Used for many cosmetic purposes including the prevention of wrinkles and fine lines, Botox is also used by the general medical community to treat and prevent everything from migraine headaches and temporomandibular joint disorder to uncontrollable blinking and crossed eyes. It is also used to treat a condition known as hyperhidrosis, which causes chronic or excessive sweating even when at rest and not under stress.

What is Hyperhidrosis?
This medical condition affects up to 1% of the population of men and women in North America and usually occurs in the underarms, palms, and feet. Those who suffer from this condition can sweat up to four times the normal amount as the body struggles to maintain a comfortable body temperature. Many of these patients acknowledge that their condition causes discomfort and embarrassment in social situations as well as making some aspects of their day-to-day lives more difficult.

While there are several other treatment methods available, Botox injections are considered one of the most effective and least invasive treatment options currently offered. Alternative treatments include prescription antiperspirants or pills and surgical options such as sympathectomy or the severing of the nerves that signal the sweat glands.

Unfortunately not all patients find prescription medications to be a successful solution to their problem and surgical options have their own obvious drawbacks.

How does Botox work?
By injecting this neurotoxin into the skin of the underarm, Botox can be used to suppress the overactive sweat production and limit it to more appropriate levels. This is because our skin contains sweat glands which respond to increases in body temperature, automatically releasing sweat to cool the body.

Botox prevents the signals from the nerve endings from reaching the sweat glands, blocking their ability to trigger the release of sweat. The effects last up to 8 months at a time and require little to no recovery time required. Studies have shown that there is no harm in blocking the sweat glands in specific areas of the body as the skin is riddled with plenty of glands to handle the task of keeping your body cool.

For more information about using Botox to control overactive sweating, contact the experts at Med-Aesthetics to book an appointment today.

First, let’s just state that Botox and other facial fillers work by relaxing muscle movements in certain areas which lead to wrinkles; Botox injections don’t target areas of the skin that crease when you move (for example, the creases that result from smiling or frowning), but rather, these injections target areas where wrinkles never existed before (like on your forehead or around your eyes). Women tend to receive Botox treatments more often than men, and treatment is usually focused around the face, because women actually have thinner facial skin than men do — meaning that wrinkles are more likely to appear, and tend to appear earlier. The average Botox patient is between the ages of 40 and 59, but it isn’t unusual for younger patients to receive Botox treatments, too. And part of the reason why Botox attracts younger patients is because this treatment isn’t just for preventing and eliminating wrinkles.

Many patients have reported fewer migraines after receiving facial Botox injections. Similarly, when injected into the shoulders, neck, and/or back areas, Botox relieves muscle tension too. Because it is so effective as a muscle relaxer, Botox has often been used to ameliorate arthritis pain as well. And if you’re suffering from hypotrichosis (excessive sweating), Botox has been proven to reduce sweating by inhibiting the chemical acetycholine, which stimulates the sweat glands.

So if you’re still associating Botox with wrinkles, but you suffer from any of these physical pains, it may be time to start doing some research and talking to your doctor about the types of Botox pain treatments that are available — and safe — for you. Botox cosmetics treatments actually increased by 8% between 2012 and 2013, as more research became available showing how effective these treatments are. You have every right to feel comfortable in your body — and Botox might just help you with that.

Hyperhidrosis can be an uncomfortable and embarrassing condition. People with hyperhidrosis may find themselves uncomfortable in social situations, afraid that people will notice the sweat stains on their clothing. They may try to avoid raising their arms in normal situations, like dancing. They may even hesitate to buy new clothes, afraid they’ll be ruined by sweat stains.

Everybody sweats, but hyperhidrosis takes it to a new level. People suffering from hyperhidrosis sweat excessively all the time, not just as a result of physical exertion or warm weather. They have often tried every antiperspirant on the market, to no avail. In this case, Botox is a treatment option they can consider.

