Botox ®

The American Society for Aesthetic Plastic Surgery ranked BOTOX® Cosmetic as the most popular physician-administered aesthetic procedure in the United States for the fourth year in a row.

Botox® is used to treat unwanted wrinkles on the face and neck.  Botox is used to treat dynamic wrinkles (motion wrinkles). These wrinkles are caused by contraction of the facial muscles. After time, this repeated muscle contractions results in permanent wrinkles (static wrinkles). Static wrinkles are defined as lines and creases that remain on the skin even when the face is not moving. Botox has revolutionized our ability to treat dynamic wrinkles of the face. Botox works by decreasing the activity of muscles which produce these wrinkles.  Perhaps, one of the most important benefits of repeated long-term treatment is prevention of wrinkle formation. By preventing the dynamic wrinkles from forming, they can not lead to static wrinkles and creases, which are much more difficult to treat once they have occurred. The preventive age-preserving value of Botox was shown in a comparative study of identical twins ( ref: Long-term effects of botulinum toxin type A (Botox) on facial lines: a comparison in identical twins. Arch Facial Plast Surg. 2006 Nov-Dec;8(6):426-31)

Botox has been approved by the FDA for treatment of glabellar rhytides (the vertical lines between the brows that appear when you frown), and is used safely to treat horizontal forehead lines as well as the "crow's feet" around the eyes. 

In our San Diego , Carmel Valley / Del Mar office more advanced techniques are preformed in order to treat:

- neck bands

- downward turning corners of the mouth

- facial asymmetries

-non-surgical eyebrow lifting

- treatment of migraines

Patients often comment on how painless and comfortable our techniques are. The effects of botox   generally  appear in 1-3 days and are fully evident within 1-2 weeks. Effects generally last 3-4 months. Published literature now shows that patients who maintain a schedule of treatments over time may permanently reduce the severity and onset of facial wrinkles.

At Carmel Valley Facial Plastic Surgery, we maintain the highest quality control with regards to storage and dilution of Botox. By minimizing dilution and disposing of unused material after several days, we are able to provide our patients with consistent, long lasting results. All botox injections at Carmel Valley Facial Plastic Surgery are administered by our facial plastic surgeon, Dr. Karam or a skilled, highly - trained nurse.

How Botox Works:

Botox Cosmetic is a purified protein produced by the Clostridium Botulinum bacteria that decreases the activity of wrinkle-forming muscles.  This botulinum protein was initially used successfully by Neurologists to treat muscle spasm in the face and neck, and the cosmetic effect of diminishing wrinkles was noticed as a side effect. 

Acetylcholine is the neurotransmitter responsible for making muscles contract. The botulinum protein, following injection into the skin and muscle, is absorbed by nerve endings (nerve terminals), where it blocks the release of  the neurotransmitter acetylcholine by those nerve endings. After several months, the nerve terminals recover and begin releasing acetylcholine again, and muscle function recovers.

Side effects of Botox:

Patients often question whether Botox will prevent them from making or conveying facial expressions. The reality is, in well-trained hands, treatment results in creating a more pleasant relaxed expression, while allowing you make natural expressions. The difference is the expression will not result in deep wrinkling and facial lines. This type of result is dependent on the skill, artistry and experience of the individual injecting.

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Hyaluranic Acids

(Restylane ® /Perlane ® and Juvederm ®)

This class of cosmetic fillers are made from hyaluronic acid, a naturally-occuring substance that provides fullness and volume to our skin. Restylane and Juvederm, are made in the laboratory and therefore has little or no risk of transmitting animal-based disease or allergy. They typically last from six to nine months depending on the site of treatment. Typical applications include:

Wrinkles/Folds

Nasolabial Folds

Lip Augmentation

Corners of the Mouth

More advanced applications include:

Treatment of hollows around the upper and lower eyelid region (see Non-Surgical Eye Lift section in Periorbital Rejuvenation Section)

Scultpra ®

Facial volume loss occurs as a result of loss of fat beneath the skin, thinning of facial muscles, and loss of bone density. These age related changes can lead to sunken cheeks, hollows beneath the eyes, and other depressions, which contribute significantly to an aged and tired appearance.

Sculptra is an exciting new FDA-approved product designed for correcting facial volume loss (facial lipoatrophy) throughout the face. Sculptra® is a synthetic biocompatible and biodegradable injectable material known as "poly-L-lactic acid." Poly-L-lactic acid has been widely and safely used for many years in dissolvable stitches and soft tissue implants. It is not a true filler. It works by stimulating production of collagen within the skin. Though Sculptra injection produces an immediate fullness, this fullness disappears over several days. However, the body reacts to its presence by gradually depositing new collagen, leading to thicker, healthier-looking skin. These "final results" take about 4-6 weeks and can be very dramatic. At that point, the patient is reassessed and a second treatment may be given. For anti-aging treatments, typically 2-3 treatments may be required. This "liquid facelift" is performed in the office with local anesthesia and no downtime. Results typically last 2 years and longer!

Radiesse ™

Radiesse is an injectable filler that is used for correction of deeper wrinkles and skin defects and may last up to one year. More advanced applications, allow this product to be used to augment the cheeks, giving results that are similar to a cheek implant without the downtime!

Radiesse is made of smooth calcium hydroxylapatite (CaHA) microspheres. The microspheres (particles) form a scaffold through which your body's own collagen grows, and this produces the long-term effect. Radiesse is especially effective for improving the nasolabial folds and depressions around the mouth and jawline. This products is often used during our “liquid facelift” procedure. Radiesse in injected with local anesthesia in the office, and produces immediate results. There is no significant patient downtime.