Botulinum Toxin

Hemingway Medical Spa offers physician administered injectables for neuromodulators (botulinum toxin) and hyaluronic acid dermal fillers (some different examples of dermal fillers are Juvederm®, Restylane®, Teoxane®, and Belotero®). Botox® Cosmetic has been FDA approved for the treatment lateral canthal lines (crow’s feet), glabellar lines (frown lines), and horizontal forehead lines.

Botulinum toxin is the active ingredient in Botox® Cosmetic, Botox® Theapeutic, Xeomin®, and Dysport®. It is a neurotoxin produced by the bacteria Clostridium Botulinum. What differentiates the ‘brands’ of botulinum toxin is the exact structure of the molecule and the amount of carrier proteins. Botulinum toxin works by inhibiting the release of the neurotransmitter acetylcholine from the pre-synaptic membrane at the cellular level. Without acetylcholine in the synaptic space, muscles are not able to receive the signal required to ‘fire’ and contract. This results in a temporary weakening (controlled paralysis) of the targeted muscle. When used appropriately, drugs like Botox®, Xeomin®, and Dysport® can reduce the appearance of: horizontal forehead lines, frown lines, and crow’s feet, and marionette lines.

 

If you would like to learn more about this treatment, please book in for a complementary consultation with Dr. Olesen and he will able to address all of your questions.

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FAQ

When used for the treatment of rhytides (wrinkles), the effect of botulinum toxin is about 3 months.

Due to Canadian Health regulation guidelines and College of Physicians and Surgeons guidelines, drugs can not be endorsed by physicians, nor advertised. Therefore, it is correct for us to refer to the active drug, botulinum toxin.

Aging

Aging and the skin

Few things in life are certain: death, taxes, gravity, and aging. Aging is unavoidable. Around the age of 30, we begin to lose 1% of our collagen each year. By the time we have turned 40, we have lost 10% of our total collagen content[1]. This is due to a genetically predetermined process commonly referred to as intrinsic aging. Simply put, the balance between active matrix metalloproteinases (enzymes that digest collagen) and neocollagensis (the production of collagen) shifts towards overall collagen loss.

There are also extrinsic factors that lead to aging of the skin, these include UV exposure (from the sun), gravity, environmental pollutants, and smoking. Sun damage (UV damage), is one of the most harmful, yet preventable factors leading to visible aging (not to mention skin cancer). UV exposure has been shown to increase wrinkles, causes thinning of the skin, hyperpigmentation, and lentigines[2]. These extrinsic factors lead to the production of oxidative stress, which is an overproduction of free radicals. Free radicals are unstable molecules that can damage protein, DNA, and lipids. Together, these factors cumulatively lead to undesirable changes to the skin.

Aging and the skeleton

There are changes to skeletal structure due to bone expansion and resorption. One well documented process is an increase in the size of the orbits with a concurrent reduction in the size of the mandible. This process results in less support for the overlying fat pads, which then track downwards. Ultimately resulting in deepening of the Nasolabial folds.[3] Cumulatively, facial skeletal changes leads to an appreciable reduction in facial height and a widening of the facial width[4].

Aging and fat pads

At younger ages, we have well defined facial features. This is due to the positioning and distribution of our natural fat pads creating smooth arcs on the cheeks, jawline and forehead. With the loss of skeletal support, decreased collagen and elastin fibers in the skin, and the effect of gravity, fat pads tend to migrate downwards and forwards. The redistribution of this fat tends to give a saggy appearance with deepening of nasolabial folds, marionette lines, and jowls.

While some fat pads migrate and gain bulk, others can atrophy. This is why the forehead loses convexity and the temples and cheeks can hollow[5].

Restoring a youthful appearance with Dermal Fillers

Dermal fillers, when expertly placed, can reshape and contour the face by restoring lost and redistributed volume. Fillers can be used to treat:

  • Tear troughs
  • Cheeks
  • Nasolabial folds
  • Vertical lip wrinkles
  • Marionette lines
  • Pre-jowl sulcus
  • Jawline
  • Hands
  • Scars and deep lines
  • Lip enhancement

If you would like to learn more about volume restoration with dermal fillers call for a free consultation.

[1] 1) Farage MA, Miller KW, Elsner P, Maibach HI. Intrinsic and extrinsic factors in skin ageing: a review. Int J Cosmet Sci 2008 Apr;30(2):87-95

[2] Scharffetter–Kochanek K, Brenneisen P, Wenk J, Herrmann G, Ma W, Kuhr L, et al. Photoaging of the skin from phenotype to mechanisms. Experimental Gerontology  May 2000;35(3):307-316.

[3] Bartlett SP, Grossman R, Linton A, et al: Age-related changes of the craniofacial skeleton: An anthropomorphic and histologic analysis. Plast Reconstr Surg 90: 592, 1992.

[4] Zimbler M, Kokoska M, Thomas J. Anatomy and pathophysiology of facial aging. Facial Plat Surg Clin North Am 2001; 9(2):179-187

[5] Coleman SR, Grover R. The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthet Surg J 2006 Jan-Feb;26(1S):S4-9.

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FAQ

Dermal fillers are a solution to sagging of the cheeks, marionette lines, fine lines and wrinkles, crow’s feet, deeper lines and folds, as well as nose and lip augmentations.

The most commonly used dermal fillers are Hyaluronic Acid (HA) fillers. This is a naturally occurring glycosaminoglycan (sugar protein) that is found in the extracellular matrix.

The longevity of fillers can be anywhere from six months to over a year (up to 18 months) depending on the amount injected, type of filler, and injection site. Over time, an enzyme called hyaluronidase will degrade the injected hyaluronic acid, therefore follow up treatments are required for maintenance.

The fillers used at Hemingway Medical Spa Inc. all contain lidocaine (an anesthetic used in procedures), and the cannula techniques also minimize swelling. Overall, most patients tolerate the procedure quite well.

The most common side effects include bruising, bleeding, and swelling.

Some risks associated with fillers are allergic/inflammatory reaction, redness, swelling, bruising, and formation of nodules/granulomas . More severe reactions are associated with intravascular injection. Although this is exceptionally rare, there are reported cases of skin necrosis, blindness, and even stroke.

With fillers, effects are seen immediately.

If you have a history of cold sores, you will put on an antiviral treatment for a short period of time before and after the procedure.

Treatment is not advisable for individuals with autoimmune disorders, pregnant and breast-feeding women.

The cost for the procedure varies depending on your unique treatment needs. The cost is typically between $650 – $2000.