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UPDATE #5
A About Botox®
B Lunch-time Surgery?

A Few Lines About Botox®
The hottest topic in plastic surgery right now is Botox®, even though there is, in fact, very little about it that’s truly noteworthy. It is being used in exactly the way plastic surgeons and others have been using it for years. The only difference is that that FDA has finally officially “authorized” its use in this manner. Essentially, Botox® (which is derived from the toxin that causes botulism, although there’s no need to go into those details here) weakens and relaxes muscles on a temporary basis. The effects on facial muscles typically last for about 4-6 months. Though originally intended for use in several medical conditions (such as persistent spasm of the muscles around the eyes) patients - and their doctors - quickly noticed that the lines around their eyes (e.g., the “smile” lines) were softened and, often, eliminated when the involved muscles contracted. This means that when you smile, or frown, the lines that would otherwise form as a result are diminished or eliminated entirely.

The frown lines are the ones that appear in between the eyes, on the lower forehead, and they are actually the lines that I treat most often. They seem to be the lines that people hate the most, and they are treated particularly well with these injections. If you must frown for some reason, you might as well not have it be so obvious. Botox® also softens lines at rest, so when these lines are fairly prominent even at rest, then treatment with Botox® is
an excellent option. The third area that is commonly treated is the forehead itself, specifically the fine, horizontal lines. It is important to note, however, that treatment of forehead lines may lower the eyebrows a bit, as the forehead muscles function, partly, to raise the eyebrows. Weakening those muscles may, therefore, lower the eyebrows. Treating just the frown lines between the eyes (without also treating the entire forehead) often provides, as an added benefit, a slight lift to the eyebrows. This is because the muscles that cause the frown lines to appear also pull the eyebrows down a bit; weakening them allows for the relatively unopposed upward pull of the forehead muscles.

Botox® is administered by a wide variety of practitioners, including doctors (such as plastic surgeons, dermatologists, and ophthalmologists), nurses in the various doctors offices, and non-medical personnel in spas and similar settings. It is important to know who will be administering the Botox®, which consists of a series of needle injections into the regions being treated. While it is not exceedingly difficult to give these injections, there is, as always, a range of capabilities among the people giving them. Finally, there is the cost of Botox.® In New York, it typically ranges from about $500 - $1000 for a treatment but the thing to know is how many UNITS one will be receiving as part of the treatment. Botox® comes as a powder that must be reconstituted (mixed with) a liquid, such as saline. There are 100 units in a vial. If you’re getting the whole vial, you’re getting 100 units. Since, however, the vial can be diluted with various amount of liquid, just being told how many syringes, or how much solution you’re getting does not tell you the whole story. If you’re planning to get Botox® injections, you might as well know what you’ll really
be getting.

Lunch-time Surgery?
Recently, a prospective patient called my office and asked if she would have to take any time off from work in order to have her nose done. She had read somewhere that she could have her nose done during lunch, and then go right back to work. We were taken aback since, in general, you need to take at least a few days off (if only a little bit is being done on the tip of the nose) or, more likely, a week or so. This is because after most nose surgery
procedures (called “rhinoplasty”) you need to keep a splint (a metal, plastic, or plaster protective device) on your nose for about a week. A splint is required any time the bones are broken (or, as we prefer to say, “repositioned”) which is actually fairly often. If the nose is wide and is being narrowed to any significant degree, or if there is a hump that is being lowered, then it is likely that the bones will need to be repositioned, thereby necessitating a splint. During the week that the splint stays on, there may be enough bruising and swelling so that you won’t want to go to work, aside from the appearance of the splint itself. There can also be some discomfort, although significant pain is unusual.

For all of these reasons, the concept of lunchtime surgery is just not very realistic for the vast majority of people, and it is misleading. It makes for good copy in magazines and newspapers, but it is deceptive since, even if the procedure itself can be performed in the amount of time it takes to have
lunch, the total preoperative and immediate recovery period is usually at least a few hours, and that doesn’t even take into account the amount of time that is needed until one can reasonably return to work. It’s unpleasant for us to have to deliver such “bad” news to patients who are expecting to have what they’ve read confirmed, but it’s important to be honest with people throughout the entire process, and that starts with the first phone call.

Of course, if you feel and look well enough, you can go back to work whenever you want to. In some jobs and situations, it may be perfectly acceptable to be in the early recovery stages after plastic surgery. And it’s easier to camouflage some procedures than others. For example, body procedures such as liposuction are relatively easier to hide. In fact, after a liposuction, the body shrinks over a period of weeks to months (hidden under your regular clothes) suggesting a remarkable weight loss through, presumably, diet and exercise alone. Breast surgery is similar; you can camouflage some of the changes under your clothes (depending, of course, on the magnitude of the transformation!).

Clearly, that is not the case for the face, which is so visible. And so, unless you want what you’ve done to be immediately apparent, you’re better off anticipating a more reasonable amount of time for the procedure and the attendant recovery. If things are going great and you want to get back to work earlier than you’d planned, you usually can. What you don’t want to do is to expect to be back at work in a day or so, and to then have to cancel out portions of your schedule. It’s better to be adequately prepared from the start. For most people, a week is a more realistic time frame than a lunch-break. Sorry.

Alan M. Engler, MD, FACS - Board Certified Plastic Surgeon
122 East 64th Street New York, NY 10065 USA
(212) 308-7000 alan.engler@gmail.com

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