A Botox injection to the affected area temporarily blocks the chemical signals from the nerves that stimulate the sweat glands. When the sweat glands don’t receive chemical signals, the severe sweating stops. About 15 injections are made into the underarm area, and the entire procedure only takes about 10-15 minutes. While this is not a permanent solution, the effect does usually last for about six months.

Hyperhidrosis affects people of all ages, both men and women. Sadly, people with severe sweating often don’t seek treatment, because they don’t realize their sweating is a medical condition that can be treated. If you are experiencing excessive sweating, and have exhausted all the usual options, check with your dermatologist to see if a Botox treatment might work for you.

But not many people know that Botox treatments can be used for several different reasons. Botox pain treatment has been around for many years, but it is rarely highlighted in the news or by medical professionals.

A condition known as axillary hyperhidrosis, or excessive sweating, affects many Canadians. The cause for the condition is not clear to doctors, but they believe it has to do with an overactive sympathetic nervous system, stimulated by excitement, nervousness, and even some foods. For these patients, Botox can be beneficial, as it blocks the impulse sent by the nerves to the sweat glands.

In addition to Botox for sweating, these injections can also be effective for migraines. These painful headaches are considered a nervous system disorder, and according to the World Health Organization, globally, they affect about 10% of adults ages 18 to 65. They can be debilitating, and make every day activities feel impossible. Botox for migraines has gained repute as a treatment for these chronic headaches. Pulsating muscles can be arrested with Botox injections, relieving the pain.

There have also been reports that Botox can be used for back spasms in children with cerebral palsy. Classified as a movement disorder, cerebral palsy affects about 17 million people around the world. Sufferers have difficulty controlling their limbs and body, because their muscles are spastic. This often places cerebral palsy patients in a specialized wheel chair to help them gain control over their movements. In one study, Botox injections helped children with cerebral palsy calm their back spasms for a period of time.

While Botox will likely still be known as a cosmetic treatment by most people, its therapeutic properties are gaining in popularity. As more studies are conducted on the alternative health benefits of Botox, these injections could become a significant treatment for more illnesses.

Botox, short for “botulinum toxin,” in addition to offering the most effective means of cosmetic wrinkle treatment, has numerous therapeutic benefits as well. It is effective for calming painful muscle spasms brought on by such disorders as dystonia and arthritis. This relieves pain and tightness in the extremities, so those afflicted can lead a comfortable and happy life.

Botox can also relieve the crippling pain from migraines, when locally injected in the neck or shoulder areas. It eases symptoms by constricting peripheral neurotransmitters. This basically means it interferes with the pain processing systems which register migraine pain. This is also the guiding principle doctors see when using the injection to successfully treat neck, back and shoulder pain.

In addition to the many tension easing and pain relieving benefits Botox can offer, it is very effective in treating hyperhidrosis, or excessive sweating. There are few topical ways to curb excessive sweating, but Botox injections block neurological signals to the sweat glands, preventing perspiration in the first place, especially to the underarms. Talking to your doctor about Botox for hyperhidrosis can effectively prevent embarrassing sweat stains.

Originally introduced as an aging skin treatment, Botox has been discovered to offer many more benefits in recent years. Inhibiting neurological function, treatment essentially paralyzes muscle to inhibit contraction and spasm. This is fundamental to its tension easing and pain relieving principles.

“Some days, I would be in my room with ice packs, taking what seemed like hundreds of pills, and just praying that I would die,” she says.

Over the years, she consulted a long line of professionals and specialists, most of whom had been disappointing at best. The worst were those who dismissed her pain as being all in her head.

“One of them even asked me if I was happy in my marriage, and another told me I likely had a brain tumour.

“Nothing really worked,” she says of the different treatments she tried. “Changing my diet helped a little, exercise helped a little, I tried allergy shots, massage, but as the years went by, the pain seemed to be getting worse.”

Then she went to see Dr. Mark Baily, who was featured in a newspaper article about the therapeutic use of Botox, a muscle relaxant produced by American-based drug company Allergan Inc.

