Patients with smaller neck muscle mass and patients who require bilateral injections into the sternocleidomastoid muscle for the treatment of cervical dystonia have been reported to be at greater risk for dysphagia. Limiting the dose injected into the sternocleidomastoid muscle may reduce the occurrence of dysphagia. Injections into the levator scapulae may be associated wit h an increased risk of upper respiratory infection and dysphagia.
OnabotulinumtoxinA is the only treatment approved by the United States Food and Drug Administration for the prevention of headaches in adult patients with chronic migraine (CM). CM assessment involves a detailed history to rule out secondary sources of headache, establish migraine features, and assess the total number of headache days. In order to diagnose migraine, the patient should have had at least five attacks that involve migraine features, as outlined below. In adults, untreated attacks usually last 4 or more hours.
In two double-blind, placebo-controlled trials in patients with detrusor overactivity associated with a neurologic condition (NDO-1 and NDO-2), the proportion of subjects who were not using clean intermittent catheterization (CIC) prior to inject ion and who subsequently required catheterization for urinary retention following treatment with BOTOX 200 Units or placebo is shown in Table 9. The duration of post-injection catheterization for those who developed urinary retention is also shown.
Normally you would see improvement within a few days. Botox requires two to four days for it to attach to the nerve ending that would normally stimulate the muscle to contract. The maximum effect usually occurs at about 10-14 days. Therefore, whatever effect is obtained two weeks after the injections should be considered the maximum effect that is going to occur.
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I tell my patients that it is not the total price that is important, but how many units are used. For instance, if a patient goes to a spa and pays $150 per area, that may sound like a great deal. However, when the patient ask how long the treatment is supposed to last, the spa responds "2 months". I have seen that many of those less expensive treatments often consist of around 10 units (and therefore carrying a "non-deal" $15 cost per unit!). So, what initially looks like a great bargain, is in fact just a treatment with an inadequate amount of Botox. Always ask your injector how many units they are using, so you can determine what price/unit you are getting. Experienced injectors know that there is no such thing as a standard amount of units, as everyone's facial anatomy and muscular strengths are variable, even from one side of the face to the other.
Reduced blinking from BOTOX injection of the orbicularis muscle can lead to corneal exposure, persistent epithelial defect, and corneal ulceration, especially in patients with VII nerve disorders. Vigorous treatment of any epithelial defect should be employed. This may require protective drops, ointment, therapeutic soft contact lenses, or closure of the eye by patching or other me ans.
Recently, there has been an emerging trend of “BOTOX® Cosmetic parties,” in which several people gather at a physician’s house or another location to have BOTOX® Cosmetic injections at a lower cost. While prices for treatment may be somewhat lower at a BOTOX® Cosmetic party than for treatment administered during a normal office visit, the situation may not be ideal. The American Academy of Dermatology and the American Society of Aesthetic Plastic Surgery have both issued warnings against such “parties,” as they have reservations about the ability of the physician to provide a safe and sterile environment outside of their office.
In general, you’ll find that Botox costs about $10-$20 per unit. While some offices and clinics charge a flat rate, depending on the area that they’re working on, you’ll more often find that you are charged based on how many units of Botox are used to achieve the results you’re looking for. You need around 20 units to treat your forehead and 5-6 units to treat crows feet, making Botox an affordable alternative to going under the knife.
BOTOX® Cosmetic targets one of the underlying causes of frown lines, crow’s feet and forehead lines — the repeated muscle contractions from frowning, squinting, smiling and raising the eyebrows over the years. Your specialist will inject these muscles with BOTOX® Cosmetic to temporarily reduce muscle activity. You will begin to notice a visible smoothing of the frown lines between your brows, your crow’s feet lines and your forehead lines.

