• What is BOTOX® Cosmetic?
• Will Botox® Cosmetic Work for You?
• Why do we get wrinkles?
• What to expect when you come to our clinic?
• The injection process
• How often is treatment needed?
• Will I be able to make facial expressions?
• Side effects of Botox® Cosmetic?
• What are alternative procedures and products?
• Frequently Asked Questions?

BOTOX® Cosmetic is a simple, nonsurgical, physician-administered treatment that can temporarily smooth moderate to severe frown lines between the brows in people from 18 to 65 years of age. It is the only treatment of its type approved by the Food and Drug Administration (FDA). One 10-minute treatment—a few tiny injections—and within days there's a noticeable improvement in moderate to severe frown lines between the brows, which can last up to 4 months. Results may vary. BOTOX® Cosmetic is a purified protein produced by the Clostridium botulinum bacterium, which reduces the activity of the muscles that cause those frown lines between the brows to form over time. In 2005, almost 3.3 million procedures were performed with FDA-approved BOTOX® Cosmetic.

Call The Vein Institute of Toronto & Medical Aesthetic Clinic to see if BOTOX® Cosmetic is right for you!

When it comes to selecting a physician-administered aesthetic treatment, chances are you’ll want proof, not just claims. The proof for BOTOX® Cosmetic is in the numbers.

• In clinical trials, nearly 90% of men and women surveyed rated the improvement in the appearance of frown lines between their brows as moderate to better 1 month after treatment. Results vary.
• Results can last for up to 4 months, and may vary.
• BOTOX® Cosmetic was approved by the Food and Drug Administration (FDA) in 2002 for the temporary treatment of moderate to severe frown lines between the brows in people ages 18 to 65, and almost 3.3 million procedures were performed in 2005 alone.

Is it just aging? Too much sun? Too much stress? In general, how skin ages and wrinkles is a complex process. It isn't just about cellular changes, collagen depletion, hormone loss, damage caused by free radicals, and so on; it's a combination of many factors.

The Anatomy of the Wrinkle

The lines that appear between your brows (glabellar lines) actually result from muscle movement and the passage of time. You may have heard the expression "wearing your emotions on your sleeve," but in reality you wear them on your face. If you're angry or annoyed, for example, you knit your brows together. Underneath your skin, your facial muscles contract, cause a pleating of the overlying skin, and then, as anyone can see, you're frowning.

After years of crinkling and wrinkling, those glabellar lines start to linger longer and can become more pronounced. For women, whose faces tend to be more animated than men's, and whose skin is typically more delicate, these lines may appear exaggerated and more permanent.

Fortunately, there is a way to temporarily reduce moderate to severe glabellar lines. Treatment with BOTOX® Cosmetic can visibly smooth and soften moderate to severe frown lines between your brows. An improvement can be seen within days and may last up to 4 months, although results may vary. In clinical trials, nearly 90% of men and women surveyed rated the improvement in the appearance of frown lines between their brows as moderate to better 1 month after treatment

The day of your appointment. Allow time before your appointment for filling out forms and for consulting with Dr. Kundu. If it's your initial visit, you may first meet with Dr. Kundu personally or a staff member. Many doctors have on-staff licensed aestheticians or nurses who are trained in skin care and skin care procedures who can answer many of your questions.

You may also be asked about your expectations for treatment and if you have any allergies or any condition that wouldn't make you a good candidate for BOTOX® Cosmetic.

Before the procedure. You'll probably be seated in a reclining chair, much like you find in a dentist's office. No anesthesia is required, although your doctor may choose to numb the area with a cold pack or anesthetic cream.

The procedure. Your doctor will determine where to administer the injections by examining your ability to move certain muscles in your brow area. The entire BOTOX® Cosmetic injection procedure takes approximately 10 minutes.

After the procedure. There's no recovery time needed. You're ready to get on with your day! The most common side effects following injection include temporary eyelid droop and nausea. Localized pain, infection, inflammation, tenderness, swelling, redness, and/or bleeding/bruising may be associated with the injection. Patients with certain neuromuscular disorders such as ALS, myasthenia gravis, or Lambert-Eaton syndrome may be at increased risk of serious side effects.

Seeing results. Within days, you may notice an improvement in the moderate to severe frown lines between your brows that can last up to 4 months. Results may vary.