Baily explained he could treat her symptoms with Botox, a protein toxin produced by the same bacteria that causes botulism, a lethal form of food poisoning. The toxin produces prolonged muscle relaxation and, in minute dosages, has been used for several years to treat eye diseases and to control spasms in people with cerebral palsy.

It’s also been used cosmetically for about 10 years, to ease the furrows and frown lines on the forehead and around the eyes. (Botox demonstrations attracted some of the biggest crowds at last weekend’s New You cosmetic surgery and anti-aging show at the Metro Toronto Convention Centre.)

The cosmetic use of Botox led to the discovery that the toxin can also reduce migraines.

“People who were being treated in a cosmetic way with Botox, and who also suffered from migraine headaches, started to report they weren’t getting headaches, or if they did they weren’t as severe,” says Baily, who specializes in headache and pain management treatment at his clinics in Brampton and Toronto. He also trains other physicians on using Botox to treat pain.

Patricia Niesczeri, a Botox medical consultant with Allergan, explains Botox is cleared from the body within 48 hours, but its muscle relaxation qualities can last for three months or longer. It has no reported side effects.

The diluted substance is injected locally into the head, facial muscles, neck or shoulders, depending on the source of the pain.

Most medical insurance companies will cover the cost of therapeutic Botox treatments, which can cost up to $700 every three months. Cosmetic use is not covered.

Foster began noticing a difference in her pain a couple of weeks after her injections into her head and neck.

“Fibromyalgia is sort of like arthritis pain,” she explains, “except that it can be all over your body.

“Every joint and muscle seems to be affected. It is a gnawing pain that eats away at you.” Her neck is particularly affected by debilitating pain, she says.

“After Botox, the pain was down so much I could think again. Before, I was living in a blur. Now … it is so much better.”

Foster has also been able to cut back on her medication, which has helped her relax a little more about her overall health. “Botox really has changed my life and that is not an exaggeration,” she says.

Deanna Pietramala of Newmarket also knows the agony of chronic pain. She had suffered from severe migraines for more than 20 years, starting in her mid-teens. Hundreds of medical appointments and specialized tests never did determine why her headaches were so constant. Medications rarely helped.

“Every single day for 20 years, I had a headache,” says the 33- year-old mother of one. “You are in terrible pain, but you still have to work, and look after your kids. I started Botox last year and had the best year of my life. Within three weeks of the first treatment, I didn’t have a headache.”

Pietramala is an education specialist who designs programs for children with special needs, including autism. No matter how bad her headaches were, she had to keep working.

“You can’t say, ‘Sorry, I have a really bad headache, so I can’t meet with you today,’ when parents and children are counting on you to help. I’ve been in a darkened room, wearing sunglasses and working on my laptop, on medications that were narcotic, so I was kind of out of it. It wasn’t fun.”

Now, she only gets a sinus-type headache when she’s due for another treatment. She had to pay for her last treatment when her insurance company refused to cover it, but she has launched an appeal.

“This is a real quality of life issue for me and, in the long run, it saves a lot of money because I am not taking the other medicines, which they will cover.”

Baily says most insurers are starting to understand the long- term benefits of Botox and are covering treatment. Pain resulting from soft-tissue injuries such as whiplash has been particularly difficult to treat in the past, he adds.

“Now, we have a treatment that works, and works well, so they (insurers) are starting to see the benefits of getting people well and productive again.”

Dr. Amber Brown is a Brantford-based general practitioner who discovered Botox when she was establishing a cosmetic arm of her family practice. The more she learned about the therapeutic uses of Botox, the more she could see the benefits for many of her patients.

“The more I heard about the pain management effects, the more intrigued I became.”

Her own mother had suffered from debilitating low back pain for years, so Brown had a personal reason to discover whether Botox would work.

“If you can keep people away from the pill bottles and from things that don’t affect the whole body- that could affect your liver and kidneys- I think you have to try,” she says. “It is so rewarding to see how well these patients do.”

