Dr Beulink’s Personal Comments – Botulinum Toxin
One of the most common questions I have been asked is “What is the difference between botox and fillers?” Simply put, Botox® is for treating a wrinkle that is caused by an underlying muscle that is pleating the overlying skin, and Botox® simply stops that muscle from moving.... hence the line gradually fades away. Fillers are more like a putty filler. They instantly fill a wrinkle by directly filling in or puffing up the skin surface. Generally speaking, Botox® is particularly suited for the top part of the face (around the eyes) while fillers are particularly suited for the lower face (around the mouth), although there are numerous exceptions to this.
Botox® and Dysport® are the only botulinum toxins fully registered for cosmetic use in New Zealand. They have been used medically for many years and have excellent safety and performance track records. I do not use any of the more recent, cheaper, but of questionable quality botulinum toxins that are now becoming available in New Zealand. Typically manufactured in Asia (eg. Neuronox, commonly referred to as "China-tox"), there are doubts as to their contents and purity, and hence their safety and efficacy (results). They are not registered and should be avoided. Be wary as to what is being injected into your face.
In my experience I have found that as with any product used for cosmetic treatments, placement is extremely important for the type and duration of results. It is very important to realise when choosing your Botox injector, that Botox is merely a product, it is not a result. All "Botox" is not the same. One of the most important aspects of the Botox treatment, is what is happening at the blunt end of the syringe. Choose your Botox injector carefully, it will make a big difference to your overall experience and result.
As every person is not “built” equal, each persons frown muscles for example, and hence frown actions, are slightly different. Treatment must be specifically tailored to that individual’s muscles and requirements, to ensure a nice, natural and maximum effective treatment. A botulinum treatment is not a standardised procedure requiring (and is often sold these days as) "X" number of "units of Botox".
Similarly, I do not charge per "unit of Botox". I find it rather odd that some people shop around looking for the best price "per unit of Botox" (as if they know exactly what needs treating, and maybe then even entering into a plea bargain as to how many units they want or think they can get away with). This would be like wishing to commission a painting portrait done of one self, and then asking each artist how much they charge per ml of paint! The paint, or Botox, itself is not the result. What I believe makes more sense, is what is the cost to fix my frown lines or crows feet etc? So instead, I simply charge per area and treat whatever and wherever needs to be treated in order to achieve a premium result. This is how I have treated since 1994.
I do not routinely get everyone back for "a check" in 2 weeks to see if a few more units (and cost!) are required. I believe in treating once and treating right. We all have better things to do in our lives. For Botox or Dysport costs, see below.
For the first 3-6 months when I initially started offering this treatment, I found that this procedure was often associated with an unacceptably high risk of bruising, particularly around the eyes. I consequently developed a unique formulation that minimises this risk and have been using this ever since. In my hands, bruising following Botox or Dysport is very rare.
This procedure is quick, easy and almost painless (with my technique and unique formula most patients exclaim how minimally uncomfortable it was!).
Some people worry that botulinum treatment will leave them with a frozen or mask-like, expressionless face. This is NOT the case, as long as this product is placed and used appropriately and sensibly. Specific, small, problem muscles only should be treated which leaves the bulk of the expression muscles intact and functional. A frozen face is caused by bad botulinum treatment!
Botulinum toxin has over 50 years use in the field of modern medicine, and although it is a “toxin” to the body, cosmetically we are using approximately 1/5000th of a lethal dose. To date, I am unaware of any long term side effects (with sensible use!).
Apart from bruising (very rare in my hands), the only side effect of significance that I have seen from Botox or Dysport treatment is an upper eye lid droop (usually only on one side) when treatment is done to the frown lines. The affected lid droops approximately 1-2mm and is temporary, usually lasting for approximately 21 days. The risk of this is said to be approximately 3% internationally, however, I’m sure poor placement and bruising contributes largely to this figure, as I have found that the risk of this in my hands (for well over a decade now), has been less than 0.25% (note technique and unique formula as above). Prescription eye drops are now available that can help lift the droopy eye lid during this time so even if it did happen, the problem should be minimised.
Another very uncommon side effect following facial botulinum treatment can be a headache lasting several days. However, for the two such cases I have seen in the last 10+ years, I have otherwise seen countless numbers of people who have experienced profound relief from their recurrent tension headaches and migraines with this treatment.
Other uses for botulinum toxin include symptomatic treatment of axillary hyperhidrosis (excessive armpit sweating). These are people that have told me “Botox has changed my life!”
Typically, they have previously tried just about every deodorant and concoction under their arms without success. The sweat just keeps pouring out no matter what the temperature is. After botulinum treatment, they go from needing 2 or 3 changes of shirt or blouse at work each day, to be able to leave home in the morning and return in the evening in the same top. Hiding it in black tops is no longer necessary; freedom to wear colours becomes the norm. It is that effective!
For hyperhidrosis, the botulinum is injected very superficially as multiple micro droplets into the armpit skin where it acts directly on the sweat glands. Placed properly like such, there is no chance of any arm muscle weakness. To ensure the right amount of botulinum is used, I perform a sweat test immediately prior to treatment. This identifies the exact location of the overactive sweat glands and thus limits the botulinum only to the affected areas. This obviously means there is no over-treatment, there is no wastage and importantly it keeps the cost down to the required minimum. I have seen extremes, where one entire armpit is generally affected while the other is limited to just 1 or 2 discrete localised areas of hyper-activity requiring only a very small amount of Botox or Dysport to fix. After treatment, within days the sweating completely dries up.
Botulinum toxin is also used for the treatment of muscle spasticity including torticollis (wry neck), blepharospasm (eye twitch), and facial spasm. It can also be used to slim down bulky jaw lines (very popular for Asian jawline), and can even help reduce teeth grinding and clenching problems.