Botox in Chicago, IL

How is Dr. Shah different?

Dr. Shah and Chughtai are diamond injectors of Botox (Allergan tier ranking for physicians) making them in the top 5% of all injectors in the world.  They are an all physician injection practice where they specialize in the best of botox including specific contouring and applications not found in other practices.  Dr. Shah is one of the only injectors in the world to use Botox for lines in the face, oil in the face, masseter hypertrophy and reducing pore size.  Many of the techniques they use require advanced knowledge of the face and its anatomy.

Dr. Shah has been featured in several lay press articles regarding his injection techniques for botulinum toxin, in particular for Botox pore reduction. Dr. Shah was one of the first injectors in the world to utilize botulinum toxin in an effort to reduce pore size and sebum production. He wrote the first paper in the Scientific Paper describing this technique and his results. He has written a seminal chapter on botox in, a leading academic text.

Before and After

Who is a candidate for Botox?

Botox is typically injected into the upper portion of the face to help improve the appearance of the number 11’s (glabella), crow’s feet (orbicularis oculi) and horizontal lines of the forehead (frontalis) muscle. Botox is ideally injected to smooth lines and in some cases lift brows.

How to avoid bruising with Botox

Dr. Shah and Chughtai have worked tirelessly to help decrease the chance of bruising.  While this can not be guaranteed, they use several technical advances and details to help minimize the incidence.

• Vein finder- Most bruising occurs from a vein.  Veins can lead early and late bruises. The use of a vein finder can help decrease the chance of bruising.  In addition, since the botox does not go in the vein, many patients report longer effect than other places.
• Small gauge needle.  Most injections with botox take place with a medium to small sized needle.  The problem is that this can create pain and more likely to cause a bruise. Dr. Shah and Chughtai use an extra fine needle which creates less impact on skin and bruising (Based on results seen in our practice)
• Pre injection prepping- For those patients who bruise easily, patients can avoid blood thinners and take MEND cosmetic to prep the patient by adding arnica, bromelein, and other blood thickening agents

How to make botox pain free?

For most patients, botox is an easy process which requires no additional steps.  However, there are several steps we can incorporate to make botox an easier process:

• use of distraction tools- vibration tools can help distract patients from botox and make it relatively pain free.  We use a variety of tools to help patients feel less discomfort.
• use of numbing cream- there are a variety of numbing products on the market.  Numbing cream tends to not be as impactful as other modalities
• use of ice- many patients have mixed results with ice.  It can be incorporated for those who desire it.
• nitrous- Nitrous is rare for patients receiving botox but can help decrease the edge seen with it.  We utilize Pro-nox in our office to help with procedures but most patients feel like this is not necessary for botox.  We do offer it for those rare patients who can not tolerate injections (extremely rare with our use of distraction devices)

Cost of Botox

The cost of botox varies from office to office.  Since we are a diamond level provider, our cost is typically less than competitors.  Please note, we only use AUTHENTIC products, including Botox from Allergan and Dysport from Galderma.  We charge Botox (Allergan) by the unit and is $15 per unit. Most patients typically need anywhere from 10-40 units.  Many patients who sign up for Brilliant Distinctions or Aspire awards will get discounts with each injection as well.

SPECIAL PRICING WITH NURSE INJECTOR JONATHON

Our nurse injector, Jonathon, is currently offering special pricing for Botox (Allergan) at $10 per unit.

Areas to treat

BOTOX FOR FACIAL WRINKLES

Forehead

• The fibers are vertical and the contraction of the muscle results in horizontal lines
• Variability in anatomy here with some patients having significant overlap in the midline and others not
• Interdigitates with the procerus and orbicularis oculi
• Contract the superior portion – a descent of hairline
• Contract lower portion – elevation of the brow

Glabella

• Composed of corrugator and depressor supercili muscles
• Brow depressors are deep and some have advocated going deeper to lift medial brow – difficult to demonstrate clinically
• Corrugator supercili – only muscle with a bony connection (medial on the skull) – laterally inserts on to the skin of eyebrow and underlying fascia of frontalis
• Procerus- horizontal lines and descent of brows- botox can slightly elevate brows here

Crow’s feet

• Keep 1-2 cm away from the oribital rim
• Bunny lines
• Caused by nasalis muscle and create transverse lines here

Perioral use of Botox

• Smoker’s lines – caused by excessive contraction of orbicularis oris – creates vertical lines- usually avoid cupid’s bow area
• Gummy smile – levator labii superioris alaque nasi
• Downturned smile – inject into depressor anguli oris
• Peau – d’orange – mentalis muscle injection- helps dimpling
• Complications – drooling, dysarthria, inability to drink from straws or purse lips

Masseter muscle

• Complications- facial expression alteration, speech disturbances, dysgeusia, transient muscle bulging

Eyebrow-raising

• Brow depressors vs brow contractors
• Main elevators are frontalis muscle and temporparietalis
• Temporoparietalis muscle – rarely described and highly variable – raises eyebrows, widens eyes and wrinkles skin of the forehead
• Depressors – procerus muscles, corrugator muscles, and orbicularis oculi muscle

BOTOX FOR JAW REDUCTION

Botox jaw reduction is a specialized technique to reduce the width of the jawline changing an overly square jawline to a more attractive oval or heart shaped face. In some patients, the masseter muscle, a chewing muscle, is enlarged creating extra facial width. Botox selectively weakens this muscle over time leading to an overall reduction in the size of this muscle.
Read more here about Masseter Reduction Chicago.