Brown has seen many women who have been living with pain for years. Statistically, women seem to suffer headaches, particularly migraines, more often than men, possibly because of hormonal changes during the menstrual cycle. In her experience, the ratio is about 8 to 1.

Chronic pain, she points out, “impairs so many areas of life.

“Imagine being unable to dress yourself, or make your bed, do your own grocery shopping, or cook a meal.”

Deanna Pietramala sees her Botox treatment results as nothing short of miraculous and is thankful for every pain-free day.

“This stuff is a godsend. It has changed everything. To have a day without a headache?

“A year ago, I just couldn’t have imagined it.”

Imagine getting relief from your headaches.

Now imagine looking younger in the process.

That’s no fantasy, according to Dr. Mark Baily, who makes both happen.

Baily, a pain management specialist, uses Botox, an injectible substance made from a distilled form of botulism toxin, to treat headaches.

The toxin, which temporarily paralyzes the muscles under the skin, also eases the furrows and frown lines on the forehead and around the eyes.

“When people are given drugs, they ask ‘What are the side effects?’ ” says Baily. “With Botox, the side effect is you’re going to get rid of your wrinkles.”

Botox, which is derived from the bacteria that cause botulism, has been used by plastic surgeons since the early ’90s as a cosmetic procedure to make the face look younger and smoother. It’s been used to treat headaches for about five or six years.

Baily believes he’s the only doctor doing both.

Here’s how he does it: Botox comes in small vials of 100 units. Usually 100 to 200 units are used in a typical headache treatment, injected into the forehead, temples, neck or head, depending on the type, severity and location of headaches the patient experiences.

With the units that are left over (it has to be used right away or discarded), Baily does additional injections into the forehead, between the eyes or at the corners of the eyes. This smoothes out the crow’s feet and lines in the upper part of the face. It’s not used around the mouth because the muscle paralysis would affect a person’s smile.

There is some overlap between the two applications (for headaches and cosmetic purposes) because “when we do headaches, we typically do the forehead but not usually crow’s feet.”

A cosmetic procedure of this sort normally costs between $400 and $600. But when Botox is used as a medical treatment, it’s often covered by drug plans with no cost to the patient. Baily charges patients a consultation and administration fee of $100 to $150. He does the additional wrinkle treatment for no charge.

Botox treatment takes several days for results to become noticeable and lasts three to six months.

It generally works for three types of headaches: migraine, tension and trauma (from an injury, for example.) It’s not used for headaches caused by a brain tumour or aneurysm.

It’s effective with chronic headache patients who haven’t responded to conventional treatment such as acupuncture, physiotherapy and massage- “those who’ve been through the gamut,” explains Baily, a headache specialist for about six years who ran a general family practice before.

“It’s not a cure,” he points out, “but it can mean a dramatic change in lifestyle.”

Improvement is usually seen in reduced severity and frequency of headaches as well as accompanying nausea, and in the amount of medication needed.

For Linda Christensen, Botox is “magic.” Now a fortysomething banker, she’s had debilitating migraines all her life and lived with headaches every day.

Six months ago, she saw Baily and received a series of injections all over her head. The change in her life has been “dramatic,” says the Mississauga resident, who had a second treatment a few months later.

“Now there are days I wake up and nothing hurts. The degree and frequency of my headaches have diminished 50 to 60 per cent.”

An added bonus is her wrinkle-free forehead: “It’s like a baby’s bum, it’s so smooth.”

According to Baily, it’s unclear how Botox works on headaches but in addition to relaxing or paralyzing the muscles, it appears to block the release of chemicals that cause headaches.

Baily works out of the Headache Treatment Clinic on Main St. in Toronto and on Vodden St. in Brampton, as well as the Alexis Anti- aging clinic on Eglinton Ave. W. near Avenue Rd.When he sees a new patient, he does a full consultation, covering all aspects of his or her headaches. He also gets a medical history and documentation from the patient’s family doctor.

