How does Botox work?
Botox is injected in minute quantities into the facial muscles that cause wrinkles. Within three to seven days the muscles relax and the results are impressive. The effect diminishes after three to four months. Clinical studies show that with routine treatments every 3 months, smaller amounts of Botox may reproduce continued desired results.
I alway look "mad", will Botox work for me?
In situations where the patient is a chronic frowner, behavior modification (known as muscle training) may be suggested. Muscle training is simple, place a strip of scotch tape horizontally between the eyes and above each brow, and place a strip vertically above each brow and in the middle of the forehead (you will form inverted T's). Now whenever an unwanted expression is displayed (frown) you will hear the scotch tape crinkle and you will feel it pull. This auditory and tactile stimulus will allow you to consciously decide whether the facial expression (frown) you just expressed is consistent with your anti-aging desires. "Turn a frown into a smile :)"
Where does Dr. Dominguez inject Botox?
Dr. Dominguez began using Botulinum A (Botox) in 1984 to treat patients with surgical conditions such as laryngeal spasms and excessive muscle contractions after Facial Reconstruction.
Dr. Dominguez is trained and teaches other physicians to inject cosmetic Botox into the muscles of facial expression. Specifically, Dr. Dominguez is a recognized expert in reducing wrinkles of the forehead, between the brow, crows’ feet, chin, and the depressor angular oris (sad clown lips).
How much Botox is injected?
Dr. Dominguez advises injecting a conservative amount in each region depending on the patients need (which may not be what the patient is demanding or has previously received at some other facility): Forehead - up to 20 units, Between the brow - up to 20 units, Crow's Feet - up to 5 units per, Raising outer brow - up to 2.5 units per, Chin - up to 5 units, Sad Clown - up to 5 units per, cheek up to 25 units per.
The muscle thickness and strength is different among men and women. Typically a man will require more Botox than a woman. However, there are women with well defined "bossy" or genetically masculine glabellar complex or forehead muscles (strong and thick) that requires repeated Botox doses to achieve a satisfactory result.
Dr. Dominguez advises against injecting into the lip edge or naso-labial region which is known to cause a flat upper lip. Dr. Dominguez does not inject for Migraine or sweat related conditions.
What is the treatment like?
Dr. Dominguez uses a small 31 gauge diabetic type needle. There may be a slight sting and maybe a mild bruise at the injection site, but this is uncommon. Bruising appears to be more common in patients taking aspirin, ibuprofen, or blood thinners.
Are Botox treatments safe?
Botox is safe in skilled surgical hands, like Dr. Dominguez. Malpractice literature reviews show that untrained practitioners (Family Practice, Pediatrics, Ob-Gyn, RN’s) have the highest rate of adverse events (eye muscle or eyelid paralysis).
Dr. Dominguez teaches other physicians to only inject the minimum amount necessary to produce a softening of the muscles, thus resulting in a younger, smooth and natural appearing face. Dr. Dominguez does not endorse complete paralysis of the facial muscles, and he says "facial muscle animation is our means of non-verbal communication, Botox is intended to reduce contractility for anti-aging purposes. When complete paralysis occurs, the Porcelain Doll face inhibits communication and is viewed by the observer as freakish."
Dr. Dominguez says “instead of injecting more volume of Botox and risking an adverse event, physicians should instruct their patients to return after 2 weeks for a “touch-up” if more Botox is desired.”
Botox should not be injected in pregnant women, or those with known neurological diseases.
What is the primary adverse event seen with Botox treatments?
Dr. Dominguez says that an academic literature review reveals that the most frequently observed adverse event of Botox is unwanted decreased or uneven facial muscle contraction or complete paralysis. Unwanted decreased facial muscle contraction is usually due to an injection of Botox that exceeds the upper limits of volume per region. This is usually a result of the practitioner yielding to the overzealous demands of the patient resulting in migration of Botox into an unwanted region. Many urban myths abound to avoid this phenomenon: "don't lay down for 4 hours otherwise your forehead and brow will be lopsided..." Dr Dominguez says "If you don't exceed the upper limits for Botox injection there is no need for urban legends."
Why do I need more Botox now than I did 2 years ago?
Dr. Dominguez's lecture includes Botox resistance. Botox resistance is a known event that occurs normally as a result of the body recognizing Botox as a foreign substance. Dr. Dominguez states that Botox resistance is known in patients who require high doses of Botox for treatment of neuro-muscular disorders, and is known to occur in cosmetic patients after one dose and in those who have been receiving Botox regularly.
Dr. Dominguez says "Botox resistance was presented as a de novo phenomenon in an Italian study in 2010, and this study described patients who had never received any Botulinum injections, but yet were resistant to Botox - Dysport - Xeomin at upto 200 units per injection site."
Dr. Dominguez advises patients who are requiring more Botox than usual to "take a break and let your antibodies to Botox diminish, they will never go away but maybe with time you can resume Botox injections for that special occasion."
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