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Therapeutic Treatment

The facts about hyperhidrosis

BOTOX Therapeutic™ is frequently used to control hyperhidrosis (excessive sweating) of the armpits and palms, and occasionally other parts of the body. About one person in 100 has a serious problem with excessive sweating in these areas. This usually starts in childhood or adolescence, and sometimes other family members have a similar problem. This kind of excess sweating is caused by a reflex reaction of the nervous system and is beyond voluntary control. Excessive sweating is sometimes brought on by stress or heat, but often there is no cause, which can be identified.

Dr. Kevin Smith is a member of the Canadian Hyperhidrosis Advisory Committee, and with several other leading Canadian dermatologists is a member of the Canadian Hyperhidrosis Guidelines Development Group.

BOTOX Therapeutic™ for excessive sweating is covered by many drug plans – we will do all the necessary paperwork for you.

Many patients who are treated with BOTOX Therapeutic™ in the axillae are also please to note that there is a great improvement in body odor – “bromhidrosis” – from the axillae!

Considerable emotional and social stigma can be attached to excessive sweating of the hands and armpits, and this can lead to a loss of confidence and self esteem. For example, those afflicted with excessive sweating often feel that -- when people see big sweat marks under their arms or feel their sweaty palms -- they may decide that the individual is nervous or insincere, even when that is not the case.

Social engagements and simple things like physical contact with other people may be avoided because of uncontrollable sweating.
Patients afflicted with excessive sweating can routinely soak through clothing in a matter of minutes, and some patients have to use Kotex™ pads in their armpits, shields, absorbent tissues and frequent changes of clothing to cope with the disorder. Shirts and jackets can be quickly stained and ruined, and dry cleaning and replacement of clothing is sometimes a substantial expense.

BOTOX Therapeutic™ -— hyperhidrosis treatment that works…

Unlike antiperspirants and other topical treatments for excessive sweating, BOTOX Therapeutic™ targets sweating at its source. BOTOX Therapeutic™ enters the specific glands which are responsible for excessive sweating and blocks the release of a chemical which causes the production of excess perspiration. In clinical studies, 95% of patients with hyperhidrosis that was severe enough to interfere with their daily lives experienced the benefits of BOTOX Therapeutic™ after just one week, with sweating reduced by an average of 83%.

...and keeps on working

Half of patients report that after one BOTOX Therapeutic™ treatment they are free of excessive sweating for more than 7 months, and more than one third of patients are still free of excess sweating after one year. Because you continue to sweat normally in other areas, there is no concern about overheating.

Questions to ask yourself when deciding whether or not to investigate BOTOX Therapeutic™ treatment for excessive sweating include:

• Over the past week, how embarrassed or self-conscious have you been because of your sweating?
  
• Over the past week, how much has your sweating interfered with normal activities like shopping or looking after your home?
  
• Over the past week, how much has your sweating influenced the clothes you wear?
  
• Over the past week, how much has sweating affected any social or leisure activities?
  
• Over the past week, how much has sweating made it difficult for you to enjoy any sport?
  
• Over the past week, has your sweating interfered with working or studying?
  
• Over the past week, has your sweating created problems with your partner, friends or relatives?
  
• Over the past week, how much has your sweating created sexual difficulties or interfered with intimacy?
  

Individuals troubled by excessive sweating often do not respond adequately to antiperspirants, and they may not respond to (or be willing to tolerate) systemic medications, electrical treatments on the areas of excessive sweating, permanent destruction of the nerves which control sweating, or surgery (in the armpits) to either scrape away the sweat glands or to cut out the areas of excessive sweating.

BOTOX Therapeutic™ treatment, by contrast with the above, is a simple office procedure with little discomfort or risk; and can be much less expensive than surgery. Some people will only want BOTOX Therapeutic™ treatment before an important event (for example, a wedding). Others, whose sweating is mainly a problem during hot weather, may have BOTOX Therapeutic™ treatment at the start of every summer. BOTOX Therapeutic™ treatments can be safely continued year-round if necessary to maintain control of your sweating.

