Dr. Mauriello has written a text for patients that answers all your questions about Botox and skin care. Botox injections are performed in the office. Patients are able to drive home from the office. The effects of treament generally last 4 TO 6 Months. The results are cumulative over time. DR. MAURIELLO HAS GIVEN FACIAL AND PERIOCULAR BOTOX INJECTIONS SINCE 1983. He was fortunate to be one of the original FDA investigators and has performed over 6000 injections of Botox for blepharospasm, hemifacial spasm, Meige syndrome, and cosmetic wrinkles. Botox is ideal for the upper face including the lines between the eyebrows, the forehead lines, and crow's feet. Botox enhances the effects of cosmetic eyelid surgery, also known as an eyelid lift or blepharoplasty by diminishes the exaggerated smile lines.
BEFORE looking up AFTER BOTOX
Forehead
BEFORE AFTER BOTOX -Note elevation of
Eyebrows left upper lid
BEFORE AFTER BOTOX
Crow's feet
NOTE PATIENT IS NOT SMILING IN EITHER PHOTOGRAPH
BEFORE AFTER BOTOX
Crow's feet
PATIENT IS SMILING
BEFORE AFTER BOTOX
Brow and Forehead
BEFORE brow area treated ONE year later before 3rd BOTOX treatment
There appears to be a cumulative effect of Botox as shown in this patient.
Note the the lines between the eyebrows are less severe than prior to the first treatment (The patient did not wish to undergo treatment of the forehead lines.)
While Botox is ideal for the upper face, Restylane rejuvenates the lower face including the mouth and lips. The results of the two simple office treatments are complementary and help the surgeon rejuvenate the entire face. The eyelid surgery is the final complement to Botox and Restylane by lighting up the eyes.
Restylane is a naturally occurring substance, hyaluronic acid, that is found in all species and throughout the human body in the dermis of the skin and in the vitreous of the eye. It is ubiquitous and attracts water. Humans lose hyaluronic acid with age and the skin, therefore, becomes less plump. Babies have much hyaluronic acid and have water filled cheeks. Restylane is a stable form of hyaluronic acid. The effects of Restylane lasts longer than collagen and for 6 months or longer. Botox generally lasts for 4 to 6 months. No skin testing is necessary for Restylane. Restylane is a "filler."
Restylane and Perlane, approved by the FDA in early 2007 for deeper lines and distributed by Medicis Aesthetics, have been used since the mid-1990's with a long track record of use outside the United States (Bosniak S., Cantisano-Silkha M. Restylane and Perlnae: a review of a six year clinical experience. Op Tech Oculoplast Orbital Reconstr Surg 2003;4:89-91). Juvederm Ultra and Juvederm Ultra Plus distributed by Allergan Inc were approved for use in the United States in 2007. A formal comparison study of the Restylane and Juvederm products has not yet been published as of July, 2007.
The effects of Botox particularly in the lip area are enhanced and prolonged by Restylane. Dr. Mauriello has observed the effects of Restylane for a one year and 10 month duration. In this patient, there was residual effect of the Restylane after the 22 month period. When Restylane is combined with Botox in the lips, the muscles in the lip are slightly weakened by Botox and Restylane appears not to break up as quickly. The Restylane molecules, therefore, attracts water for a longer time. Mild redness may be immediate and lasts for one to two days as shown below:
Before Immediately after Restylane to lips and nasolabial lines
Before After Restylane to right nasolabial line
Before Immediately After Restylane to lips
and nasolabial lines
Before After Restylane to nasolabial lines
Before Immediately after Restylane to lines around mouth
Before After 1st treatment Immediately after Restylane to nasolabial 2nd treatment
BEFORE AFTER BOTOX
Crow's feet
PATIENT IS NOT SMILING
FRACTIONAL LASER SKIN RESURFACING
with ENCORE CARBON DIOXIDE LASER
This office treatment requires only one treatment unlike other treatments that may require more than one session to achieve any effectiveness.
The skin is tightened, pigmentation is reduced, and the texture of the skin is improved. Generally patients return to work by the beginning of the next work week if the procedure is done towards the end of the preceding week.
Before treatment
One week after treatment
Day 1 after treatment
Immediately after
(moisturizing applied)
4.5 months after treatment
6 weeks after treatment
2.5 months after treatment
Note improved tone, texture, and tightness of skin of entire face that gradually improved over 4.5 months after a single office treatment at mild settings.
Joseph A. Mauriello, Jr., M.D.
Board Certified Ophthalmologist
Oculoplastic (Oculofacial Plastic) Surgeon
Cosmetic Eyelid and Facial Rejuvenation Center
EYELIDMD.NET
130 Maple Ave. Suite 9B-2
Red Bank, NJ 07701
732.530.0010
Joseph A. Mauriello, Jr., M.D.
Board Certified Ophthalmologist
Oculoplastic (Oculofacial Plastic) Surgeon
Cosmetic Eyelid and Facial Rejuvenation Center
EYELIDMD.NET
130 Maple Ave. Suite 9B-2
Red Bank, NJ 07701
732.530.0010
Latisse® (bimatoprost ophthalmic solution 0.03%) LATISSE® (bimatoprost ophthalmic solution, 0.03%) is presently the only prescription treatment with FDA-approval that is designed to generate longer, thicker, and darker eyelashes.
Mechanism of Action The precise mechanism of action is not known. Research suggests that the drug increases the percent of hairs in the anagen or growth phase. It also appears to increase the duration that eyelashes remain in this growth phase.
Method of Application to the Base of the Upper eyelashes only Latisse® is applied thinly (topically) to the base of your upper eyelashes only. It is important to use the single-use applicator brush supplied by the manufacturer. The drug should not get in the eye and should not be applied to other areas. In the clinical trials necessary for FDA-approval, patients experienced results in as few as 8 weeks with most patients showing maximum response in 20 weeks. Not all patients respond.
Possible side-effects Permanent iris pigmentation rare but may occur and that is why photographs are necessary and are taken by Dr. Mauriello prior to treatment for during treatment over time. There is an increased risk if the drug is applied to the eye. Furthermore, patients that are pregnant should not use the drug. If the eyelid or eye tissues are red or inflamed or if eye or eyelid surgery is planned, the drug should be discontinued are restarted after consulting personally with your physician. The drug’s effect will no longer be evident once the medication is stopped. It is important to recognized that dark pigmentation of the skin may occur if the drug is applied anywhere on the skin. This pigmentation is generally reversible but it is possible that the resulting dark circles may not improve once the drug is stopped. Therefore, patients must use the applicator provided by Allergan and be instructed and monitored by a physician when using this prescription drug. All possible side-effects should be explained to you in detail by the prescribing physician before you start using this medication.
Possible side effects and complications include but are not limited to: • Pruritis (itching) • Hyperemia (redness of eyelid skin or eye tissues) • Skin hyperpigmentation • Irritation • Permanent iris darkening and pigmentation • Dry eye • Increased risks if the drug is applied to the eye
Furthermore, it is unsafe for you to take this medication without careful periodic office examinations at the discretion of the prescribing physician and as recommended by your physician.
Latisse®: A Great Treatment There is no question that the drug is a wonderful modality for patients who wish to have longer, thicker, and darker eyelashes. The medication has been promoted by Brooke Shields on the www.Latisse.com website. You may wish to view the website for further information. Also, call Dr. Mauriello’s office for an in-office consultation to learn more about Latisse®.