The beauty of a BOTOX® Cosmetic treatment is that it's a simple, 10-minute, non-surgical process. A few tiny injections, and within days there can be a noticeable improvement in the moderate to severe frown lines between the brows that can last up to 4 months. Results may vary. And there’s no recovery time. You can even do it on your lunch break.

• Your doctor will administer several tiny injections of BOTOX® Cosmetic directly into the muscles that cause those moderate to severe frown lines between the brows.
• Your doctor will determine where to administer the injections by examining your ability to move certain muscles in your brow area. The location, size, and use of the muscles that create a furrowed brow vary markedly among individuals.
• No anesthesia is required, although your doctor may choose to numb the area with a cold pack or anesthetic cream prior to injecting. Discomfort is usually minimal and brief.

You can expect to be in and out of the physician’s office without downtime. You may see a marked improvement in the moderate to severe frown lines between your brows within days. Improvement may continue for as long as a month, and could last up to 4 months.

If you're pleased with the results of a BOTOX® Cosmetic treatment, you'll probably want to get on a treatment schedule so you can keep on being pleased.

BOTOX® Cosmetic is a non-surgical, physician-administered aesthetic treatment that can temporarily reduce the moderate to severe frown lines between your brows for up to 4 months. Within days, you may see a noticeable improvement. Results may vary. You can receive injections with BOTOX® Cosmetic up to every 4 months to help you maintain the results. If you discontinue treatment, the frown lines between your brows gradually will look like they did before treatment.

After treatment with BOTOX® Cosmetic, you may look in the mirror and see a marked improvement in the moderate to severe frown lines between your brows.

But BOTOX® Cosmetic will not radically change your facial appearance. You can still frown or look surprised—without the wrinkles and creases between your brows. BOTOX® Cosmetic works by temporarily reducing the contractions of the muscles that cause those persistent frown lines that have developed between your brows over time.

Within days, you may see an improvement that can last up to 4 months. Results may vary. If you do not continue treatments, the frown lines between your brows will gradually look like they did before treatment.

Do not use BOTOX® Cosmetic if you:

• have an infection where BOTOX® Cosmetic will be injected
• are allergic to any of the ingredients in BOTOX® Cosmetic
• are pregnant or think you might be pregnant.

What should I tell my doctor before using BOTOX® Cosmetic?
Only your doctor can decide if BOTOX® Cosmetic is right for you. Before starting treatment, tell your doctor if you:

• have any diseases that affect your nerves and muscles. These diseases may increase your chance of side effects with BOTOX® Cosmetic treatment.
• are breastfeeding
• are planning to become pregnant soon.

Can any of my medicines interact with BOTOX® Cosmetic?
Be sure that your doctor knows the names of all the medicines you are using, including:

• antibiotics used to treat infections, such as gentamicin, tobramycin, clindamycin, and lincomycin
• medicines used to treat heart rhythm problems, such as quinidine
• medicines used to treat different conditions, such as yasthenia gravis or Alzheimer’s disease.

As with all prescription medicines, you should also notify your doctor if you are taking any over-the-counter medicines or herbal products.

BOTOX® Cosmetic is the only treatment of its type approved by the Food and Drug Administration (FDA) for the temporary improvement of moderate to severe frown lines between the brows. What's more, unlike many procedures and over-the-counter wrinkle remedies, BOTOX® Cosmetic treats the cause of these frown lines by reducing the muscle contractions that cause the lines to form over time.

Other procedures and products		What they are
Alpha-hydroxy acids		Alpha-hydroxy acids (AHAs) are derived from fruit and dairy products and act as exfoliators and moisturizers. Many dermatologists recommend AHAs to soften rough skin and erase fine lines. The strength of AHAs depends on their acid concentration.
Chemical peeling		Also called chemabrasion and dermapeeling, this facial skin rejuvenation procedure does what its name implies—it peels the skin. Chemical peels may contain alpha-hydroxy acids or other acids. Peels are typically used to treat wrinkles and pigment changes caused by sun exposure.
Collagen injections		Collagen is a fibrous protein substance that is part of all human and animal tissue. Collagen injections typically involve bovine (cow-derived) or human collagen. Collagen injections are used to minimize lines and scars, filling wrinkles between the eyebrows, wrinkles from mouth to nose, and forehead wrinkles. Collagen is typically a dermal filler that offers a partial, short-term approach to fill in and smooth mild lines or folds.
Dermabrasion		With dermabrasion, the surface layer of the skin is removed by high-speed sanding. This technique is used for a wide range of purposes, from removal or reduction of acne and scars to facial skin rejuvenation. Microdermabrasion is a technique that removes less surface skin and is used most often for superficial skin defects.
Laser resurfacing		Laser resurfacing with a pulsed CO2 laser works best on fine, shallow wrinkles caused by aging or sun damage. Lasers emit a very brief pulse of high-intensity light that's fast enough to limit heat damage in the skin, yet strong enough to vaporize tissue cleanly.
Fat implants		Fat implants are used as sub-dermal fillers. With this procedure, fat is essentially taken from one area (usually the belly, buttocks, or thighs) and put elsewhere—in an area where you want it. The fat is cleaned of blood and other fluids and deposited in laugh lines, frown lines, sunken chins, and hollow cheeks.

