.

As Dr. Richard Glogau of San Francisco has noted: the same self-esteem that makes our patients successful in their chosen fields, precise in their consultation questions, well groomed and well dressed, and often careful in their diet, exercise, and other aspects of health maintenance lead our patients to seek help for their wrinkles and frown lines.

These individuals are normal healthy people, and the same degree of self-interest that prompts them to exercise, be selective in what they eat and drink, and protect themselves from sun damage leads them to explore the benefits of BOTOX®. Our patients simply want to look their best.

9. What are the possible side effects?
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There have been no long-term side effects, allergic reactions or health hazards related to BOTOX® use thus far. Some patients have been getting BOTOX® treatments for more than 10 years, with no problems.

10. Are there people who should not use BOTOX®?
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People who are pregnant, breast feeding, have rare neurological disorders like Eaton-Lambert syndrome or myasthenia gravis, or who are allergic to albumin should generally not be treated with BOTOX®.

11. BOTOX® for headaches.
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A number of patients treated with BOTOX® for lines on the forehead, frown lines between the eyebrows, and for crow’s feet have reported that a pleasant side effect of BOTOX® treatment was reduction or elimination of headaches.

Formal studies of patients with headaches have confirmed that BOTOX® treatment often reduces the frequency and intensity of both muscle tension headaches and also some migraine headaches. Patients who respond well to BOTOX® generally experience improvement within a few days, sometimes enjoy several months of relief from headaches, and are able to greatly reduce (and in some cases eliminate) headache medications. BOTOX® for headache is covered by many drug plans, because BOTOX® can be very cost effective when it reduces consumption of medications, and allows patients to avoid missing work. An increasing duration of effect is often noted in headache patients who repeat their BOTOX® treatments as soon as they notice that the BOTOX® effect is declining.

In some cases, each point which you can identify as being associated with your headaches will be injected with BOTOX®, usually starting at 5 to 10 units of BOTOX® in each point. In other cases, it is more effective to treat larger areas (for example, the forehead and sides of the scalp) with a total of 75-100 units of BOTOX®, or up to 150 units of BOTOX® when muscles on the posterior scalp, neck and upper back are also treated.

BOTOX® for headache costs $200, plus the BOTOX® (which is usually delivered to Dr. White by the pharmacy, and paid for by your drug plan.)

12. BOTOX® to control excessive sweating.
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BOTOX® is also used to control excessive sweating of the armpits and palms, and occasionally other parts of the body. About one person in 100 has a serious problem with excessive sweating in these areas. This usually starts in childhood or adolescence, and sometimes other family members have a similar problem. This kind of excess sweating is caused by a reflex reaction of the nervous system and is beyond voluntary control. This kind of excessive sweating is sometimes associated with stress or heat, but often there is no cause which can be identified.

There can be considerable emotional and social stigma attached to excessive sweating of the hands and armpits, and this can lead to a loss of confidence and self-esteem. For example, those afflicted with excessive sweating often feel that -- when people see big sweat marks under their arms or feel their sweaty palms -- they may decide that the individual is nervous or insincere , even when that is not the case.

Social engagements and simple things like physical contact with other people may be avoided because of uncontrollable sweating.

Patients afflicted with excessive sweating can routinely soak through clothing in a matter of minutes, and some patients have to use Kotex™ pads in their armpits, shields, absorbent tissues and frequent changes of clothing to cope with the disorder. Shirts and jackets can be quickly stained and ruined, and dry cleaning and replacement of clothing is sometimes a substantial expense.

Questions to ask yourself when considering BOTOX® treatment for excessive sweating include:

• Over the past week, how embarrassed or self-conscious have you been because of your sweating?
• Over the past week, how much has your sweating interfered with normal activities like shopping or looking after your home?
• Over the past week, how much has your sweating influenced the clothes you wear?
• Over the past week, how much has sweating affected any social or leisure activities?
• Over the past week, how much has sweating made it difficult for you to enjoy any sport?
• Over the past week, has your sweating interfered with working or studying?
• Over the past week, has your sweating created problems with your partner, friends or relatives?
• Over the past week, how much has your sweating created sexual difficulties or interfered with intimacy?

Individuals troubled by excessive sweating often do not respond adequately to antiperspirants, and they may not respond to (or be willing to tolerate) systemic medications, electrical treatments on the areas of excessive sweating, permanent destruction of the nerves which control sweating, or surgery (in the armpits) to either scrape away the sweat glands or to cut out the areas of excessive sweating.

BOTOX® treatment, by contrast with the above, is a simple office procedure with little discomfort or risk; and can be much less expensive than surgery. Some people will only want BOTOX® treatment before an important event (for example, a wedding). Others, whose sweating is mainly a problem during hot weather, may have BOTOX® treatment at the start of every summer. BOTOX® treatments can be safely continued year-round if necessary to maintain control of your sweating.

Before your BOTOX® treatment, a simple iodine solution will be applied to the area of excessive sweating. This solution is dried with a small fan, then powdered starch (of the sort found in most kitchens) is sprinkled on the area. Where there is excess sweating, the moisture of the sweat allows starch to combine with iodine, producing a dark blue color. This “starch-iodine” test indicates the precise areas of excess sweating, and allows us to concentrate the BOTOX® treatment where it is needed -- reducing both the number of injections and your costs.

The blue marks from the starch-iodine test will be wiped off after your BOTOX® treatment.

It is important NOT to apply any local anesthetic creams (for example, EMLA™) before your BOTOX® treatment for excessive sweating, because these local anesthetic creams interfere with the accuracy of the starch-iodine test.

When used to reduce sweating, BOTOX® is diluted to 25 units per ml (in order to increase the spread of BOTOX® around the treated area). Usually, 2 units of BOTOX® are injected every 1 - 1.5 cm in the area of excessive sweating identified by the starch-iodine test. When it is used to control excessive sweating, BOTOX® is injected into the top layer of the skin (where the sweat glands are) rather than into the muscles under the skin (as is the case when we are treating dynamic wrinkles, muscle tension headaches and some migraine headaches).

Treatment of the armpits is easy, and no anesthetic is needed. Both armpits can be treated at the same time.

A simple local nerve block is usually used before treatment of the hands, to ensure your comfort. Because there can sometimes be a bit of weakness of the treated hand for a week or two, it is generally best to treat one hand at a time. After several weeks, the other hand can be treated.

If small areas of troublesome sweating persist, they can be identified with a starch-iodine test for $75 and then treated at relatively low cost with BOTOX® when you return for follow-up several weeks later.

After BOTOX® treatment, excess sweating starts to decrease within a couple of days, and the full effect in reached in a week or two. The goal of BOTOX® is reduction of sweating to a normal level, but not total elimination of sweating to the point where the treated area becomes abnormally dry.

The effect of the BOTOX® treatment for excessive sweating usually lasts for 4-6 months, but in some cases can last for up to a year. Because you continue to sweat normally in other areas, there is no concern about overheating.

Patients usually report very high satisfaction with BOTOX® treatments, return for additional treatments, and would recommend BOTOX® treatments to their friends.