By now, virtually everyone is familiar with the use of Botox to reduce horizontal forehead lines, frown lines between the eyebrows, and crow's feet lines around the eyes. The treatment of these three areas with Botox accounts for the great majority of all of the Botox that is used for cosmetic purposes. The results from these treatments are uniformly good, which is why Botox treatments are the single most commonly performed cosmetic procedure in our country and worldwide.

However, you may not be aware that Botox can be used in many other areas on the face and neck to soften lines and relax muscles. The goal of these treatments is to produce a relaxed look to the face while preserving full movement. In this article we will review some of these more unusual cosmetic uses of Botox.

Eyebrow Injection – With age, the eyebrows start to droop. By injecting Botox into the eyebrow, the eyebrow can be elevated. The resulting "Botox brow lift" not only restores the eyebrow to a more youthful position, but it also opens up the upper eyelids.

Upper and Lower Lip Vertical Lines (Smoker's Lines) – Very small quantities of Botox can be injected into the upper and lower lip to soften lines in these areas. Often, Botox is used in combination with collagen or Restylane to soften these lines.

Depressor Anguli Oris – The depressor anguli oris is the muscle responsible for turning down the corners of the mouth. This very unattractive facial feature can be significantly improved by injecting this muscle with Botox. Injecting the depressor anguli oris allows the corners of the mouth to turn in a more upward direction, producing a far more attractive appearance. This is one of Dr. Amerian's favorite injections, and she regularly has this injection done on herself.

Gummy Smile – When some people smile, their upper lip elevates above their upper teeth, exposing their gums and producing an unattractive "gummy smile." An injection of Botox into the upper lip can easily correct this.

Bunny Lines – "Bunny lines" are the lines that occur on the side of the nose when some people smile. They are quite unattractive, and can be easily treated with a small amount of Botox.

Chin – Many patients, especially when speaking, develop folds, creases, and wrinkling in their chin. Two injections of Botox into the chin can significantly improve the chin's appearance.

Neck – An overactive neck muscle will result in vertical bands below the chin, known as "platysmal bands," and horizontal wrinkles across the neck. Injection of Botox into the bands and wrinkles will soften the bands and significantly improve the wrinkles.

The next time you're in the office getting Botox for your frown lines or crow's feet, take advantage of the opportunity and speak with us about whether treatment of any of these other more unusual locations with Botox could further enhance your cosmetic result.

There are literally a myriad of reasons why many men and women choose to remove unwanted body hair. It might be a cosmetic, social, or cultural reason, or possibly a medical reason. Unwanted pigmented hair is an extremely common problem for both men and women. Many methods are available for temporary or permanent hair removal, and each method has advantages and disadvantages. In this month’s newsletter, we will review the various methods of treating and removing body hair.

Although excessive hair growth commonly occurs in the normal healthy population of individuals, at times it can be a manifestation of an underlying hormonal disturbance. For this reason, every patient who desires hair removal should first have a complete medical history and physical examination. If the doctor suspects that a hormonal problem may be contributing to or causing the excessive hair growth, a referral to an endocrinologist or a gynecologist is warranted.

Shaving:
Removal of body hair with a razor blade on wet skin using shaving cream or another lubricant is one of the most common methods of removing unwanted hair. The main advantage of hair removal by shaving is that it is fast, easy, and inexpensive. However, as every man knows, the results are temporary, lasting at most three days and often only one day. Because shaving removes hair at the skin surface, it is the most temporary method of hair removal.

Plucking, Waxing, Sugaring, and Epilation:
Epilation means the removal of the entire hair shaft. It is the most effective method for temporarily removing a hair. Epilation includes waxing and plucking, as well as some other methods that can be used for removal of the hair shaft. It is not known whether repetitive epilation results in permanent changes in the hair being removed. Epilation lasts longer than shaving because the hair is removed from below the surface of the skin.

Manual plucking is an easy way to remove single hairs and is useful for removing small amounts of unwanted hair. When the area of skin to be treated is too large for plucking, waxing techniques are more useful. Waxing involves the application of warmed wax to areas of hair bearing skin followed by removal of the wax and the associated embedded hairs.

Sugaring is similar to waxing and is an alternative to waxing for people who are sensitive to wax. A syrupy sugar mixture is prepared by heating lemon juice, water, and sugar. The syrup is then applied to the skin, after which it is quickly stripped away, removing the unwanted hair in the process.

