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How do Muscles Cause Wrinkles and Frown Lines?

There is a one vertical Procerus muscle and two Corrugator muscles that cause wrinkles and frowning in the area between the eyebrows.

The frotanus muscle runs upwards from the bridge of the nose and inserts into the skin.

Muscle fibres run upwards along the muscle and, when they contract, this produces shortening of the muscle and a cross line transverse (horizontal line at the upper bridge of the nose).

The Corrugate muscles run upwards and sideways from the bone in the frown area to the skin above the inner aspect of the eyebrow.

When these muscles contract they pull the eyebrows inwards, downwards and cause either vertical or slightly slanted lines on either side of the frown areas.

The muscles run in different directions and therefore the contractions cause lines in different orientation. It is important to know which muscle is responsible for which line when treating the frown area with Botox in order to correctly target the right muscle. In future blog posts we’ll talk about variation in muscles between other people and tell-tale signs if someone has had Botox Therapy.

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Can Botox cause Brain Damage? As Allergan faces continued law suits, should Aesthetic Practitioners be worried?

It is perhaps unsurprising in America’s compensation culture.  A controversial product like Botox is a bit of a sitting duck for legal allegations and, in April this year, manufacturers Allergan found themselves at the centre of exactly such a court battle.

After claiming that Botox injections left him with Brain Damage, 67-year-old Douglas Ray Jnr was awarded a whopping $212 million in compensation from Allergan. His is one of 3 court cases brought against Allergan, linking Botox to Brain Damage (the other 2 will be heard later this year). An inevitable media-frenzy followed.

This is despite the fact that no firm evidence was produced definitively proving Botox to be the cause of Mr Ray Jnr’s symptoms. Allergan also protest the allegations that they provide inadequate information about the potential risks associated with the drug. The company are now challenging the charges.

So CAN Botox cause Brain Damage?

Of course, regardless of our skepticism about the “trigger-happy claims” tendencies in the U.S., allegations such as these are bound to have patients – and practitioners – concerned.

At around the time of this court case, The Journal of Neuroscience (April 2nd issue) featured an Italian study conducted on adult rats. Type A Botulinum Toxin injected into one side of the rats’ brains was demonstrated to appear on the other side as minute protein particles. The ‘Botox causes Brain Damage’ media frenzy began, neatly tying in with the Allergan court battle.

Yet, as Fabulously40 bloggers Lois Stern and Patty Kovacs point out, the rats received purified botulinum toxin. The Botox typically injected into patients is not the same. And although migration of protein particles might be worrying, it cannot be taken as definitive proof of brain damage. In fact, senior Harvard surgeon Gary Borodic emphasises: “There is nothing in this paper that says these injections will damage neurons or that there are long-term side-effects.”

Be Careful of Misinterpreting the Facts

 The fact that the Journal of Neuroscience article could create such media hype, despite being based on very little solid theory, has to make Practitioners also question the basis of the court case against Allergan.

For starters: what actually constitutes “Brain Damage”? Very few articles about this case actually describe Mr Ray Jnr’s symptoms in tangible detail (though this does not necessarily mean they are not physically as well as mentally present). And of the 2 other upcoming cases against Allergan, at least one of them (according to sideeffects.net) ‘linked the [Botox] injection to a person’s limited ability to perceive the emotions of others’. This seems a rather woolly definition of Brain Damage. It also reminiscent of the symptoms of Autism, bringing with it the connotations of another recent media hype surrounding an injectable drug treatment: the children’s MMR injections.  As earlier stated: any controversial drugs or treatment programme becomes a scapegoat for criticism and compensation claims. But it is very hard to prove a definitive link when you are talking in terms of emotional capacity damage.

Secondly, it must be pointed out that Mr Ray Jnr did NOT receive Botox treatment for lines or wrinkles. By not clarifying this, the media has generally allowed the public to  think that he was…and therefore created the mass panic of hundreds of Botox affeciendos! He was in fact having treatment for hand tremor and writer’s cramp.  One of the charges brought against Allergan by the Justice Department are for promting Botox for “off label” use such as these,plus migraine headaches, juvenile cerebal palsy etc. All of these uses for Botox require different concentrations and methods of treatment which may involve a greater element of risk and have been tested for less time, on a lesser number of patients than Botox treatment for wrinkles.

In the Journal of Neuroscience featured study, the rats were injected directly into their brains…hardly a realistic testing condition for patients receiving treatment in standard cosmetic procedures. However, perhaps “off label” uses of Botox should be approached with greater caution until further investigations are carried out.