“They have to be legitimate headache sufferers,” he says, adding his female headache patients outnumber men four to one.

A number of studies have shown Botox is effective in treating headaches. One of the most recent, done by two University of Toronto doctors last year, showed that small doses of the toxin can alleviate bad tension headaches, whiplash and neck pain, and reduce the intensity and frequency of some migraines. The research was funded by Botox manufacturer Allergan Inc.

The desire for physical beauty is not just a 20th century phenomenon. For proof of that all we have to do is examine 3 quotations from some famous individuals who are considerably older than even me.

“Beauty is a greater recommendation that any letter of introduction”  ARISTOTLE

“The three wishes of every man: to be healthy, to be rich by honest means, and to be beautiful”   PLATO

Asked why people desire physical beauty, ARISTOTLE replied, “No one that is not blind could ask that question.”

As Nancy Etcoff explained in her book “Survival of the Prettiest – The Science of Beauty”, it is really not that hard to understand for the following reasons:

Studies have shown that individuals who feel good about the way they look lead more productive and happier lives and can actually live longer.

Good looking people are more likely to win arguments and persuade others of their opinions. People divulge secrets to them and disclose personal information. Basically, people want to please the good-looking.

Attractive people do tend to be more at ease socially, more confident, and less likely to fear negative opinions; and are apt to be more assertive.

Beautiful people find sexual partners more easily; and are more likely to find leniency in the court and elicit cooperation from strangers.

Beauty conveys modest but real social and economic advantages.

Although most people would say that they no longer believe that “what is beautiful is good”, preferential treatment of beautiful people is extremely easy to demonstrate, as is discrimination against the unattractive.

For these and other reasons it is easy to explain the exponential growth the past decade in the number of cosmetic injectable treatments administered to patients across the globe.

These treatments(Botox and Facial Fillers) tend to be affordable, have minimal side effects, and when administered properly will typically result in the patient’s expectations either being met or exceeded. Although results are temporary, they are nevertheless often dramatic and extremely effective in producing a more youthful appearance as well as in the case of Botox, actually arresting the aging process in terms of wrinkles caused by movement of the muscles of facial expression.

That’s the good news. Now here is the bad. It should be clear what the benefits are to patients receiving these treatments. The benefits to the injector are equally dramatic, but in a different sense. The income generated on an hourly basis can actually exceed that of a heart surgeon doing bypass surgery! This factor, combined with greed, has literally led to an “underground industry” and a highly illegal proliferation of poorly trained, if even trained at all, injectors who are putting patients at risk for complications including permanent disfigurement.

Patients who go to some of these injectors, who are often doing it out of their homes, must assume some of the blame for poor outcomes. In their search for bargain basement prices they are allowing individuals to inject them without checking out their credentials whatsoever. I find it incredulous that anyone would allow someone to inject multiple needles into their face including some within millimeters of their eyes, without verifying the injector’s competency.

What actually is the law concerning who can inject both Botox and Facial Fillers(i.e. Juvederm) in this province? Regardless of their training, it is legal for any physician holding a valid license with the CPSO(College of Physician and Surgeons of Ontario)  to both order the products and administer the treatments. In addition, both nurses and actually non-physician  – non nurses (yes, even you!) can inject, but not order both Botox and Facial Fillers under the following circumstances:

A physician with expertise in these procedures must first see and assess the patient, at which point he can permit someone else (nurse or not) to perform the treatment. He also has to be available in the event of a side effect or complication, as ultimately should things go wrong and there be litigation, he will be named on any statement of claim. This is referred to as a Delegated Medical Act, and a full description is available on the CPSO website as there are other criteria that must be met.

Unfortunately, many individuals, for the sake of the almighty dollar, have turned a blind eye to these laws, which are designed to protect the public; and hence are placing patients at high risk for potentially dangerous complications. I recently saw a patient in my office who had her lips illegally injected by a poorly trained non physician on a dining room table at the injector’s home and the outcome was gruesome; and the patient continues to suffer disfigurement and embarassment. There also obviously exists a “black market” whereby these people are even able to obtain the products as the manufacturers will only sell to physicians.