Is the cosmetic injectable product real? Great question! The answer is maybe? It is possible that the provider dispensing Botox or Dysport obtained the drug from an overseas dispensary outside of the United States. These foreign vendors sell Botox and Dysport to doctors and nurses in the U.S. at a discounted price but their product is not always the real thing. That’s right! The Botox maybe counterfeit. The bottles may look identical but the product inside may not be real which means it may not work as effectively or not at all ! So if the provider is offering Botox or Dysport really cheap The first question should be –Was it manufactured by the U.S. company?
How much is Botox is a frequent question we get in our dermatology offices. The cost of Botox runs typically about $400 – $600 per first treatment area, and up to $300 for each additional area. The most popular areas for Botox treatment are the glabella (those lines in between your eyebrows also known as the “11’s”), the crow’s feet are around the eyes and the horizontal lines on the forehead. When injected by a trained professional who has experience with facial aesthetics, Botox can also give the brows and eye area a mini eye lift. When Botox injections are performed by a trained, licensed and experienced medical expert, the results can be amazing. You will not appear frozen or as though you’ve had work done, when injected properly, Botox makes you look more relaxed, more rejuvenated and just better than before. It’s important to seek out a professional who knows about facial anatomy and can inject you in the exact right places.
I always tell my patients that you get what you pay for. However, you need to advocate for yourself and understand what you are getting for your dollars. Ensure that your injector is experienced and properly trained; that you are getting FDA approved Botox Cosmetic from Allergan; and know how many units you receive. As well, a physician's office should maintain a medical record of your treatments so you can optimize and customize your Botox to achieve the best effect and value. Good Luck!
Botox comes as a crystalline substance from the manufacturer, which then has to be reconstituted with saline or another liquid. Practitioners add varying amounts of liquid when reconstituting it. Although there is no right or wrong amount of liquid to add, most physicians add about 2 mL-3 mL (about a half a teaspoon) of liquid to each vial. Some add quite a bit more, which can lead patients to think they are getting more Botox when, in reality, they are getting the same or less amount of Botox than samples reconstituted in a stronger way. It is the total dose of medication, not the volume of liquid, that leads to the desired effect.
The one side effect that we most commonly see with Botox for migraine, ironically, is increased headache pain in the days immediately following the injections. Interestingly, some patients have the opposite effect, noticing immediate pain relief. That may be due to an acupuncture-like response, where poking needles into unhappy muscles actually makes them feel better.

Vials of BOTOX have a holographic film on the vial label that contains the name “Allergan” within horizontal lines of rainbow color. In order to see the hologram, rotate the vial back and forth between your fin gers under a desk lamp or fluorescent light source. (Note: the holographic film on the label is absent in the date/lot area.) If you do not see the lines of rainbow color or the name “Allergan”, do not use the product and contact Allergan for additional information at 1-800-890-4345 from 7:00 AM to 3:00 PM Pacific Time.
“I don’t think it is physically addictive,” says Dr. Matarasso. “But, I have to be very frank with you, when I get a new patient I tell them (and I say this tongue-in-cheek) this product is truly addictive. I make jokes with my patients that we need a 12-step program for it, because when it’s done correctly, it’s a very simple office procedure, with impressive cosmetic results.”
Of 1242 overactive bladder patients in placebo-controlled clinical studies of BOTOX, 41.4% (n=514) were 65 years of age or older, and 14.7% (n=182) were 75 years of age or older. Adverse reactions of UTI and urinary retention were more common in patients 65 years of age or older in both placebo and BOTOX groups compared to younger patients (see Table 18). Otherwise, there were no overall differences in the safety profile following BOTOX treatment between patients aged 65 years and older compared to youn ger patients in these studies.
“We don’t believe Botox is expensive when you look at the value that we provide,” says Marc Forth, senior vice president of US marketing at Allergan, the maker of Botox. Botox halves migraine days in 50 percent of patients who get the injections, Forth says. “We believe that value is worth the tradeoff.” Allergan doesn’t have a say on step therapy policies. Insurers “ultimately make that call on their own,” Forth says.
BOTOX blocks neuromuscular transmission by binding to acceptor sites on motor or sympathetic nerve terminals, entering the nerve terminals, and inhibiting the release of acetylcholine. This inhibition occurs as the neurotoxin cleaves SNAP -25, a protein integral to the successful docking and release of acetylcholine from vesicles situated within nerve endings. When injected intramuscularly at therapeutic doses, BOTOX produces partial chemical denervation of the muscle resulting in a localized reduction in muscle act ivity. In addition, the muscle may atrophy, axonal sprouting may occur, and extrajunctional acetylcholine receptors may develop. There is evidence that reinnervation of the muscle may occur, thus slowly reversing muscle denervation produced by BOTOX.
Botulinum toxin has been investigated for use in patients with blepharospasm in several studies. In an open label, historical ly controlled study, 27 patients with essential blepharospasm were injected with 2 Units of BOTOX at each of six sites on each side. Twenty-five of the 27 patients treated with botulinum toxin reported improvement within 48 hours. One patient was controlled with a higher dosage at 13 weeks post initial injection and one patient reported mild improvement but remained functionally impaired.
Proper refrigeration at temperatures below 3 °C (38 °F) retards the growth of Clostridium botulinum. The organism is also susceptible to high salt, high oxygen, and low pH levels.[citation needed] The toxin itself is rapidly destroyed by heat, such as in thorough cooking.[72] The spores that produce the toxin are heat-tolerant and will survive boiling water for an extended period of time.[73]
Now, thanks in large part to off-label use, Botox--the wrinkle smoother that exploded as a cultural phenomenon and medical triumph--is increasingly being drafted for problems that go far beyond the cosmetic. The depression suffered by Rosenthal's patient is just one example on a list that includes everything from excessive sweating and neck spasms to leaky bladders, premature ejaculation, migraines, cold hands and even the dangerous cardiac condition of atrial fibrillation after heart surgery, among others. The range of conditions for which doctors are now using Botox is dizzying, reflecting the drug's unique characteristics as much as the drug industry's unique strategies for creating a blockbuster.

