Safety Before Beauty

What you need to know before you opt for injectable wrinkle-reducers like Botox and Restylane.
If you're considering getting Botox or one of the other newer injectable wrinkle-busters like Restylane, you should be armed with some crucial information before you go under the needle.
First, decide which of the treatments is best for you. Botox is a neurotoxin and it works by temporarily paralyzing wrinkle-making muscles. It's usually used in the forehead to get rid of the vertical "11" lines between your eyes or the horizontal creases higher up on your face. It lasts three to four months and costs about $500 a session, depending on how many injections are needed. It's sometimes sold by the "unit," which makes it sound cheaper but, usually isn't, as it takes several units to do even the smallest area. Botox was introduced as a cosmetic in 2002, but has been used for eye disorders and migraines since the 1980s. It can also be employed to stop excessive sweating. (Some celebs get shots in the armpits before big events so they don't spoil their designer dresses.) Next year, the makers of Restylane will likely be getting FDA approval for a Botox-like neurotoxin called Reloxin which works in the same way. Some people feel a little pain at the sight of the injection, but you can get numbing agents. Botox usually takes a few days for the effects to be seen.
Restylane is the leading hyaluronic-acid dermal filler. It was introduced in the U.S. in 2004 and works by plumping up the deeper creases in the lower face-like those folds between your nose and the corners of your mouth. It's somewhat moldable and can be used to smooth out other uneven areas of the face. A competitor to Restylane is the newly introduced Juvéderm, made by
the same folks who make Botox. It has a slightly different consistency but works in a similar way. The fillers usually last five to six months and cost $500 to $600, depending on how much you need done. There can be some significant pain as the filler is injected, but you can ask for numbing agents. There may also be some temporary bruising at the site.
Next, decide who does the procedure and where. Badly done injections can result in an unnatural expressionless look, or, worse yet, droopy eyes or facial paralysis in the case of Botox, and lumps or infection with the dermal fillers. We asked Dr. Deborah Sherman of Nashville, who has been administering Botox for nearly 20 years, to give us some tips. Her advice:

• Remember these are medical procedures that should be taken seriously and done in a medical setting. It's not something to do on the spur of the moment at a party or a massage spa.
• Find a highly trained medical professional whose focus is on aesthetic procedures to administer the shots. When interviewing a doctor, ask how long they've been administering the product and how many days a week they do injections. It should be something they do every day or at least three days a week. Botox has been around since 2002, so you want someone with several years' experience. Restylane was only introduced in 2004, but your doctor should have been using it for more than a year. To find good doctors, you can get recommendations from friends whose results you like, or Google the product. The manufacturers often have lists of qualified physicians on their Web sites.
• Get a consultation with the doctor before the first treatment. Tell them your goals and ask about the limitations of the products and possible complications. It's important to set reasonable expectations.
• In some cases, the person actually administering the shots is not the doctor whose name is on the door. Should that happen, be sure to ask for a consultation with the doctor beforehand. And make sure that the person who will be doing the injections is properly licensed to do the procedure. Ask the same questions about their experience as you would the doctor.
• Don't fall for those $99 Botox ads. Botox costs the same for all physicians, so if you're being offered it on the cheap, be suspicious. You may be getting an over-diluted product or something that isn't Botox at all.
• Take your own before-and-after pictures.

[Newsweek]