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Botox and Fillers

M.B.B.S, D.L.O ENT, Head-Neck
& Cosmetic Surgeon,
Phone: 01199845531

Lately I am seeing a lot of interest in patients about fillers and Botox but not everyone seems to know the functions of these and where they are applicable. So today I will elaborate on these products, their availability and proper use. First let us talk about Botox. This is an injection which is used to reduce wrinkles.

How are wrinkles produced?
There are muscles present under our skin all over the body. The ends of these muscles are inserted into our skin so when that muscle contracts, the skin to which it is attached also contracts. These muscles are also present under the skin of the face, known as muscles of facial expression. When these muscles contract, creases appear on our face, creating a facial expression. For example, when we frown, the muscles on our forehead contracts and produces a wrinkling effect on the forehead. Over the years, these creases become more and more prominent due to laxity of skin and loss of facial fat. So the wrinkles become visible. The same happens to muscles around the eyes and lower face. This happens at different ages for each person. So, whenever a person feels uncomfortable with the appearance of wrinkles on their face, they can opt for rejuvenation using Botox injections

What is Botox?
It is an acetylcholine blocking neurotoxin which is produced by bacteria known as Clostridium Botolinum. There are several types of toxins that are produced by this bacteria, but the one that we use commercially for facial rejuvenation is known as BTX-A. Different pharmaceutical companies all over the world make BTX-A commercially. The FDA approved the use of BOTOX for facial rejuvenation in 2002 and so far it is considered the best drug available for elimination of crease lines on the face and neck. The emphasis of getting results is in the teqnique as well as dosage and so the expertise of the doctor administering the injection is very important. No anesthesia or hospitalisation is needed and it is usually done as an office procedure.

How does Botox work?
It works on the nerve endings present in the muscles in our body. Usually we use botox on the face or facial muscles to be precise. It is available in vials as freeze dried powder which the doctor prepares just before injecting. The procedure is more or less painless as very small gauge needles are used. The patient is made to sit in an upright position, then asked to produce wrinkles on the face to asses the depth as well as the prominence of the lines. Then the areas to be treated are marked. After injecting into the muscles their activity decreases, thereby reducing the pull on the skin and so there is reduction in the wrinkles. As the amount injected is very low, it is a very safe procedure with almost no side effects. Botox in variable doses are also used to treat patients with different diseases. What the patient needs to remember is that this is not a permanent procedure and top up injections need to be given at 6-9 month intervals for continuing results.

Now let's discuss Fillers and lipoinjections. As time passes a lot of changes take place in our skin as a result of aging, photo damage, trauma, scarification and diseases. Also, with age there is redistribution of fat in our body and face. The search for an ideal dermal filler for the correction of rhytids, facial lines and depressions has been an ongoing process for years. The goal is to get something, which is non-toxic, safe, and lasting. So far the FDA has approved many products for dermal and sub dermal filling. These are products are produced from animal dermal collagen and also some are artificially produced. Most of these products are safe and their durability varies. In aesthetics we use these to fill up defects in small scars, deep wrinkles or lines and to augment lips or eyelids. Basically as the name suggests, it is used to fill up gaps. The products used vary from surgeon to surgeon. It is important to remember that these are not permanent and top ups are needed from time to time.

Injection of fillers can be done under local anesthesia or if small areas are treated no anesthesia is needed. It can be done as an office procedure and the patient does not need any hospitalisation.

Nowadays lipoinjections are becoming very popular as a filling agent. It is a procedure by which fat is taken from the body, usually abdomen, then processed and injected into the areas that need to be treated. As it can be taken from the patient's own body there is less chance of side effects and it is said that its absorption rate is slower. It is a very good filler for large areas like depressions under the eyes, augmentation of lips, filling up of wrinkles on hands and feet. The procedure is done as a day case under general anesthesia. It is a very safe procedure and results are longer lasting than fillers, but do need top up from time to time according to patients' needs.

In endnote, whatever product a cosmetic surgeon is using, you should know the details so you can make a good and informed decision.


The elevator test

Many of us have the problem of not being able to speak precisely and concisely during a presentation, or a talk, or simply when putting forward an idea to your boss -- or even your spouse!

Sometime we just get carried away with our idea or plan, thus we keep going on and on, which compounds to a bad and boring presentation, meeting or discussion.

No matter what situation you are in, making a precise statement in little time can give you an edge -- in your job, as a student or sometimes even in your personal life.

In order to do that, try a trick used by McKinsey & Company, one of the most prestigious consultancy firms in the globe.

Any employee from McKinsey, whenever he/she has to present an idea to the client, must make sure that he/she can pass the elevator test: being able to communicate the whole idea in 30 seconds or less.

Suppose your boss is in a hurry and the only time he or she can give you is the duration she is going to spend on her way down. You, astonished, see yourself in an elevator full of people, speeding its way to another floor.

You need to communicate your whole idea in a nutshell -- and not forgetting any important or vital information -- to your boss within 30 to 40 seconds or even less.

Therefore, the next time you are giving a presentation or putting forward an idea, first ask yourself whether you have passed the elevator test. If you can pass that, you are on the right track about being concise and to the point.

By M H Haider


Map in my pocket

I wrongfully thought that my business with maps was over on my last day of eighth grade. I thought that I would not have to deal with maps again unless I accidentally agreed to teach geography to a middle school child. Oh well, but what one thinks for the future does not always come true therefore, today I look at the U.S. map every time I decide to find a new restaurant, mall, hotel, clinic, salon, tourist spot, bank, pharmacy, in short, almost any establishment. Now, I often say, "What would I do without Google Maps or a GPS (Global Positioning System) unit?"

The age of technology has made living in a foreign land so much easier - the Google Maps application on my phone almost on a regular basis helps me find myself in downtown Minneapolis, MN. For someone whose sense of direction is rather deplorable, finding her way in a new city is only possible with a map. Street numbers are often just random numbers to me, for I also need pictures of buildings and streets to assure myself that I am on the right track. The satellite images on Google Maps are therefore a blessing.

One of the things that hubby and I thought was one-hundred percent worth buying was a Garmin GPS unit. American roads and highways can leave one in a confused state of mind -- too many roads leading to too many places of this vast country. These days we do not even take the GPS unit off our windshield. The little device has finally found its permanent home in our car after we moved to Minneapolis. A few touches and the screen shows and tells you how you can reach your desired destination -- talk about a talking map!

In Dhaka, people would mention landmarks to give directions. I am so used to that method that when people give me directions using avenue and street numbers, I give them a blank look. They probably wonder if I hail from a country where streets are numberless or whether I am mentally challenged in a way or two. I often end such a conversation by saying, "I will look it up on a map, thank you." It is true that a mobile map describes better than a human being when it comes to locating an address.

So yes, life is easier with a map, I admit. I cannot imagine roaming around by myself in an American city without a virtual map in my pocket.

By Wara Karim


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