Before your BOTOX Therapeutic™ treatment, a simple iodine solution will be applied to the area of excessive sweating. This solution is allowed to dry, and then powdered starch (of the sort found in most kitchens) is sprinkled on the area. Where there is excess sweating, the moisture of the sweat allows starch to combine with iodine, producing a dark blue color. This starch-iodine test indicates the precise areas of excess sweating, and allows us to concentrate the BOTOX Therapeutic™ treatment where it is needed -- reducing both the number of injections and your costs. The blue marks from the starch-iodine test will be wiped off after your BOTOX Therapeutic™ treatment.

When it is used to control excessive sweating, BOTOX Therapeutic™ is injected (using ultra-fine needles) into the top layer of the skin (where the sweat glands are) rather than into the muscles under the skin (as is the case when we are treating dynamic wrinkles, muscle tension headaches and some migraine headaches).

Treatment of the underarms is easy, and no anesthetic is needed. Both armpits can be treated at the same time.

In most cases excessive sweating of the hands and feet can be treated without anesthesia. Dr. Smith has pioneered the use of ice to prevent discomfort when treating the palms and soles with BOTOX®, and has taught this technique to other physicians at meetings across Canada, and in the United States and Mexico. Your BOTOX® treatment will be done in a way that greatly reduces sweating with little or no effect on the muscles.

If small areas of troublesome sweating persist, they can be identified with a starch-iodine test and then treated at relatively low cost with BOTOX Therapeutic™ when you return for follow up several weeks later.
After BOTOX Therapeutic™ treatment, excess sweating starts to decrease within a couple of days, and the full effect in reached in a week or two. The goal of BOTOX Therapeutic™ is reduction of sweating to a normal level, but not total elimination of sweating to the point where the treated area becomes abnormally dry.
Patients usually report very high satisfaction with BOTOX Therapeutic™ treatments, return for additional treatments, and would recommend BOTOX Therapeutic™ treatments to their friends. Dr. Smith’s youngest BOTOX® patient was a lovely little ten year old girl who had excessive sweating of the palms -- she did great, and we are sure you will too!

Botox Therapeutic™ for headaches.

A number of patients treated with BOTOX® for lines on the forehead, frown lines between the eyebrows, and for crow’s feet have reported that a pleasant side effect of BOTOX® treatment was reduction or elimination of headaches. BOTOX® used for headaches and for excessive sweating is marketed as Botox Therapeutic™, DIN 01981501. This is the same medication as BOTOX®, but has a different DIN# so that some drug plans will pay for it when it is being used to treat medical rather than cosmetic indications.

Formal studies of patients with headaches have confirmed that BOTOX Therapeutic™ treatment often reduces the frequency and intensity of both muscle tension headaches and also some migraine headaches. Patients who respond well to BOTOX Therapeutic™ generally experience improvement within a few days, sometimes enjoy several months of relief from headaches, and are able to greatly reduce (and in some cases eliminate) headache medications. Many drug plans pay for BOTOX Therapeutic™ for headache, because this can be very cost effective when it reduces consumption of medications, and allows patients to avoid missing work. An increasing duration of effect is often noted in headache patients who repeat their BOTOX Therapeutic™ treatments as soon as they notice that the BOTOX Therapeutic™ effect is declining.

In some cases, each point which you can identify as being associated with your headaches will be injected with BOTOX Therapeutic™, usually starting at 5 to 10 units of BOTOX Therapeutic™ in each point. In other cases, it is more effective to treat larger areas (for example, the forehead and sides of the scalp) with a total of 75-100 units of BOTOX Therapeutic™, or as much as 150 units if the posterior scalp and neck are also treated.
Botox Therapeutic™ is also used for the treatment of temporomandibular joint (TMJ) discomfort, and bruxism. In these cases, BOTOX Therapeutic™ is injected into the masseter muscles.

Some questions to ask yourself when considering BOTOX Therapeutic™ for headache:

1. On how many days in the last 3 months did you miss work or school because of your headaches?
   
2. How many days in the last 3 months was your productivity at work or school reduced by half or more because of your headaches? (Do not include days you counted in question 1 were you missed work or school).
   
   For questions 3 and 4, household work means general housework, home repairs, shopping, caring for family or other activities around the home.
   
