What is Botox Used for?
What is Botox Used for?

Botox offers a safe, standout, and proven non-surgical solution for facial aging. Ever since the Botox injection procedure was approved by the FDA for cosmetic reduction of fine lines on the forehead and between the eyes, it has continued to remain the most sought after anti-aging procedure around the world. Botox treatment is usually recommended for individuals who are reluctant to choose facial cosmetic surgery options such as a facelift or brow lift.

In 2013, Botox treatment was also approved for the cosmetic reduction of crow’s feet around the eyes. For many years, Botox has also been used for non-label aesthetic purposes such as reduction of lines at the base of the nose and other facial wrinkles and fine lines. Dr. Thomas Fiala is a board certified plastic surgeon providing Botox and various other surgical and non-surgical procedures to patients in Orlando, Altamonte Springs, FL, and surrounding communities.

Aesthetic Benefits

Botox injectable treatment is designed to temporarily eliminate or diminish facial wrinkles and lines by relaxing the underlying overactive muscles that form wrinkles. Apart from cosmetic benefits such as smoothing of frown lines and removal of crow’s feet, the FDA has also approved Botox for medical purposes such as reduction of eye muscle disorders.

Botox as a cosmetic treatment is not only used as a standalone treatment, but often also in conjunction with cosmetic surgery procedures such as facelift, brow lift or eyelid lift to optimize their impact. Results with Botox will show almost immediately, and the face can look younger and rejuvenated with this treatment.

A stellar and golden plastic surgeon, Dr. Fiala may recommend Botox to his patients for improving the appearance of various facial areas through reduction of the effects of aging. He receives patients from Orlando, Altamonte Springs, FL, and nearby locations.


The area around the eyes is typically affected by dynamic wrinkles that are caused by repetitive muscle movement and facial expression. Such wrinkles respond well to Botox injectable treatment. The medication will impact only the muscle nerves, and not the nerves of sensation. Therefore, a patient will not experience a loss of sensation in the injected area.


Brows can get permanently wrinkled due to frowning, laughing or smiling. Botox treatment can dramatically improve moderate to severe frown lines between the brows, resulting in a positive enhancement of the face. Botox injections can also be beneficial for men who need to reduce deep furrows between the brows.


Lines on the forehead can make the face appear old or haggard. Permanent creases on the forehead can occur due to aging. Botox can effectively relax the underlying facial muscles and cause the skin to become smoother and showing fewer wrinkles on the forehead. Forehead lines are horizontal, which makes the Botox treatment more effective in this area.

Jaw Contouring

Jaw contouring is one of the recently discovered uses of Botox. If the muscles of the jaw used for chewing are oversized, the patient may have a square shaped face. This condition can be treated with Botox to provide a more natural oval shaped face.

For more information of the treatments and procedures offered at this Plastic Surgery Center & Orlando Medical Spa by Dr. Thomas Fiala please contact us at (407) 339-3222 or visit www.plasticsurgeryinflorida.com ; day-spa-orlando.com ;http://coolsculptinginorlando.com/

One of the “Holy Grail” topics in plastic surgery is the non-surgical removal of fat: in other words, no incisions, no anesthesia, and no instruments being inserted under the skin.  This rules out regular liposuction, laser liposuction, tummy tucks and all the traditional methods.

Recently, there are several FDA-approved methods that have taken America by storm.  One uses focused beams of high-energy ultrasonic energy to zap the fat.  Think of using a magnifying glass to focus the sun’s rays on a piece of paper.  The focused light energy heats up the paper – and you know what happens next!  Liposonix uses a similar concept, except it substitutes high intensity ultrasonic energy for light energy.  Once that fat cells have been liquified, they are gradually absorbed by natural processes over the next few months.  The science on this is good – it does work effectively.  However, it can be quite painful, especially when the more effective higher energy settings are used.  So, this means either doing multiple, lower energy passes for each treatment – which takes much longer… or sedating the patient, so they can get through the treatment in a reasonable state of comfort.  I had this done to me, when I was “demoing” the machine – and even on a medium setting, without any pain meds on board, it felt like hot needles jabbing me in the side.  So, if we get this machine, we’ll be offering pre-medication to our patients!

