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Dermatologist offers botulinum toxin injection pearls for the general ophthalmologist
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 Joely Kaufman |
KAANAPALI, Hawaii — Botulinum toxins offer a number of options for ocular aesthetic procedures, but it is best to start with the "easiest, most successful areas" before branching out, a presenter here said.
Joely Kaufman, MD, FAAD, gave pearls during a presentation at Hawaiian Eye 2011 for general ophthalmologists who wish to start using botulinum toxin injections in their practices.
Some of the more common indications for injections ophthalmologists can perform are forehead wrinkles, bunny lines, glabella lines and crow's feet.
In injecting for crow's feet, "it's important to note that some people are left with a line below the crow's feet, which is actually from the cheek muscles," Dr. Kaufman said.
Dr. Kaufman recommended storing the toxin in the freezer at 2° C until reconstituted and then moving it to the refrigerator at 6° C to 8° C in preparation for injection. Recommendations for dilution and concentration levels vary depending on the type of procedure, but should be done using a non-preserved or a preserved 0.9% saline solution, she said.
Dr. Kaufman recommended using either an insulin syringe with a 32-gauge needle or a hubless insulin syringe with a 30-gauge needle.
"I use a hubless 30-gauge needle," Dr. Kaufman said. "The problem with a 32-gauge needle is the needle is not changeable."
Patients should return to the office 7 days after a botulinum procedure for follow-up. "A significant number of patients will have further improvement after this time, with a maximum response at 30 days post-injection," Dr. Kaufman said.
She noted that men generally require 30% to 50% more botulinum units per area than women.
"As for the future, what we are starting to see is the use of small amounts all over the face as sort of a pseudo-facelift, which I think is subtle at best but an interesting technique," Dr. Kaufman said. She also noted the possible future introduction of topical botulinum.
- Disclosure: Joely Kaufman, MD, FAAD, has no relevant financial interest to disclose.
Hawaiian Eye and Retina 2012 will be held January 15-20 at the Grand Wailea Resort & Spa in Maui. Learn more at OSNHawaiianEye.com or RetinaMeeting.com.