   
3. On how many days in the last 3 months did you not do household work because of your headaches?
   
4. How many days in the last 3 months was your productivity in household work reduced by half or more because of your headaches?
   
5. On how many days in the last 3 months did you miss family, social or leisure activities because of your headaches?
   
6. On how many days in the last 3 months did you have a headache? (If a headache lasted more than one day, count each day).
   
7. On how many days in the last 3 months did you have to take medications for headache?
8. On a scale of 1-10, on average how painful were these headaches?
   (Where 0 = no pain at all, 10 = pain as bad as it can be).
   
   
9. When you have headaches, how often is the pain severe?
   [ Never ] [ Rarely ] [ Sometimes ] [ Very Often ] [ Always ]
   
   
10. How often do headaches limit your ability to do usual daily activities including household work, employment, school, or social activities?
    [ Never ] [ Rarely ] [ Sometimes ] [ Very Often ] [ Always ]
    
    
11. When you have a headache, how often do you wish you could lie down?
    [ Never ] [ Rarely ] [ Sometimes ] [ Very Often ] [ Always ]
    
    
12. In the past 4 weeks, how often have you felt fed up or irritated because of your headaches?
    [ Never ] [ Rarely ] [ Sometimes ] [ Very Often ] [ Always ]
    
    
13. In the past 4 weeks, how often have you felt too tired to do work or daily activities because of your headaches?
    [ Never ] [ Rarely ] [ Sometimes ] [ Very Often ] [ Always ]
    
    
14. In the past 4 weeks, how often did headaches limit your ability to concentrate on work or daily activities?
    [ Never ] [ Rarely ] [ Sometimes ] [ Very Often ] [ Always ]

1. What is BOTOX®?
   
2. What is BOTOX® treatment like?
   
3. Are there any special instructions for me to follow after treatment?
   
4. How much do BOTOX® treatments cost?
   
5. Am I vain?
   
6. What are the possible side effects?
   
7. Are there any people who should not use BOTOX®?
   

What is BOTOX®?
BOTOX® is a medicine made from a highly purified, naturally occurring protein which has the ability to very precisely relax the muscles to which it is applied. This relaxation lasts for a number of months, and then the treated muscles gradually return to their original condition.

BOTOX® does not affect the nerves responsible for sensation, so there is no numbness in the treated areas.
You can stop BOTOX® treatments at any time and be confident that you will gradually return to your pre-treatment appearance. If you have BOTOX® treatments for several years, you may find that the clock will slow down or stop in the treated areas, in particular if you are careful to protect that skin from sun exposure and smoke.

What is the difference between BOTOX® and fillers like Restylane®, Juvéderm® and ArteSense®?

BOTOX® relaxes the muscles which cause many facial lines and unwanted facial expressions.

Fillers fill creases, lips, cheekbones, and also defects like acne scars. Sometimes BOTOX® is used in combination with fillers, for example when treating frown lines on the lower forehead or wrinkles around the lips.

What is BOTOX® treatment like?

BOTOX® treatments are gentle and quick. No sedation or local anesthetic is required, so you will be able to continue with all of your usual activities immediately after your treatment. You can certainly drive yourself home or back to the office.

BOTOX® treatments take only a few minutes, and performed personally by Dr. Smith, using the finest 31 gauge needles to maximize your comfort.

A small amount of discomfort may be felt when the needle is inserted and a few drops of BOTOX® are applied to exactly the muscles which need relaxation. This sensation lasts approximately 5 seconds. Many patients are pleasantly surprised by the lack of discomfort, in particular when they are treated with the very fine and smooth 31 gauge needles.

Occasional patients experience a slight temporary bruising, perhaps the size of their baby fingernail, at an injection site. This can be hidden with cover up, and fades away in a few days.

Are there any special instructions for me to follow after treatment?

1. Exercise the treated muscles during the first hour after your BOTOX® treatment.
   To ensure the best possible uptake of BOTOX® by the treated muscles, Dr. Smith will encourage you to exercise the treated muscles using normal facial movements during the first hour after your BOTOX® treatment.
   
