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Keith Denkler, M.D.


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Kybella


Common Procedures


BOTOX® for Wrinkles


 Dupuytren's Disease



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Dupuytren's Contracture (Maladie de Dupuytren)


Dupuytren's for Patients


FAQ/Needle Aponeurotomy


XIAFLEX for Distal Joint Dupuytren's Contracture


ASSH Hand Society Presentation of NA


AAPS Presentation on Needle Aponeurotomy for Severe Dupuytren's


Dupuytren's Boutonniere Deformity Treated with XIAFLEX


XIAFLEX Boutonniere Treatment


2011 ASSH Dupuytren's Needle Presentation


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 Needle Release for Beauty



Needle Release for Beauty

Keith Denkler M.D.  
415-924-6010  
275 Magnolia Ave.  
www.PlasticSurgerySF.com  
Larkspur, CA 94939  


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BOTOX®

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BOTOX® FOR WRINKLES AND HEADACHES



 BOTOX®, a focal agent intended to reduce muscle contraction is the brand of botulinum type A made by Allergan. BOTOX® is the most studied brand of botulinum neuromodulators.  BOTOX®  was first used by Dr. AB Scott for stabismus (cross-eyed children and infants) in a publication from 1980.  This use in children and infants was the first medicinal use of BOTOX®.  It has been used for aobut 30 years for a variety of reasons in adults and children with a remarkable safety profile.  It still is used in children and infants with strabismas and very large doses (100-300 units or more) of BOTOX®  are used commonly in children with cerebral palsy.


INTRODUCTION

In April of 2002, Botox was approved by the FDA for cosmetic use.  Since it has been an approved medical product for more than a decade for blepharospasm and nystagmus treatment, its use in cosmetic purposes was off label.  In April of 2002 the FDA for cosmetic use approved it.  Companies are now able to advertise its use to patients and market the product to physicians.

BOTULISM

Botulism is food poisoning, caused by uncontrolled large doses of botulinum toxin.  BOTOX®, MYOBLOCK® and DYSPORT®  are medicines produced by the same bacteria and carefully controlled by the FDA for quality control.  BOTOX® is very useful for treatment of crow's feet, forehead lines, and frown lines.  It can also be used for neck banding and drooping lateral mouth lines.  Other off-label useful medical uses include back pain, neck pain, headaches, muscle spasticity, plantar fasciitis, tennis elbow, golfers elbow, and chronic regional pain syndrome.  BOTOX® would be dangerous high concentrations; however, there have been no deaths reported after its cosmetic use of 25 to 100 units of Botox per session.  Large doses in the neck for severe spasticisy have led to difficulties swallowing in some patiens with resulting aspiration pneumonia. To have a toxic effect it has been estimated that five thousand units would have to be used at a single setting.  However, this would be extremely expensive, and it is unlikely that this would ever occur.  Much as Tylenol®  can be dangerous, or fatal, with a dose of more than 8 a day, BOTOX®  can be dangerous if used in high doses.  

HOW LONG DOES BOTOX® LAST?

BOTOX® seems to last for about 3 to 6 months; however, in some patients it may last 9 to 12 months.  Some patients are resistant to injections.  Resistant patients are more commonly men.  BOTOX® resistance is probably related to the larger muscle mass in male patients.  

ARE THE SIDE EFFECTS?

Side effects are few and can be related to localized trauma or bleeding from the injections.  Some people report headaches in the first few days.  

DOES BOTOX® WORK FOR HEADACHES?

BOTOX® has been very successful in the treatment of tension and migraine headaches.  Although it is not approved by insurance companies or the FDA for this use, clinical results are very promising.  Sometimes insurance companies will pay for its use in headaches.  See the BOTOX® hotline number below.

HOW DOES BOTOX® WORK?

BOTOX® prevents the release of acetylcholine at the junction of the nerve with the muscle.  This blocks the transmission of nerve signals to the muscle.  The nerve senses that there is no communication and over time sends out new sprouts to reinnervate the muscle.  That is why BOTOX® wears off slowly over a period of time.

REACTIONS TO BOTOX®?

There have been no true allergic reactins to Botox.  The doses used are so small that Antibody formation has been noted only with larger doses, such as 100 units, or with repeated booster injections.

USE IN PREGNANCY

BOTOX® use is not indicated in pregnant patients; however, it is not likely to cause any damage, since the chemical is too large to cross the placental membrane.


PAIN OF INJECTION

In an effort to reduce the pain of injection, ice cold or frozen needles are used, which have been shown in the Journal of the American Medical Association to dramatically reduce the pain of injections.  This study, by Dr. Denkler, was published in JAMA Oct 3rd, 2001 and later referenced in the New York Times and Readers Digest.

DOES BOTOX® ALWAYS GET RID OF THE WRINKLES?

In patients with deep or severe wrinkles, the muscle will be smoothed out, but the wrinkle in the skin may continue.  This can be treated with injections JUVEDERM®  or RESTYLANE®.

DOSING

The standard cosmetic dosing for frown lines is 20 units and for crow's feet it is 10-20units.  Forehead frown lines require another 10-20 units.  Since the price of the injections is very much related to the cost of the medicine, make sure you are comparing equivalent unit doses when comparing prices.

EXCESSIVE SWEATING

Some people experience inappropriate or excessive sweating of the hands or axilla.  BOTOX® is very effective for blocking the nerve transmission that causes this problem.  BOTOX®  for hyperhidrosis can last up to six or nine months after treatment, or much longer than standard cosmetic use.  An alternative to BOTOX® is reverse liposuction to the sweat glands of the armpit.  This suctions the sweat glands out under local anesthesia and is useful for reducing armpit sweating.  Temperature control in heat is readily controlled via the rest of the body which has a much larger surface area.









Keith Denkler, M.D.  |  Contact Info  |  Kybella  |  Common Procedures  |  BOTOX® for Wrinkles  |  Dupuytren's and XIAFLEX Pictures  |  Dupuytren's Contracture (Maladie de Dupuytren)  |  Dupuytren's for Patients  |  FAQ/Needle Aponeurotomy  |  XIAFLEX for Distal Joint Dupuytren's Contracture  |  ASSH Hand Society Presentation of NA  |  AAPS Presentation on Needle Aponeurotomy for Severe Dupuytren's  |  Dupuytren's Boutonniere Deformity Treated with XIAFLEX  |  XIAFLEX Boutonniere Treatment  |  2011 ASSH Dupuytren's Needle Presentation  |  Credentials  |  Curriculum Vitae  |  Directions/Office Hours  |  Links  |  News Articles  |  Needle Release for Beauty

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