As medical practitioners, it is our duty and our honour to be able to treat our patients – and that is why we always take any side effects that that patient may have from the treatment that we give them incredibly seriously. The very last thing that we would want is for them to suffer an unintended consequence due to the treatment that we give them, but unfortunately with absolutely everything that happens in medicine, there is always a slight chance that something could not quite go right. With Botox, one of the more frequent side effects is bulging in areas that the patient would definitely not want to experience! So how can you prevent bulge side effects when treating your patients?
The key thing to remember is that the depth of the injections that we give to our patients really does make a huge difference to the way that their bodies react. Superficial muscle is the first area of muscle that a needle can come across, and if the Botox injection only reaches superficial muscle, it becomes weaker and the deeper muscle will bulge through, causing a bulge that the patient will find very unsightly. This most commonly occurs when you are treating the muscles on the cheeks.
Another mistake that some people make when it comes to treating the cheek muscles is injecting too high on the face. If you inject the muscles too close to the ears, you will hit a gland and puncture this gland causing a huge amount of trauma, and it will swell up and bulge in order to protect itself – and this swelling will occur within seconds so you will know that you have made a mistake! To avoid this, you should always make sure that you inject the check muscle the lowest that you can.
With every single medical procedure there is the chance of side effects. That is just a fact of life that we as medical practitioners have to accept, and every single one of our patients have to accept when they decide that they want to have a procedure. There is absolutely nothing within the medical world that does not have some risk, but that does not mean that we should just simply accept that: instead, we should be working our hardest to reduce those risks, and minimise the chances of them happening to our patients.
When it comes to Botox, one of the essential things that you have to is to make sure that the concentrate, or the mixture of the solution of the chemical, is absolutely perfect. If it is not the right concentrate level, it can cause huge side effects in your patients. This is especially important if a patient has come to you from another medical practice, and they have side effects from receiving Botox injections from another doctor. What many people do not realise is that we will then use Botox to correct these problems, but at a 0.1 ml concentrate, nothing too strong. Anything stronger would just exacerbate the problem even further.
You should make sure to separate the 0.1 ml concentrate on the areas of the eyes as well, because these areas are very delicate and you do not want to give them the normal concentrate of 1 ml. To create a 0.1 ml concentrate, put the 1 ml concentrate into a vial and then remove 0.1 ml with a syringe. Then add that to the saline, to create that 0.1 ml concentrate – and you should always have some of this with you so that you can treat patients who really need that extra bit of care.
Botox is one of the most precise and delicate arts that you will find in medical science, and for some people it will take years and years of training to ensure that they can be confident in administering Botox to their patients to the absolute best of their ability. This is because the facial muscles that we all have are incredibly small and all connected, so one wrong move in one area of the face can lead to massive side effects in other areas of the face. One of the places that is the most delicate, and patients are the most conscious of, is the area around their eyes. So how can you make sure that you can prevent side effects around the eyes of your patients?
Unfortunately, side effects around the eyes are the most common side effect that patients who receive Botox will experience, and the most frequent is bruising – though rarer side effects include droopy eyes and blurred vision. Bruising happens when the patient is injected far too close to the eye. These delicate muscles will instantly get bruised, and this can also lead to swelling which is not very attractive and can be quite painful. The key thing to prevent bruising the eye is to make sure that you know where the bony area around the eye socket is – and then make sure that you never inject closer than an inch to this area.
By avoiding this delicate area by at least an inch, you can be confident that the Botox does not get too close to the eye, and it will therefore not become bruised, or droop, or cause vision problems in the eyes of your patients, and they will be very grateful to you for your skill and expertise.
Botox is becoming increasingly popular for many people, not just those who would typically be expected to be the traditional customer: affluent, female, and in their forties. Today, it is completely impossible to guess what sort of person is going to walk through the door to receive their Botox injections because the taboo of receiving it has completely disappeared. Now there are plenty of men who are happy to say that they have received Botox, people in their seventies or twenties, and those who would not be considered particularly affluent.
This widening of the appeal of Botox is because people are really understanding the incredible difference that Botox can make for a patient, especially when it comes to their forehead – but this is often considered to be one of the most difficult places to inject Botox properly. As not all patients are exactly the same, you will often have to consider each patient as completely fresh and new. Some will have lines on the bottom of their forehead, some in the middle of their forehead, and some on the top of their forehead.
The key thing to remember is that you want to inject into the muscles where they are the strongest, and this will be where the lines on their forehead are the deepest. It doesn’t matter if your first patient of the day has them deepest in the middle of their forehead and your second patient of the day has them at the top of their forehead – follow the lines, and you will find the perfect place to inject. Injecting in that zone will make sure that your Botox is the most effective, as it will diffuse around that area and ensure that every muscle is relaxed and your Botox injections will be the most successful.
