BOTOX® Cosmetic

Combining Botox with Facial Filler
BOTOX® Cosmetic for Excessive Sweating
BOTOX® Cosmetic for Migraine Headaches

Each resource article presented to the right of this page, are individual cases that have educational value. I hope that by studying them, you too will gain insight into the challenges of our profession.

In my own practice, I have injected hundreds of patients with BOTOX® Cosmetic . The only problems I have seen is that once in a while a patient is resistant to the drug or becomes resistant and sees little or no benefit. Occasional temporary bruising may be noted. It takes about 2-5 days for effects to be noticed. Although results usually last 3-4 months, we recommend repeat injections at about 2-1/2 months just as the muscles are beginning to recover. By intervening before the muscles make a full recovery, we are trying to take advantage of the concept of "disuse atrophy." We want the muscles to slowly waste away, allowing for a reduced number of injections. This approach also applies to the use of BOTOX® Cosmetic for sweating and migraine headaches. After 3-4 sessions (usually about 1 year), smaller less frequent doses are used for maintenance. After treatment the overlying skin remains smooth and unwrinkled while the untreated facial muscles contract in a normal fashion, allowing normal facial expression to be unaffected. This procedure cannot improve wrinkles due to aging and sun-damaged skin since these are unrelated to facial muscle contractions.

For patients with deep furrows in the frown area, or permanent wrinkles due to muscular activity, BOTOX® Cosmetic is combined with a facial filler to both plump out the areas and reduce muscular activity. It has been noticed that when combining a facial filler, such as synthetic Restylane or Radiesse, that the results are longer lasting due to the reduction in muscular activity. Fat grafting from the patient's own natural tissues can also be used.

The use of BOTOX® Cosmetic for excessive sweating (hyperhidrosis) has been dramatic. Patients are often embarrassed because they soak through their blouses or shirts. Sweaty hands are equally embarrassing because of the frequency of hand shaking. In these instances, some patients ask that only their right hand be treated. The use of BOTOX® Cosmetic for the armpits, hands and feet has allowed these patients to live a life free from the worries and embarrassment. Injections are repeated every 2-1/2 to 3 months.

BOTOX® Cosmetic has also proven to be extremely valuable for migraine headaches, especially when the trigger zone is in the area of the frown lines. Here too, injections are repeated after 2-1/2 to 3 months.

All of our patients get a questionnaire to fill out after their BOTOX® Cosmetic treatment so that we can determine both the effectiveness of the injections and levels of satisfaction with the treatment. Patients sometimes indicate that they don't want a complete elimination of the faulty area, only a reduction of the muscular activity, so that some degree of animation persits. By working with different dose schedules, we are able to titrate the proper dose on an individual basis.

Almost all of our patients are on our skincare program to combine the best of facial rejuvenation with healthy, radiant skin.

Peter T. Pacik, MD, FACS

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The Plastic Surgery Center of Manchester, New Hampshire specializes in cosmetic plastic surgery, including body lifts, breast enlargements, breast lifts, breast reductions, eyelid surgery, ear surgery, facelifts, fat grafting, liposuction, neck and chin surgery, rhinoplasty (nose surgery), surgery after massive weight loss, and tummy tucks. We also offer facial rejuvenation (chemical peels, dermabrasion, Obagi Blue Peels, Glycolic Peels, Microdermabrasion), injectables and facial fillers (BOTOX® Cosmetic, Radiesse®, JUVEDERM™ Injectable Gel, Perlane® and Restylane®) and advanced skin care to patients from all over New England (Maine, Vermont, New Hampshire, Massachusetts). While no responsible practitioner gives guarantees for the work they do on the human body, we can at least reassure you that you will receive the expertise and dedication of over 30 years in practice. Our patients become an important part of our family and we try to get to know each patient individually and customize their treatment to meet their desires.