   For example, so that your BOTOX® will work to maximum advantage:
   
   -frown to exercise the muscles above and between the eyebrows which frown lines,
   -raise the eyebrows to exercise the muscles which cause forehead wrinkles, and
   -squint and smile to exercise the muscles which cause crow’s feet.
   
   
2. Do not touch or rub the treated areas until one hour after your BOTOX® treatment.
   It is also important for you to avoid rubbing or pressing on the injected areas for one hour to avoid spreading BOTOX® out of the treated muscles and into non-targeted muscles. If your BOTOX® was moved out of the muscles it is injected into, there might less effect on those muscles, and unwanted temporary relaxation of nearby facial muscles, which could be a nuisance for a week or two. In rare cases (perhaps one case in a hundred), this unwanted relaxation of muscles could cause temporary drooping of an eyelid or slight asymmetry of facial expression. Because the effects of BOTOX® are completely reversible, these rare side effects are temporary, and resolve after a few weeks.
   

After one hour there are no restrictions at all.

How much do BOTOX® treatments cost?

In Canada, BOTOX Cosmetic™ is not expensive; however there is a cost involved. Many cosmetic treatments were once considered a luxury item only for those who had a high disposable income. BOTOX Cosmetic™ is very affordable even for those with modest incomes, but some people need to budget for it just as they would for buying accessories like shoes and having their hair styled.

If your drug plan covers the cost of Botox Therapeutic™ for sweating or headache, your only cost for treatment of the following will be Dr. Smith’s fee. Otherwise, Botox Therapeutic™ will cost you $4 per unit, plus the administration fee.

Excessive sweating of the hands or feet: $200 per session for either or both hands, or either or both feet
Excessive sweating of the underarms: $150 for either or both underarms,
Migraine and muscle tension headache: $200

Remember that in Canada any costs for therapeutic treatment that is not covered by a drug plan or health spending account are a tax-deductible medical expense. Americans are generally allowed to use the cost of therapeutic treatments as a tax-deductible medical expense.

Am I vain?

Many people at some time before BOTOX® treatment for wrinkles or excessive sweating have fears and doubts. A common concern is that they are being vain. My experience has been that just about all patients who have BOTOX® treatment, laser hair removal, and other procedures to maintain their appearance and comfort are no more vain than anyone else. What does distinguish these individuals is a desire to get the most out of life, and to look as good as they feel.

Looking after your appearance is not a fault. After all, would you leave your house with broken gutters or peeling paint? Why do less for your body? I think you should feel proud of yourself for having the will and the ability to change something that you find unacceptable. I emphasize that you should only have BOTOX® treatment, laser hair removal, and other treatments if it is for you. It is a big mistake to do these things if it is just for somebody else.

As Dr. Richard Glogau of San Francisco has noted: the same self-esteem that makes our patients successful in their chosen fields, precise in their consultation questions, well groomed and well dressed, and often careful in their diet, exercise, and other aspects of health maintenance lead our patients to seek help for their wrinkles and frown lines.

These individuals are normal healthy people, and the same degree of self-interest that prompts them to exercise, be selective in what they eat and drink, and protect themselves from sun damage leads them to explore the benefits of BOTOX®. Our patients simply want to look their best.

What are the possible side effects?

There have been no long-term side effects, allergic reactions or health hazards related to BOTOX® use thus far. Some patients have been getting BOTOX® treatments on a regular basis for more than 15 years with no problems.

Are there people who should not use BOTOX®?

People who are allergic to albumin should generally not be treated with BOTOX®.

Our staff — many of whom have had BOTOX® treatments themselves — can take the time to discuss your wishes and options, and answer your questions.
No referral is required.

Niagara Falls Dermatology & Skin Care Centre Limited
Kevin Smith, MD, FRCPC Dermatologist
Licensed and inspected by the College of Physicians and Surgeons of Ontario

Fellow of the Royal College of Physicians and Surgeons of Canada
Board Certified in the United States by the American Board of Dermatology
Suite 201, 6453 Morrison Street, Niagara Falls, Ontario

Please call us Toll Free: 1-866-760-1000 if you have any questions, and to arrange for a prompt, confidential consultation and treatment. No referral is needed.