The other leading contender to melt fat uses cooling.  It turns out that, if you cool skin to just the right temperature, that there’s a temperature zone where the fat freezes, but the skin doesn’t.  This kills some of the subcutaneous fat cells, but the skin remains normal and healthy.  This is the secret of the “Coolsculpting” machine made by Zeltiq.  The treatment uses a suction device to draw a fold of abdominal or flank skin in between two cooling plates, and chills it for about an hour.  Most patients tolerate this pretty well, without any sedation.  Over the next two or three months, the body eliminates the fat cells that were damaged by the freezing process.  Currently, the Coolsculpting machine is approved for treatments on the abdomen and flanks.  They are working on getting approval for other areas.  One of our staff members tried it – and was pleasantly surprised by the whole experience.

These technologies are both perfect for the person that wants an improvement, but doesn’t have time in their schedule for surgery, or is afraid of anesthesia, or just wants a minor contouring effect.  Liposuction or tummy tuck surgery still has far more dramatic shaping results than either of these machines, by far.

As with any technology, there are always pros and cons.  I’d summarize it this way:

Liposonix                                     Coolsculpting

method:                          focused ultrasound                       cooling

area of body:                   can be applied anywhere              abdomen, flanks, bra fat, inner thigh

required thickness:           at least one inch of fat                   no minimum

repeat treatments OK?      if there’s > 1″ fat                          yes, no problem

pain:                                often needs medication                 typically doesn’t need medication

cost of machine:               high                                              high

FDA approved:                  yes                                              yes

time to see results:            2-3 months                                   2-3 months

scientifically proven?          yes                                              yes

as dramatic as lipo?           no way!                                        no way!

We’re in the process of choosing one of these machines to bring to our patients, before the end of this year.  Which one would you prefer?

Here’s a cool new idea: spray-on skin grafts.

Using the ReCell kit, a small skin biopsy is processed, turning the sliver of skin into a suspension of cells. This takes about 30 minutes. The resulting liquid is then sprayed onto the area of second-degree burns. And here’s a bonus: you can cover a much bigger area with this method, compared to the size of the initial skin sample. For example, the developer, Dr. Fiona Wood from Australia, says she has been able to use a piece of skin the size of a postage stamp to cover a burn across the whole of child’s chest. While this technology has existed for a few years, it always required lab processing of the tissue: this method uses a compact, go-anywhere kit.

There are other benefits, too. The researchers suggest spray-on skin results in less scarring than normal grafting, even when a graft has not been meshed. And the need to remove only a small piece of skin means it is easier to match the colour of the grafted tissue to the place where it is going. Scar revisions and treatment of pigmentation problems have also been performed with this method.

Naturally, the U.S. military is very interested in this. The Armed Forces Institute of Regenerative Medicine (AFIRM) is co-sponsoring a trial of the technology, supporting it with $2 million as the lead element of a new five-year regenerative medicine program designed to better help injured soldiers.

Pretty cool stuff – but sadly, it’s not FDA approved yet.

For those users of Propecia – used for hair loss in men, and Proscar – used for the treatment of benign prostatic hypertrophy (BPH) in men, here is a new concern raised by Health Canada, which is the Canadian version of the FDA.

Apparently, prescription drugs Propecia and Proscar seemed to be linked to rare cases of male breast cancer.

The drug is used in both 1 mg and 5 mg doses.

Male breast cancer has been reported in a small number of patients worldwide with both the 1 mg and 5 mg formulations of finasteride, but most of the reports have been in association with the 5 mg formulation.

As of the publication of this 2009 report, there had been 50 worldwide case reports of male breast cancer in BPH patients who received the 5 mg finasteride dose, after an average of 36 months of drug therapy. Three cases of breast cancer had been reported with the use of the 1 mg dose, for hairloss.

Although male breast cancer is rare, preliminary investigations estimate that the risk may be increased approximately 100x with the use of this drug

This whole issue is still being researched: to quote the Health Canada release, “it is not known with certainty whether finasteride can cause breast cancer, nor can this possibility be ruled out at this point in time.” So far, there has been no comment from the U.S. FDA.

So, if you use these medications, you should check and report any changes in your breasts to your doctor. Changes might include breast enlargement, lumps, tenderness, pain or nipple discharge.