Finally, Douglas Ray Jnr’s ‘significant and catastrophic injury to the brain’ came about not through the Botox treatment itself but as a result of ‘severe accute immune reaction’ (BNET). This is where the charge against Allergan for failing to provide adequate information about the possible side-effects and risks of Botox comes into place. It is the duty of all good Aesthetic Practitioners to sufficiently warn their patients that, as with all drugs, Botox is not without risks. However (and especially in the case of the dosages used for anti-wrinkle treatment) these risks are well tested and marginal. A case like Mr Ray Jnr’s would be the absolute exception, not the norm.

And this is why, although it is of course important to express concern and to do your research when cases like the Allergan Botox Brain Damage trials come to light, we do not feel that Cosmetic Practitioners need to be putting Botox on the backburner just yet.

Article by Cosmetic Courses, leading UK providers of Aesthetic Injectables training (Botulinum Toxin and Dermal Fillers) to medical professionals. Call 0845 230 4110 for more details, or visit our website.

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Can you learn to perform a “Botox Facelift”?

The procedure hailed the “Botox Facelift” is actually a more modern technique using Botox treatment to improve the jaw line and give it a better definition.

Botox works by weakening muscles and it is possible to selectively weaken muscles which pull down the jawline producing an elevation and tightening of the jaw line.

Typically small injections are given just below the jaw line into the muscles which pull down the skin of the jaw. A real improvement in the jawline using this technique has been developed in the last few years, known as the Nefertiti Lift (after the Egyptian Queen with the famously slender and beautiful jawline).

This form of treatment is extremely effective in treating the jawline areas and a very popular treatment amongst patients. You can learn Advanced Botulinum Toxin techniques like these (and more!) on Cosmetic Courses’ Advanced Level training, or on a bespoke 1-1 course focusing on areas like this. Call us on 0845 230 4110 for more information, or book your Advanced Course securely online today.

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Botox for Asthma: The latest Botox buzz

First Migraines, now Asthma…what else can Botox Treat?

We are not skeptics about the wonders of Botox, or Botulinum Toxin Type A.  We are, of course, already familiar with its potential for smoothing fine lines and wrinkles, treating excess sweating (hyperhidrosis) and even of its medicinal uses for an array of good: from Essential Tremor to Multiple Sclerosis and Cerebal Palsy (almost any condition involving involuntary muscle movement!).  More recently, those in the Medical Aesthetics industry have heard of the potential to treat their patients with Botox injections for Migraine. And now, the most recent development launched in Australia on Tuesday, comes testing of Botox as an Asthma alleviant.

Monash University tests Botox for Vocal Exhaustion
The research, conducted at Melbourne’s Monash University, involves particularly severe asthma cases….and Botox injections directly to the voicebox!

The focus is ‘vocal exhaustion’: as the Telegraph has reported, ‘half of people with asthma also have voicebox spasms that can make it difficult to exercise or perform other normal activities’.  The theory is that using Botulinum Toxin Type A to work its paralysing magic on the voicebox will stop the spasms, allowing severe asthma sufferers to resume normal standards of breathing and activity.

Is Botox to the Throat really Safe
Botox is already used for other vocal chord disorders (like spasmodic dysphonia) so there is definitely logic behind this line of thinking and it could well work…if patients can be persuaded to have shots of paralytic toxin directly to their throats! The trials (lasting a year and initially conducted on 60 patients – 30 real, 30 placebo) are only based in Australia for now and the USA and UK are likely to take a little more persuading before theydecide to go ahead with similar research.  For now, these countries are probably happy to sit back and watch with interest as director of respiratory medicine, Phil Bardin, and his team conduct the pioneering study: particularly as they are currently only “reasonably reassured that it’s safe”. Temporary quietness of the voice, however, is the only side-effect that they claim to be expecting.

One thing is for sure: continued research like this does show the credibility of Botulinum Toxin as a career path for Medical Professionals….this is not just a “Beauty” sector and there is a great deal of good, potential for pioneering work and health treatments which can be performed once you choose to train in Botox techniques.

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Entering the Medical Aesthetic Industry: Be Realistic, not Pessimistic!

Be Realistic…but Stay Positive: You Can Do It!

There has been a trend recently to draw awareness to the fact that entering the Aesthetic Industry is not always plain sailing.