BOTOX FOR PORE REDUCTION

Botox represents the latest technique for pore reduction. In fact, intradermal Botox is the only treatment for which directly targets pores. When all of the pores reduce in size, the surface area of the skin is reduced and the skin is tightened, creating a lift effect.
Read more about Botox Pore Reduction Chicago.

BOTOX FOR HYPERHIDROSIS:

Hyperhidrosis is a condition where a patient suffers from excessive sweating from their sweat glands. Botox can be used to treat this issue by temporarily blocking the chemical signals of the sweat glands’ nerves which stimulate the glands overproduction of sweat. To read more about Hyperhidrosis, click here.

OTHER TREATMENTS WITH BOTOX:

Dr. Shah is a leading innovator of Botox uses. Other treatments using Botox include: Hyperhidrosis, Botox for Oily Skin, TMJ Disorders, Headaches, Facial Nerves, and Underarms.

Types of Botox

1. Onabotulinumtoxin A (Botox by Allergan)
   • approved in 1979 by FDA for strabismus
   • approved for glabellar wrinkles FDA 2002
   • approved crows feet FDA 2013
   • 900kDA complex of 150kdA botox and nontoxic proteins through purified ethanol and crystallization
   • onset is 1 week and effects last 3-4 months depending on areas
2. AbotulinumtoxinA (Dysport by Galderma)
   • approved in 2009 by FDA for cervical dystonia
   • approved in 2009 for glabellar rhytides in patients younger than 65
   • 500-900 KDA complex purified through an ion-exchange process
   • Clinical onset is 5 days and duration is 3-4 months
3. IncobotulinumtoxinA (Xeomin by Merz)
   • homogeneous solution of 150 kda BoNTA created by ion exchange and pH elution
   • FDA approved for glabellar wrinkles in 2002
   • found to have faster onset (3 days) as well as longer duration of effect
   • 1 study found that patients switched from Xeomin from botox due to lower cost but switched back citing less efficacy and duration ( Banegas RA,Farache F, Rancati A, et al. The South AmericanGlabellar Experience Study (SAGE): a multicenter retrospective analysis of real-world treatment patterns following the introduction of incobotulinumtoxinA in Argentina. – Aesthet Surg J. 2013;33:1039–1045.
4. RimabotulinumtoxinB (Myobloc, Solstice Neurosciences)
   • not clinically used for cosmetic use
   • least duration
   • higher levels of immunologic resistance

Recovery Time

Typically, most patients experience a few moments of redness from the injection site. Dr. Shah recommends patients avoid blood thinners if possible before Botox therapy to minimize downtime.

A botox procedure typically takes several minutes.

Testimonials

How does Dr. Shah charge for Botox?

Dr. Shah’s office charges for Botox by the unit rather than by the area.

Can Botox be used for sweaty underarm areas?

Yes. Botox can be used here to control sweating. It works on the inhibition of acetylcholine from releasing sweat.

What are the risks of botulinum toxin?

There are several risks. Although bruising is rare, it is the most common side effect of botulinum toxin. Asymmetries can result from the use of botulinum toxin, as well. A lowered brow (brow ptosis) or lowered eyelid (eyelid ptosis) can occur but is rare with experienced hands.

When was botox first developed?

Botox began its use originally as a treatment for strabismus (abnormal eye muscles) in 1973.

Later on, it was approved by the FDA in 1989 for hemifacial spasm and blepharospasm.

The first aesthetic use of Botox was also in 1989 for treatment of a nerve injury after a facelift. In this case, the patient’s face was balanced to mimic the paralyzed side. Since then the use of botox has ballooned and become commonplace having millions and millions of satisfied patients.

How does Botox work?

Botox causes paralysis in muscles by inhibiting the release of ACh (Acetylcholine) at the neuromuscular junction. Of the seven known subtypes of Botox, types A and B are the only ones used for commercial preparation. Botox A works by cleaving synap protein 25 which prevents the release of ACh and Botox B cleaves synaptobrevin which is essential for presynaptic vesicle fusion and ACh release.

Paralysis often occurs within a few hours after a Botox injection but the full clinical effect takes up to one week. The reason for this delayed effect is that there may be persistent ACh release at the neuromuscular junction. The blockade created by Botox is irreversible with axonal sprouting and formation of new muscular junctions responsible for the clinical effects over time.

Is Botox dangerous?

Botox is one of the safest procedures performed. There are several advantages to Botox therapy which include the fact that it stays where you inject it (meaning it does not course its way throughout the entire body) and it requires small amounts. The major disadvantage of Botox is that it requires a skilled injector to perform it.

How long does Botox last?

Botox typically lasts about 3-4 months for muscles of the face. The exception would be the masseters (typically last about 1 year). For the use of sweating, oil and other factors botox typically lasts about 6 months.

How does Botox compare to Dysport and Xeomin?

The strength of botox varies due to the dose, injection technique, and patient factors. In an individual 3 month study looking at the clinical response for glabella, the study noted that improvement was noted to be 50% for Botox, 40-50% for Dysport, 25% for Xeomin (however Xeomin was looked at 2 points and others were looked at 1 point of improvement). Less than 20% of patients maintained improvement beyond 4 months. This study points out that the most improvement was seen in Botox with Dysport either being the same or slightly less response. It is hard to compare products head to head since dosing is not interchangeable between each of these neuromodulators.

Will increasing my dose increase the duration?

Increased doses may prolong duration and number of responders but maximal dose where additional benefits are gained has not been established.