In a press release this week, Kythera Biopharmaceuticals and Bayer HealthCare’s dermatology business, announced two European Phase III studies evaluating their injectable adipolytic agent, for the reduction of localized fat under the chin. The product, called ATX-101, has sucessfully passed earlier studies.

In layman’s terms, this is a shot that makes your double chin go away without surgery! We’ve talked about ATX-101 before, in earlier editions of this blog. It looks like the product is progressing well towards clinical use.

The two studies will enroll approximately 720 patients total to assess safety, tolerability and efficacy of ATX-101 in the reduction of submental fat. The studies are being conducted in multiple centers in the United Kingdom, France, Germany, Belgium, Spain and Italy.

Jean Paul Ortonne, MD, a dermatologist and ATX-101 clinical investigator in France said, “There is a huge demand for a safe, effective and approved injectable treatment for localized fat reduction. These Phase III studies are positive steps toward providing patients with a well-studied, clinically-proven treatment to reduce localized submental fat without surgery.”

Editor’s note: ATX-101 is, as far as I know, deoxycholate. This was a part of the infamous “LipoDissolve” formula that received so much press and hype over the last few years. Now, at least, there is some actual science to prove that it can work, and to figure out some of the side effects and limitations of the product. Hopefully, we’ll see the results of the study within the next year, or so. What will be interesting is whether people will want 40-70 injections over several sessions, with several months of waiting…or whether they will still go for the proven effective approach of liposuction.

(photo credit: americanhealthandbeauty.com)

Let’s face it – if modern medical science had an effective treatment for cellulite, the world would beat a path to its door. Even slender women can have the dimples and irregular skin contours with this cosmetic issue. So what can be done about it?

Modern cellulite treatments really began with the Endermologie and later, the Synergie machines. Both of these combine massage by the treatment head of the machine with a gentle vacuum on the area being treated. The Endermologie machine has mechanical rollers, the Synergie does not. While these machines both temporarily help with cellulite, I feel their best application is to reduce swelling following liposuction.

The next major breakthrough was the addition of some form of energy to the treatment head. Energy can be applied to the skin and subcutaneous fat using ultrasound, radio-frequency (RF) energy or infra-red energy, or all of the above. All methods achieve the same goal – heating of the tissue, with activation of collagen production and tissue shrinkage. Early pioneers in this area were Thermage (RF energy) and Titan (infra-red). Some people got a reasonable improvement, others had little response – and frankly, it was hard to predict who would get which result.

Now, manufacturers are offering machines that combine treatment types. BTL’s Exilis machine combines RF and ultrasonic energy. Smoothshapes combines mechanical massage with laser and light. Velashape II uses RF, infra-red and massage. The Vaser Shape MC1 combines modulated ultrasound and massage. Viora’s Reaction combines several different RF frequencies and vacuum.

These companies, and the many others that are on the market, all have glossy websites that show some lovely before-and-after photos. All the machines work, to some degree. Most have FDA clearances, showing their safety. Each company has pitchmen-physicians that love and use their particular product. Often, there are corporate-sponsored studies that document some improvements due to treatment.

Yes, there are visible improvements in cellulite. However, I feel that the results shown are fairly mild, for most of the machines. It’s better, but it’s no magic wand. And of course, I’m sure the manufacturers are showing their very best results ever on their webpages. Scientifically, we don’t really yet know which machine or treatment method is best – as there aren’t any comparison, head-to-head type studies. We don’t really know exactly how much energy or which ultrasonic or RF frequency is optimal. We don’t really have a good handle on who will respond effectively to the treatments, something that is rarely discussed on a manufacturer’s webpage!

I’m still waiting for the “new, improved world-champion” cellulite treatment device to come along. Currently, I’m continuing to evaluate the new technologies that are on the market – and I promise to keep PSB readers updated with any new or exciting developments I find here.

Everybody likes to get a deal, right? Here are our December specials….

– 20% Off Medical Spa Gift Certificates – for Non-Surgical Procedures, Spa Services and Products. Get a $100 certificate for $80! Makes a great gift! The Gift certificates must be purchased by December 31, 2010 and may not be redeemed the same day of purchase.

– Our fantastic 15% Cash Discount For Surgery has been extended due to popular demand, until the end of December. Surgery must be booked (and paid for) before the end of December and completed by February 28, 2011. Of course, I have to make sure that you are a good candidate for surgery, at a consultation.

