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Office Notes: Botox ®

June 30th, 2014


Botox ® is FDA approved for frown lines and now for crow’s feet. During injection clinics in our office, the comments I hear from new patients are, “My last Botox ® did not last as long as I would like. The Botox ® did not work as well as I had hoped.” Patients with these complaints have usually had their last injections elsewhere. Often times, the injectionist  is a non-physician and sometimes an individual with little or no medical training. Only physicians administer  Botox ® in our office.

Botox ® is packaged in 100 unit bottles. This “unit” measurement is determined through a physiologic assay. The Botox ®  package insert  recommends 20 units for the frown lines. When the full 20 units is used in this one area, the results are consistent and should last for the full 3 to 6 months. It has become common practice in salons or med-spas to inject less than 20 units of   Botox ® into the frown lines. Injecting less saves money. Reducing the dosage leads to decreased effectiveness   and decreased longevity, so patients must often return for “touch up” injections to get the result they desire.  My advice for the increased likelihood of a obtaining a professional and lasting result, is to consider having the full dosage recommended by the manufacturer (20 units for the frown lines)  and to consider having your Botox ® done by a physician.

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Breast Lift: Pencil Test

June 24th, 2014

The “pencil test” is a simple and an effective way to tell if breast lift surgery might be helpful to correct sagging breasts.  The pencil test helps to identify true sagging. You do the “pencil  test” by placing a pencil beneath your breast where it attaches to your chest and if your nipple hangs below the pencil when you sit or stand, then you might consider a breast lift.

True sagging of a woman’s nipples can occur following pregnancy or as a result of any dramatic weight gain/loss. There may be slight evidence of this condition even before weight gain. True sagging refers to nipple position below the crease beneath your breast. I do not recommend breast lift surgery if nipples are above the crease or at the level of the crease. Breast enlargement is usually sufficient to correct the saggy breast shape in most cases. Breast lift surgery repositions the nipple and areola (pigmented skin around the nipple) upwards toward your shoulders. The natural position is about one half to three-quarters of an inch above the crease. Positioning them any higher than this can result in an odd breast appearance. The size of the areola can also be reduced if desired.

Breast enlargement or breast reduction may be considered at the same time as breast lift surgery. Changing the breast size may be accomplished at the same time and through the same incisions made for the breast lift and is often part of the Mommy Makeover. As with all breast surgery, size is a personal choice. Many woman are able to breast feed following breast lift surgery. Patients report a high degree of satisfaction after having a breast lift.

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