Quite rightly, skeptics have stressed the perils of skipping blindly away from your day job (which may have its downsides but nonetheless pays the bills, right?) after promises of reduced working hours, more input and creative freedom…not to mention money, money, money.

So, What Does it Take?

Let’s be sensible here: Everything in life, particularly with an economy like ours in the UK today, is what you make of it. As Elton John penned in “The Circle of Life”: Some will fall by the wayside, others will shoot to the stars. But a great deal in this industry comes down to:

a)having the required skillset to begin with. This is why the best training providers will, like Cosmetic Courses, only take on medical professionals. We talk about Insurance but this is a very real issue: if you can’t get insured after your training, you won’t get work, therefore it simply would not be fair for us to train you under false pretences. Also, we have found that professionals from roles like Nurses, Doctors and Dentists already have a high number of the skills required to make it in this sector. For more information on this, take a look at our brand new Transferable Skills pages for Doctors, Nurses and Dentists.

b)Ability to network. This is partially being in the right place at the right time, but largely putting yourself out there and making contacts, getting to know others within the industry who can recommend products and techniques, introduce clients…and possibly even provide jobs or partnerships! Self-promotion is absolutely vital so you do need a strong backbone and a creative streak (which of course you have already to be considering Aesthetics!). With online resources like Linked-In, Gumtree, Facebook and regular conferences to attend…the medical aesthetic world really is your oyster.

Market Yourself

To illustrate this point further, here is a real recent enquiry from a Delegate. This both shows the need to be realistic about the industry you are considering going into, and the things that can be done to ensure you give yourself the best chance possible:

Question:
Dear Cosmetic Courses,

I took a medical aesthetic training course in April 2010, and have yet to get my first client! I work full time, as a Practice Nurse, and realise I  may not have promoted myself enough. I have advertised myself in a local dentists, and beauty salon.

Answer from Libby Stewart, Cosmetic Courses Aesthetic RGN:

It can be difficult to get going with your practice.
You could consider holding an open evening at a salon or practice to inform potential patients of what treatments you can offer and how the treatments may work for them. People seem to need more than an advertisement to encourage them. Patients who are regulars to procedures are usually happy to stay with their existing practitioner unless something interests them to leave eg. your prices or they just like you better. Patients who are new to treatment and just considering it need a lot of encouragement and benefit from a good consultation so that you can establish a relationship with them.
Yes, the insurance has to be paid once you commence treatments but most of the companies allow for monthly payments that you can cancel at any time should you find this is not the right field for you. Remember that what initially looks like quite a mark up on product cost can seem less of a profit when you take purchase of product and consumables, paying yourself an houly rate, any rent or commission that you pay to a third party and insurance and training costs incurred by you into consideration. So the price you charge for your treatments should reflect all of these to make sure you still make a profit!

Cosmetic Courses are always on hand and happy to offer advice if you are Entering the Aesthetic Industry or about your Business and Marketing Strategy. 24 hour Advice is available through our Telephone Line, 01844 390110…simply leave your question and we will get in touch very quickly!

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Correcting Difficulties Smiling After Azzalure

Question :

Dear Cosmetic Courses,

I attended your basic and advanced courses in 2005.

I recently treated a 37 year old lady using Azzalure 3 x 0.1ml (15iu in 0.1ml) bilaterally to her orbicularis occuli. I performed my usual technique, injecting into the sites I usually inject into, and making sure I did not inject too low down on orbicularis occuli.

She came for review 2 weeks later, complaining of a heaviness over her cheeks making smiling difficult, more so on the right side.

Could you advise on any intervention that may alleviate this?

I have heard of practitioners advising stimulating the muscle using an electric tooth brush?

Answer :

It does sound like some of the Azzalure may be affecting your patient’s Zygomaticus Major or Minor.

This would cause the symptoms which you describe and is usually caused by the lowest of your crows feet injections.

We have seen this once before and it was caused by Dysport- there is some evidence that Dysport and Azzalure may disperse more than Botox making side effects like these more likely.

Unfortunately, there may not be much you can now do to alleviate it other than being supportive.

The electrical toothbrush trick may work and is certainly worthwhile trying, to both muscles 3 times a day for 5 minutes.

Good luck with this case and let us know how it goes.

The Cosmetic Courses Team

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Anti-Ageing for Men: What Doses?

In this blog we answer one of your most frequently asked questions, anti-ageing for men.anti ageing for men cosmetic courses

Question :

Dear Cosmetic Courses,

Please can you let me know the recommended doses for administering Botox to men? 