• What exactly is BOTOX® Cosmetic?
• How does BOTOX® Cosmetic work?
• When will I see results from a BOTOX® Cosmetic treatment?
• How long does BOTOX® Cosmetic last?
• Is treatment with BOTOX® Cosmetic painful?
• Who should not use BOTOX® Cosmetic?
• Will I experience any side effects?
• Will my facial expressions continue to look natural?
• What will happen to the frown lines between my brows if I choose not to continue treatments?
• Is BOTOX® Cosmetic affordable?

BOTOX® Cosmetic is a purified protein produced by the Clostridium botulinum bacterium. It is a nonsurgical, physician-administered treatment that can temporarily reduce moderate to severe frown lines between the brows in people 18 to 65 years of age. During treatment, very low doses of BOTOX® Cosmetic are administered via a few tiny injections directly into the muscles that cause those stubborn lines. The treatment is usually done in about 10 minutes, and no recovery time is needed. Within days, you may see an improvement that can last up to 4 months. Results may vary.

Those moderate to severe frown lines between your brows form over time as the result of muscle activity. BOTOX® Cosmetic is injected directly into the muscles between your brows. It works by blocking the transmission of nerve impulses to the injected muscles; this reduces the activity of the muscles that cause those persistent lines to form.

Within days, you may see a marked improvement in the moderate to severe frown lines between your brows. Lines continue to improve for up to a month, and results can last for up to 4 months. In clinical trials, nearly 90% of men and women rated the improvement in their appearance as moderate to better 1 month after treatment. Results may vary.

Results from treatment with BOTOX® Cosmetic can last for up to 4 months. If you discontinue treatment, the frown lines between your brows gradually will look like they did before treatment.

Discomfort is usually minimal and brief. Prior to injecting, your physician may choose to numb the area with a cold pack or anesthetic cream. The entire procedure takes approximately 10 minutes. Many people are in and out of the physician’s office without downtime following BOTOX® Cosmetic treatment.

BOTOX® Cosmetic should not be used in the presence of infection at the proposed injection site(s) and in individuals with known hypersensitivity to any ingredient in the formulation. Patients with neuromuscular disorders such as ALS, myasthenia gravis or Lambert-Eaton syndrome may be at increased risk of serious side effects.

The most common side effects following injection include temporary eyelid droop and nausea. Localized pain, infection, inflammation, tenderness, swelling, redness, and/or bleeding/bruising may be associated with the injection. Patients with certain neuromuscular disorders such as ALS, myasthenia gravis, or Lambert-Eaton syndrome may be at increased risk of serious side effects.

Although the results are visible, a treatment with BOTOX® Cosmetic will not radically change your facial appearance or make you look as if you "had work done." The muscle activity that causes frown lines between the brows is simply reduced, so you can still frown or look surprised without the wrinkles and creases between your brows.

If you do not continue treatments, the moderate to severe frown lines between your brows will gradually look like they did before treatment.

When considering your facial aesthetic options, BOTOX® Cosmetic is quite affordable. Like other appearance-related investments, such as hair coloring and cuts, teeth whitening, and chemical peels, the cost must be weighed relative to your expectations. Consult your doctor for further information.

At the Vein Institute of Toronto we offer Restylane® fillers. The treatments are performed by our Medical Director Dr. Sanjoy Kundu, a world expert in venous and medical aesthetic procedures. We will offer you a consultation prior to your treatment to discuss your requirements and expectations, your medical history, details of the treatment and the injectable substance, clinical studies, possible side-effects and forms of anaesthesia. The consultation should tell you whether your expectations of the treatment are realistic, how long the effect will last, how much the treatment is going to cost and so on. Ask to see before and after photographs and ask the physician how Restylane® will benefit you.