Depilation:
Chemical depilatories remove part of the hair shaft, and are easy and painless. Depilatories work by breaking down the protein in the hair shaft, causing the hair to break in half, and allowing the hair to separate from the skin. They work best on the legs, bikini line, face and underarms. For a good result, the hair should be neither too long nor too short. Since some people are allergic to the chemicals found in a depilatory, a small spot should be tested prior to use to determine whether the product is safe to use in that person.

Eflornithine (Vaniqa):
This drug is used in a topical cream available only by prescription. It was recently approved by the FDA for the reduction of unwanted facial hair in women. The drug works by reducing the rate of hair growth. It can be used in conjuction with other methods of hair removal to prolong their efficacy. Eflornithine is generally used twice a day for six months. Unfortunately, once the drug is stopped, facial hair growth returns to pretreatment levels within 2 months.

Electrolysis:
Electrolysis involves the insertion of a thin needle into the hair follicle, after which a pulse of electric current is passed through the needle to damage and eventually destroy the hair follicle. Generally, multiple treatment sessions are required. During electrolysis it is important to insert the needle accurately into the follicle, and to choose an appropriate intensity and duration of the electric current.

Only hairs that are actively growing should be treated with electrolysis. This can be determined by shaving the area to be treated, then treating a few days later only those hairs that are visible on the skin surface. With electrolysis, each hair must be treated individually and the process is slow.

Laser Hair Removal:
Laser hair removal first became available in 1996, and since that time many advances have occurred in the technology. Lasers can treat large areas of skin at one time, making laser hair removal a cost-effective and efficient method of hair removal. Commonly treated areas include the legs, armpits, upper lip, chin, and bikini line. The effects of laser hair removal can last for several months to several years. Laser hair removal works by using laser energy to destroy the hair follicle, thereby inhibiting future hair growth from the follicle.

For the hair removal laser to be effective, the hair pigment should be darker than the surrounding skin pigment, so that the hair absorbs more of the laser light. If the skin is darker than the hair, the skin will absorb more of the laser light, potentially leading to adverse tissue reactions following the procedure. For this reason, it is important that patients undergoing laser hair removal not come to the office with a tan.

Over the last several years, laser hair removal has become very popular because the results are superior to hair removal using more conventional treatments such as waxing, shaving, and electrolysis. Approximately 80% of all patients respond well to laser hair removal. Patients may expect approximately a 30% decrease in hair with each treatment. For this reason, multiple treatments are generally necessary to achieve the desired reduction in hair in a given body area. In general three or more treatments are required at each site to achieve permanent hair growth reduction. Typically, treatments are spaced 1-3 months apart.

In our office, Karen Ballantyne performs the laser hair removal treatments. Karen is a registered nurse for fifteen years, and she has extensive experience in laser hair removal. Any of our patients who would like to undergo laser hair removal are invited to call the office and make an appointment with Karen.

Recently, the FDA gave its approval to Juvederm for use in the correction of facial wrinkles and folds. Juvederm is a technologically advanced formulation of hyaluronic acid that is safe and effective in patients of all skin types and all skin colors.

Hyaluronic acid is a naturally occurring substance found in the body. Its injection into folds and wrinkles creates volume and fullness, and enhances the moisture content of the skin. This combination of effects fills and softens the injected lines, folds, and wrinkles, resulting in the aesthetic correction. Hyaluronic acid has turned out to be an ideal filler for correcting folds and wrinkles. For this reason, the treatment of facial folds and wrinkles with hyaluronic acid is currently the fastest growing non-surgical aesthetic procedure in the United States.

The Juvederm gel is very smooth and flows easily into the skin, creating a smooth and natural look and feel. This allows us to provide a correction for facial wrinkles and folds that is easily tolerated and looks natural. Juvederm contains the highest concentration of hyaluronic acid currently available in a dermal filler. Therefore, it has a long duration of effect, with results lasting for up to six months or longer. Juvederm is an ideal filling agent for moderate wrinkles in the cheeks and moderately severe nasolabial folds. In addition, it can be used in lips to better define the lips and to make the lips appear fuller.

In our office we have used hyaluronic acid fillers for several years on hundreds of patients. Our patients have truly enjoyed the cosmetic enhancement these fillers have provided. We are pleased that Juvederm is now available to provide an additional facial rejuvenation option.

Because of our extensive experience with fillers and other injectable products, the manufacturer provided our office with Juvederm prior to its release into the general medical community. (The general release is scheduled for next year.) Any of our patients who believe they might benefit from Juvederm are welcome to call our office for an appointment.