Mary Garafalo, of the Global Program 16 X 9, recently did a segment on what currently exists in Canada in terms of the use of injectables by unlicensed individuals who are literally “practicing medicine without a license”, and could face criminal charges. Following her expose, she received over 100 calls from patients who had horror stories to tell her concerning their own negative (to say the least) experiences.

This brings us finally to the point of this whole article, namely, how do you, the patient, credentialize the injector whom you are trusting with your face; such that you are one of those whose expectations and goals are totally achieved.

An excellent first approach would be to go to the manufacturer’s website (for example, Allergan Canada, manufacturer of both Botox and Juvederm) and search on their “Find A Physician” page to see who they recommend in your postal code or city. You can rest assured that any physician recommended by Allergan has met their stringent criteria for the privilege of being on their site.

If you have a friend or family member who has been delighted with their treatments on multiple occasions with their cosmetic injector (whether M.D. or nurse), then it is quite reasonable to assume that you will have a positive outcome should they recommend them to you. In our practice, we do no advertising and rely entirely on referrals from existing patients; as there is nothing more powerful than a strong endorsement from a close friend.

For the record, I have nothing against nurse injectors and would go so far as to say that I know at least 6 nurses who I regard as being just as competent as any physician. In fact, my own personal injections are performed by non physician injectors. That being said, should you decide to go with a nurse injector please be advised that you MUST be seen by a physician first, or the procedure is being performed in violation of the guidelines of both the CPSO and the Ontario College of Nurses. In the event of a complication you will have no one to turn to; as neither emergency departments or your family physician may have the training to deal with a situation gone bad. There are occasions, when even in the best of hands, Facial Fillers may have to be dissolved immediately with product known as hyaluronidase in the case of a blockage of a vessel. Only physicians performing cosmetic injections would possess this product as well as the knowledge to use it. Remember – BUYER BEWARE! If it seems too good (or in this case, too cheap) to be true – then it probably is!

If you are seeing a physician for the first time it is not unreasonable to question them in regards to their experience or their training; however whether you get an honest answer or not may be a different story. Someone may have been trained 10 years ago may have less experience than someone with one year of experience if they are only doing a few patients per month. A book of before and after pictures of their own patients certainly adds credibility.

In addition, do not trust any office that gives you a quote over the phone. You must compare apples with apples. You can query as to how much an office charges per unit of Botox (which is the way it is measured) or per syringe of Juvederm; however anyone who tells you how much your treatment will cost over the phone is clearly more interested in your money than your satisfaction. Also, beware of marketing tricks like “Groupons” which offer Botox for $99.00. There is no area of the face that can be done properly for that kind of money. When you are arrive at the office, they will attempt to upsell you more units as well as a variety of other services such as laser treatments, chemical peels and microdermabrasion with huge profit margins.

For those of you who are spa owners and are considering adding injectables to your menu of services, PLEASE DO YOUR HOMEWORK FIRST! Obtain legal advice in regards to your own provincial laws and guidelines such that you are operating both legally and ethically, with your patient’s well being as your primary concern. This will probably mean having either a well trained physician performing the injections and being available at all times in the event of a complication; or a nurse under the guidance and supervision of a physician who assesses all new patients prior to them being injected for the first time. Anything less than this could put you at great risk in the event of a problem, to the extent that your insurance carrier could deny covering a claim such that you could literally lose your business and all the hard work and money that you put into it.

Karyn and I hope that we have provided you with some basic information such that you can make an informed decision concerning whom you allow the privilege of performing cosmetic injectables for you.. Remember, your face is the first thing someone sees when they look at you for the first time, and first impressions can last a lifetime.

Please feel free to e-mail Karyn at info@med-aesthetics.com should  have any questions or if we can be of any further assistance to you.

by Mark Baily and Karyn M. Baily, Brampton, Ontario