LOOK THE WAY YOU WANT

Always perfectly personalized, Restylane® gives you the ability to tailor your own image. The Restylane suite of products is designed with different gel particle sizes that are utilized for different effects and purposes—from eliminating tiny lines to enhancing facial contours. Using the Restylane Tissue-Tailored Concept™, Dr. Kundu will choose the right product combination to create the look you want.

• Antiaging
• Lip augmentation and lip enhancement, and tear-trough fill
• Wrinkle reduction and removal
• Smile and forehead lines and wrinkles
• Acne scar treatment and removal
• Safety Information
• Frequently Asked Questions

As we age, soft tissue in the face degenerates, resulting in a thinning of the skin and a loss of firmness, plumpness or volume, and elasticity. This leads to sagging, sinking and a general flattening of facial features. Treatment with Restylane® can help to at least partially restore the appearance of all of the areas of the face affected by this aging and loss of volume, creating an anti-aging effect.

Surgery can help tighten the skin and botulinum toxin injections can relax facial muscles to release dynamic wrinkles, but neither can replace lost volume. The Restylane® suite of products is the most effective solution for restoring volume-reducing the signs of aging and helping you look fresher and more youthful. When Restylane's crystal-clear gel is injected into the skin, the result is increased volume-softening wrinkles and folds on the face. Increased volume can create facial fullness and symmetry, enhance certain facial features, and lessen the signs of aging.

Restylane® products contain different gel-particle sizes that are utilized for different effects and purposes-from eliminating tiny lines to enhancing facial contours. Utilizing Restylane's Tissue-Tailored Concept™, your aesthetic physician will choose the right product combination to create the look you desire.

Restylane® is an ideal substance for restoring and enhancing portions of the lips, and filling in the areas of the face known as tear troughs.

Tear troughs are deep grooves that can appear between the lower eyelid and the cheek.
Treatment with Restylane® can be successful with even the most pronounced tear troughs. The procedure of filling the tear troughs takes approximately 10 - 15 minutes, and can make you look much more rested and youthful for approximately 6 months.

Many of us also would like to have a fuller and more sensuous mouth. The use of Restylane® produces a more pronounced mouth or a soft, pouting look without surgical intervention. Restylane® is injected into the inside of the upper and/or lower lip to produce the augmentation. This is often combined with injection of Restylane® along the edge of the lips, producing a more youthful and appealing look.

The use of very small volumes of Restylane® creates a more defined and pronounced mouth and fuller lips without altering or distending the lips and mouth. The injections also are done with a very small-tipped needle after the area is anesthetized, so you don't feel any pain. The physician also is very careful to make sure both sides of your mouth are symmetrical after the procedure, and to massage in the Restylane® so it is evenly distributed and the appearance is not bumpy or unnatural looking.

Our skin contains less hyaluronic acid and hence is less full as we age. This makes the skin become looser, resulting, in turn, in wrinkling and an older appearance of the skin. Other things can cause wrinkles as well: smoking, sun bathing and pollution can damage the skin at any age.

Restylane® can smooth out the folds and wrinkles in your skin, making a very big difference in your appearance. The injected gel produces natural volume under the wrinkle, which is lifted up and smoothed out. The results can be seen immediately. Treating wrinkles with Restylane® is fast and safe, and leaves no scars or other traces on your face. The effects last for approximately 6 months.

Smoothing out folds and lines by adding volume can make an enormous difference to your appearance. With Restylane®, facial rejuvenation can be carried out without the use of foreign substances or surgical intervention.

When treating lines or folds, Restylane® is injected into the skin in tiny amounts with a very fine needle. The injected gel produces natural volume under the lines and folds, which are lifted up and smoothed out. The results can be seen immediately. Treatment with Restylane® is fast and safe and leaves no scars or other traces on the face.

Specifically, Restylane® can be used to decrease both the horizontal lines across your forehead and the vertical lines between your eyebrows that are a normal part of the process of aging and loss of skin volume. A 15-minute treatment with small amounts of Restylane® can produce a facelift-like effect, making smile lines and forehead lines less visible and pushing back the hands of time.

Restylane® treatment is long-lasting but not permanent. This means that you always have the option to assess your looks. The length of time a treatment maintains its effect is very individual and depends on many factors, such as your age, skin type, life-style and muscle activity, as well as the injection technique. Experience shows that Restylane® can be effective for up to one year or more after the treatment of lines and folds. Together with your practitioner, you can draw up a plan for regular future visits to maintain the result. Most patients choose to have a follow-up treatment approximately six to 12 months after the initial treatment of wrinkles, lines and folds.