When it comes to medicine, so much of what we have to do runs on instinct. We have to listen to our gut so often because it almost always leads us to the correct answer, even if we can only prove it through medical treatment much later on. However, that can sometimes lead to decisions that are just wrong, and that is never more true when it comes to choosing a needle for an injection.
Most of us would go for the very thinnest needle when we are about to give a patient an injection, and to our gut instincts that makes perfect sense; the thinner the needle, the easier it will be to push through the patient’s skin, the blunter the needle, the more painful it will be for the patient. However, if you do decide to use a 32G needle, the absolute thinnest, that does not necessarily mean that it is going to be the sharpest.
The bevel that is at the end of the needle is what decides how sharp or how blunt a needle is, and that does not really have anything to do with how thin or wide it is. A 32G needle may be very thin, but any other needle could be sharper, and therefore going to be much better to use with your patient. In fact, in some cases you can find that the bevel of a 32G needle is not only blunt, but completely bent over making it completely impossible for you to use it to inject a patient without a good deal of pain and discomfort for them.
That is why you should avoid the absolute thinnest needles, even though your gut may tell you that it is the best choice – instead, focus on the sharpness of the needle instead.
One of the biggest problems within medicine today – and one of the biggest expenditures that those within the industry often have to deal with – is the cost of medicines and solutions, because it is all too easy to ruin them and make it impossible to use them, creating a cost that simply does not need to be there. This is never more true than when working with Botox and its different chemical make ups, because before it is possible to inject the Botox solution it needs to be mixed with another agent, usually a form of saline. However, many people make the categorical error of shaking the vial with the two mixtures inside as a way to mix them.
It is easy to see why people feel compelled to do this; after all, it is important that the solution mixes will with the crystals to ensure a uniform approach within the vial itself, so that it can be properly injected by needle. The trouble is that the Botox molecules are incredibly fragile and this shaking is just going to be too violent for them, causing them to disrupt, burst, and ultimately be destroyed. This then makes the Botox completely useless, which is a rather expensive mistake to make.
So that is the wrong way to mix Botox and saline, and a brilliant way to ruin a Botox vial. So what is the correct way? Actually, it is not really necessary for you to do anything to ensure that the two elements mix together well, because of the vacuum in the vial. The vacuum will pull the Botox and the saline together and mix them well so that you do not have to do anything to them in order to ensure their precise mixing. Any violent movements will just ruin the Botox, and that is just not necessary.
Even those who actually work within the medical industry, whether as a doctor, a nurse, a dentist, or any other sort of health professional, will often admit to hating injections – and that’s receiving them, not giving them! It’s no wonder that many people fear receiving injections because most of the time it can be very painful, from the initial sharp scratch that we feel when the needle goes in, to the slight bleeding that we often experience once the injection has been given, right through to the aching feel that is common for hours, and for some people, days after. So what can medical practitioners do to change this, and give their patients pain free injections?
One aspect of injection giving that is often ignored by doctors and others that give injections is the precise features of the needle itself. It is important to think about the angle of the injection of course, but if the needle itself is not right, then the injection will be sore no matter what angle it is placed into the body – although this is the part that most people focus on.
Almost everyone is aware that the smaller the needle the easier it will be to insert into the body, but often people disregard the sharpness of the bevel, which is the very end of the needle itself. The blunter the point at the end of the bevel, the more painful it will be for the patient, so you should always ensure that you are only using the most pointed and sharpest bevelled needles for your patients.
This small difference will make a huge difference to the experience of your patients, and is well worth focusing on to ensure that they are happy and comfortable with the injection experience.
No medical professional wants to give an injection to a patient that will be painful – it is not in their nature to harm a patient, and they want their patient to be able to trust them completely, something that is a little harder if they have just received pain from your hands. That is why so many health professionals strive to ensure that they always reduce the amount of pain and/or discomfort that their patients feel when they give them an injection.
The key to giving injections that are painless is to first understand exactly what it is about injections that make them difficult in the first place. By understanding that, it is possible to remove or reduce those elements, and therefore give patients a much more pleasant experience of receiving an injection. The main problem with injecting Botox to patients is that the manufacturers advise that it is first mixed with saline, and this mixture will have a pH of around about 4. This means that the mixture has become very acidic, and this causes the scratch and sharp feeling of pain that patients experience when the needle breaks the skin.
If you are injecting Botox and you want your patients to have a much more pain-free experience, then you can choose not to mix it with saline as the manufacturers suggest, but to instead mix it with bacteria static saline, a very different mixture altogether. This creates a solution that has a pH of around 6, almost neutral so that your patient does not have to endure an acidic injection, making the whole experience of receiving an injection much more pleasant and easy to undergo. Very few people realise that this small change within their medical practice could make a huge difference to their patients.
One of the most important aspects of Botox injections is ensuring that the patient does not experience any pain from the injection that you give them. This is a lot easier to say than to do, especially as every single patient is different, with different reactions to injections, different sensitivity, and a different approach and psychological relationship with needles.