Answer :

Thank you for your email. We generally recommend you add 40% more Botox at each injecting site for men.

This will depend on how heavy you feel their muscles are. If you feel they have more than average muscle bulk, adjust this to 50% and if they are finer featured add 30%.

Unlimited support

Alongside our aesthetic training we also offer unlimited support to our delegates. Our team are always on hand to answer any questions or concerns you may have in regards to aesthetic medicine and your aesthetic business.

Anti-Ageing for men courses

We offer a wide variety of aesthetic medicine courses which cover anti-ageing for men. All of these courses contain theoretical sessions with our expert faculty and treatment practice on live models provided by us. We use a wide mix of models on our courses so you can understand how to treat each patient individually. You can view all of our practical courses here in aesthetic medicine. We also offer an online learning academy which demonstrates popular treatments, you can find out more here. 

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Bruising with Botox: Fake Botox products like Fabtox

Question :

Last week my mum had what she was told was Botox.

She has since found out it was a product called “Fabtox” (which I have never heard of): a bespoke product made up of Vistabel.

Within minutes her eye was swollen up and had started to go purple, now her cheek is swollen down to her chin. She has been to A&E and her GP who can’t do anything.

She had it done down at a dental/cosmetic studio in Shoreham near Brighton.

Have you ever seen anything like it?

Thanks so much

 

Answer :

It sounds as if the injection has hit one of the blood vessels which surrounds your mother’s eye.

The blood then moves inside the orbit and produces the bruise you see.

This bruising will settle over the next couple of weeks but it might be worthwhile asking her to massage Arnica cream into the bruised area daily.

Let us know how she gets on.

It is really very important that you research carefully into where you are going for your Botox treatments and the products which they use.

We hope that your mother gets better soon!

If she would prefer to enrol as a model with us in future, we can promise that we do not use any “Fabtox” products here and all our delegates are medical professionals, closely supervised by expert Aesthetic Practitioners. She can enrol by calling our team on 0845 230 4110 or find comfort in our other models’ testimonials at http://www.facebook.com/CCModels.

The Cosmetic Courses Team

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Practicing Botox & Dermal Fillers: Am I required to register with the Care Quality Commission?

Question :

Hi Cosmetic Courses,
I’m not sure whether you can help with this?

I have been asked by someone I will be working for, giving Botox /dermal filler injections, whether I am
registered with the Healthcare Commission.

Apparently this is a Commission for places rather than people / things and I was wondering whether I had to register here or if there was a Loop-hole around it?

Many thanks for your advice.

Answer :

You are right that the Healthcare Commission monitor premises rather than individuals.

If your future employers are a Medical Practice then they should be registered with them.

As you may know, Mr Adrian Richards of Cosmetic Courses does regular podcasts on topics such as this with Ron Myers from the Consulting rooms.

Ron is extremely knowledgeable about topics such as this so we will ask Ron for his opinion on your query.

Ron what are your views on this?

Ron Myers:  “Care Quality Commission registration should only apply (currently) if you are offering cosmetic surgery procedures (you should be fine if you only offer laser/IPl & injectables).”

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What units of Azzalure are Equivalent to Botox (in areas other than the Glabellar?)

Question :

Dear Cosmetic Courses,

I have just seen your video on youtube about reconstituting Azzalure and it was very helpful.

I understand the units are not the same as Botox.

Could you point me in the right direction to find what is equivalent?

I have looked at all the Azzalure literature and it looks to me that they are only promoting it for the glabellar area and therefore have only given units for that area.

I am assuming that it is fine for other areas too and wondered if you could give me any guidelines on dosage/units for other areas.

Can you also tell me where you are based.

My initial training was with another leading company. I do a lot of post graduate dental courses and feel I would have preferred a training course that was a bit more professionally presented rather than just a money making machine.

 

 

Answer :

Thanks for your question.

Azzalure,  like Vistabel,  is only licensed for use in the glabellar area.

It is, however, given in other areas – the forehead and crows feet –  like Botox and Vistabel.

I tend to make up a syringe of Azzalure with 1ml of bacteriostatic saline and use like Botox.

Azzalure comes in 125 unit vials which is roughy equivalent to 50 units of Botox or Vistabel.

I hope this helps.

Please feel free to contact us again on 0845 230 4110 if we can be of any further help. We are based at the National Cosmetic Training Centre in Princes Risborough, Buckinghamshire.

 

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