Acne scars unfortunately can stay on your skin for years after you've passed adolescence. They also tend to become more accentuated with age, as skin loses its volume. More than one million Canadians suffer from acne scarring. The most common types of acne scars are pockmarks and ice-pick scars. Restylane® is best suited for filling and hence removing either shallow or deep pockmarks left over from adolescent acne. It s injected into the area of the scar, filling and smoothing the surface of the depression. After Restylane® treatment your skin will be smooth and the scars will be barely visible. The results are immediately apparent. Patients usually require touch-up treatments approximately every six months to a year.

People around the world have safely used Restylane since 1996, with dermatologists and plastic surgeons performing more than 3 million procedures. As with all medical treatments, however, it's important to discuss Restylane with your health care professional to see if it's safe for you.

Is Restylane Safe for Me?


Restylane should be safe for you unless you:

1. Have a history of severe allergies manifested by a history of anaphylaxis, or a history or presence of multiple severe allergies.
2. Are allergic to the bacterial proteins (gram-positive) that it contains.
3. Are pregnant.
4. Are breastfeeding.
5. Are younger than 18 years old.

Why these concerns? Restylane is made from bacteria. Some people are allergic to the bacterial proteins (gram-positive) that it contains. Also, researchers haven't yet established Restylane's safety during pregnancy, breastfeeding or in people under 18.

Potential Side Effects

Some people have minor injection-related reactions. These include swelling, redness, pain, itching, discolouration and tenderness at injection sites. These typically resolve by themselves, usually within a few days for skin injections and within a week for lip injections.

• How much does a Restylane treatment cost?
• How is the treatment performed?
• How long will the treatment take?
• What will I look like after the treatment?
• What is Restylane?
• What is hyaluronic acid?
• Is Restylane safe?
• What is the history of Restylane?

Restylane treatments are customized to each individual's specific needs, so the cost varies from client to client. Treatments typically cost in the $300 to $1,000 range. With follow-ups required only about twice per year, Restylane proves to be economical over the long term.

Restylane is injected directly into the skin in tiny amounts by an ultrafine needle, resulting in minimal discomfort. The procedure is simple and convenient, and results are practically instantaneous. To optimize your comfort during the short procedure, your physician may anesthetize the treatment area. Restylane is available only through a licensed health care professional.

As no pre-testing is required, the treatment can be carried out immediately. A session generally takes about 30 minutes, although the time varies depending on the effect you want to achieve. The procedure is simple and convenient, and results are practically instantaneous.

Immediately after the treatment, you can expect slight redness, swelling, tenderness or an itching sensation in the treated area. This is a normal result of the injection. The discomfort is temporary and generally disappears in a few days. After a lip treatment, the lips may become swollen and look somewhat uneven. This can persist for up to a week. If the discomfort continues, please contact your physician.

Restylane consists of 20 mg/mL of stabilized hyaluronic acid and physiological sodium chloride solution with a pH of 7. All Restylane products are clear, transparent and viscous gels. The only difference between the products is the size of the gel particles. In contrast to some similar products, the hyaluronic acid in Restylane is not produced from animals. This means that there is no risk of animal or human disease being transmitted or allergic reactions being elicited if you are sensitive to common foods, such as beef, chicken and eggs.

Hyaluronic acid is a natural substance that is found throughout your body. It gives volume to the skin, lubricates the joints and gives the eyes their shape. The hyaluronic acid in Restylane is stabilized for a long duration and is not of animal or human origin.

Yes. Restylane has been used safely by physicians in over 3 million procedures worldwide since 1996. After your treatment, you might have some redness or swelling. This will normally last less than seven days. Sunbathing and cold outdoor activities should be avoided until any redness or swelling disappear. If you are pregnant, breastfeeding, or under 18, you shouldn't use Restylane.

After many years of research, Q-Med AB, the Swedish manufacturer that licenses out its products to Medicis Aesthetics™ Canada, succeeded in developing NASHA™, a Non-Animal Stabilized Hyaluronic Acid, to replace the loss of volume in the skin. The first product, Restylane, was launched in 1996. Before this, only collagen made from cowhides and hyaluronic acid made from rooster combs had been available.

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