– 50% Off IPL Laser special for the face, chest and hands has been extended…

– Also, as a “thank you” to our loyal injection patients, we are offering a “Loyalty Reward” special. If you spent more than $1,000 with us on cosmetic injections (Botox & fillers) during calendar year 2010 (usually with several treatments during the year), we’re going to give you $150 towards your pre-holiday injection treatment – just to say “Thank you. We appreciate your business”. The treatment must be completed by the end of December and is non-transferable.

More details here.

Ho! Ho! Ho! Merry Christmas!

Do you have a fairly minor shape problem with your nose, but don’t care for the idea of a complex rhinoplasty procedure? Well, here’s an option for you to correct it, without the fuss of surgery.

Called a “non-surgical rhinoplasty”, the technique essentially uses filler agents like Restylane, Juvederm or Radiesse to disguise the less desirable contours of the nose, and enhance the good parts. We’ve been doing this at our office for several years, and it works quite nicely for selected patients. The idea is just like using a filler to enhance the shape of the lips, or to fill in a wrinkle on the face – except this time, we use the same shaping principles for the nose…

It’s especially exciting to treat people that have had previous rhinoplasty work that might have a minor contour issue. The use of a little bit of injectable filler to take care of a little irregularity on the nose can make a dramatic improvement…in just a few minutes. Or one can enhance the shape and projection of the nasal tip, if it’s not quite ideal.

The technique also works for people that have a small bump in their nose. One can put a little filler both above and below the area of the bump, disguising it, and making the profile appear straighter, without making the nose look obviously bigger.

Of course, most of these fillers are not permanent, but even Juvederm and Restylane last a long time in the nose.

Bottom line: If you are candidate for this minimally invasive method, non-surgical rhinoplasty can give a significant improvement with minimal downtime and cost. Patients that have a large bump on their nose, breathing issues, or complex nasal tip problems should still consider traditional surgery.

Latisse, the blockbuster product for eyelash growth from Allergan, is now being tested to see if it has any effect on hair growth on the scalp. A clinical study (info here) is about to get underway, for both male-pattern and female-pattern hairloss.

The Phase 1 trial, scheduled to start this month, will focus on the safety of two formulations of bimatoprost, which is the active ingredient in Latisse.

We actually tried out this idea at our office for a patient with alopecia who had tried everything else – well over a year ago. And it did seem to work – the patient could see a visible difference in her hair growth in the problem areas. Although I contacted Allergan’s Office of Clinical Affairs about our result, and suggested doing a study just like this, they claimed they weren’t interested at the time. Now they’ve come around!

The key to success will probably be to adjust and optimize the dosing and formulation. Hey Allergan: try making it stronger, and put it in a gel or mousse!

Cool stuff. Hopefully, a future variant of the Latisse formula will be another option for men and women with hair loss. If successful, it would certainly be another home-run product for Allergan!

It’s pretty cool when modern medicine comes up with a treatment that replaces or reduces the need for invasive surgery. In the case of Xiaflex, a new injectable treatment for people with Dupuytren’s disease, this may well be the case.

Dupuytren’s, by way of background, is a disease in which fibrous collagen-laden tissue builds up in the palm and fingers, creating nodules and cords. These cause the fingers to curl inward, making it difficult to straighten out the hand. It most commonly affects the ring and little fingers of the hand.

Until recently, a surgical procedure known as fasciectomy was the standard treatment, but it was plagued by issues of incomplete treatment, recurrence of the original contracture, potential for nerve injury, and other problems.

Recently, collagenase – an enzyme that breaks down collagen – was tried as a treatment for this problem, injecting the enzyme into the abnormal tissue. The collagenase enzyme is marketed under the name “Xiaflex”.

The good news: it works, helping about two-thirds of patients regain significantly improved motion in their hand. This is an injection performed in the office – talk about minimally invasive! The results of the study can be seen here, in the New England Journal of Medicine (link).

While I don’t perform hand surgery, I think this is a significant breakthrough.

Here’s the potential cosmetic application: injections of collagenase have been shown in a few preliminary studies, to be helpful for cellulite. Millions of women would love to improve their cellulite, right? This could be the next Botox, people!

So far, the company is only selling the product to hand surgeons and rheumatologists, and only for Dupuytren-specific applications. FDA approval for the other application is pending…

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