The skin that lies across our bodies is actually relatively thin, even though it consists of many hundreds of layers. Underneath these multiple layers of skin are the muscles, those ingenious things that enable us to move – and are very sensitive, with millions of nerves running through them in order to be able to move effectively and efficiently. Underneath all of them is the bone.
Now of course, a Botox injection should never be reaching so deep as the bone, but for a good practitioner, the needle should not be getting anywhere the bone at all. That is why, depending on the thickness of the patient’s skin, the needle should be entering their body at an angle to ensure that it does not penetrate the bone. The exact angle will depend on the area of the body that you are injecting. For some areas, a 90 degree angle is appropriate, but this is rare.
By determining exactly how thick the muscle is in the area that you are injecting, you will be able to tailor the way that you give the injection to ensure that the patient does not feel any pain or discomfort. Every patient will provide a unique puzzle, and it is one of the joys of working in medicine that you can never treat a different person exactly the same way as you have treated another – and this is perfectly true when giving painless injections to your patients.
Whether or not you agree with people using it, it is impossible to deny that there are now large numbers of people who have Botox in order to use it to remove those wrinkles and lines – but what people often do not realise is that Botox can be used as a medical treatment, such as for excessive sweating.
The FDA approved Botox as a treatment for excessive sweating over a decade ago in 2004, and for people who go through medical grade antiperspirant within a week this can really change their lives. What Botox is able to do is block the sweat glands in the body, preventing them from even making any sweat for up to one year after treatment.
Now, this can be used as a cosmetic thing, such as by brides on their wedding day because they want to make sure that they do not overheat and get their gown dirty, but it is estimated that one in three people in the American population actually suffer from excessive sweating.
Botox For Sweating
The official name for excessive sweating is hyperhidrosis, and this can occur in many parts of the body not just underneath the arms – face, feet, hands, and groin are just a few examples. Those who have it do not just sweat when it is very warm, but continuously, and far more than other people.
Many people will not actually realise that they have a medical condition: they will have always sweated like that, and will just assume that it is completely healthy. That is just how they are. Often it is only when they begin to notice that other people are not sweating nearly as much as they are that they realise that there is something different about them.
How Does it Work?
Botox does not destroy or kill the sweat glands in our body, but it does block them or switch them off, so the body does not feel the need to make more sweat. The chemical reactions are slowed down and then prevented by two weeks after the treatment, although after a year the treatment will cease to work, and the patient will need to have another treatment.
The procedure is very simple. The practitioner who is administering the Botox will create a grid of dots on the area that requires treatment, probably only around 1 cm apart, so that they cover the entire area to prevent sweating. Around 100 units of Botox will be required for two underarms, which may sound a lot but any less will probably not create the desired effect.
Although the treatment does not go very deep underneath the skin, most administrators of Botox prefer to use a numbing cream on their patients so that they do not need to worry about any pain. For a truly skilled Botox professional, they can have two underarms completed in less than ten minutes, which is great for patients who are wary of needles – it can be over quickly!
What About Side Effects?
95% of people who receive Botox report that they have complete satisfaction, which makes Botox one of the most safe and effective courses of treatment that is available. Its predictability is what makes it so trusted by doctors and patients alike, and apart from a small amount of bruising, patients do not really notice any side effects.
And Does it Actually Work?
Botox underneath the arms for excessive underarm sweating has an 87% complete success rate, allowing patients who have never been able to go to the gym for a full on workout before because they were so embarrassed about their excessive sweating to go, and push themselves harder and faster than they ever have been before. They can enjoy wearing whatever they want, and going wherever they want, and doing whatever they want, because they do not have to worry or be self-conscious about their excessive sweating anymore. This treatment plan can really release people who have felt restricted by their medical condition for so long.
Patients should wait for up to two weeks in order to feel the full effects of the treatment, but by the third day they will already be able to notice drastic improvement. This should last for months, though of course the exact amount of time will always vary depending on the patient, and their natural metabolic response. People that exercise frequently or who suffer a great deal amount of stress will find that their treatment does not last as long as other people.
Try it For Yourself
Some patients are concerned about something called compensatory sweating. This means that because your body realises that it can no longer sweat through your underarms because it is being prevented from doing so by the Botox, in order to cool your body down it will try and sweat excessively somewhere else on your body, such as the patients’ feet or hands. However, for most people this simply does not happen. In the rare cases that patients do notice a subtle shift in the way that their body works, it is easy enough for their doctor to prescribe Botox in those areas too, although the success rate for feet is not as high.
As hyperhidrosis is a medical condition, many people will be able to receive Botox as a treatment under their health insurance, which means that they can truly change their lives for the better without any cost.
Would you like to be able to inject your patients to treat excessive sweating? If so, register for Dr. Katz’s Botox program here.