The potency Units of BOTOX® Cosmetic are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, units of biological activity of BOTOX® Cosmetic cannot be compared to nor converted into units of any other botulinum toxin products assessed with any other specific assay method.

Most SkinMedica® products are intended to meet the FDA's definition of a cosmetic product, an article applied to the human body to cleanse, beautify, promote attractiveness, and alter appearances. These SkinMedica® products are not intended to be drug products that diagnose, treat, cure, or prevent any disease or condition. These products have not been approved by the FDA, and the statements have not been evaluated by the FDA.


Tell your doctor if you received any other botulinum toxin product in the last 4 months; have received injections of botulinum toxin such as Myobloc®, Dysport®, or Xeomin® in the past (tell your doctor exactly which product you received); have recently received an antibiotic injection; take muscle relaxants; take allergy or cold medicines; take sleep medicine; take aspirin-like products or blood thinners.
University of Utah senior and track star Lauren McCluskey told campus authorities that her ex boyfriend was harassing her earlier this month, but officials didn't take further action. McCluskey's family says the 21-year-old athlete broke off her month-long relationship with Melvin Rowland after discovering he was a registered sex offender who had lied about his name, age, and criminal history. According to authorities, Rowland - who was really 37-years-old - allegedly harassed McCluskey and she reported him to campus police in mid-October.
But even if the laws remain unchanged, as long as off-label uses are permitted by law, expect doctors to keep pushing the boundaries of Botox's applications--sometimes in the name of medical progress and sometimes with remarkable results.Norman Rosenthal, the Maryland psychiatrist who recommended Botox for his suicidal patient, says he's seen the upside firsthand. The patient, persuaded by Rosenthal, did indeed get Botox shots on his forehead and between his brows. Days later, Rosenthal got an email from the patient. It was a thank-you note. Finally, the patient wrote, he was feeling better.
Lastly, a Botox treatment does not offer permanent results. Botox is most effective when treatments are carried out at regular intervals before the results fully wear off. On average, the results last for three to four months,  although Botox metabolizes at different rates in different individuals. The first ever Botox treatment you receive may not last as long as subsequent treatments, plus you may require touch-ups two weeks after the procedure as your injector determines the right dosage for you. Over time, however, many patients notice that they can wait longer intervals between treatments as their treated facial muscles weaken.
As with with plastic surgery or any other cosmetic procedure, what you are paying for is an injector who has experience and a proven track record of beautiful results. If you're looking for a precise estimate of what it will cost to achieve your Botox goals, I encourage you to meet with a board-certified plastic surgeon or dermatologist for an initial consultation.
It may be necessary for the patient to have additional procedures, such as the use of filler substances (for example, Restylane, Perlane, Juvederm, Sculptra, or Radiesse) in order to plump up the wrinkles that are now relaxed. Additionally, it may be necessary to have two or three sessions of Botox treatment for deeper wrinkles before results become optimal. The area of the crease between the eyes is a particularly ideal area for Botox use in conjunction with filler as these fixed wrinkles don't always respond optimally to Botox alone. There is some controversy about using filler in that area as it may block veins or arteries and result in loss of blood and a scar to the area. Generally, the smaller particle fillers, such as Restylane or Juvederm Ultra, are best in the area between the eyes for this reason.
Tell your doctor if you have received any other botulinum toxin product in the last 4 months; have received injections of botulinum toxin such as Myobloc®, Dysport®, or Xeomin® in the past (tell your doctor exactly which product you received); have recently received an antibiotic injection; take muscle relaxants; take allergy or cold medicines; take sleep medicine; take aspirin-like products or blood thinners.
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