Botox® has been one of the most popular cosmetic treatments of the last 20 years.

For many, Botox and other brands of botulinum toxin injections have been a great way to maintain their youthful appearance. Botox injections work by blocking nerve signals to muscles. The injections prevent muscles from contracting for several months. While Botox injections are used to ease certain medical conditions, the results are not a cure and always temporary.  These injections are also used to treat hyperhidrosis (sweating), overactive bladder, migraines, and neck spasms.

In this Q&A, Ahuva Cices, MD, Assistant Professor of Dermatology at the Icahn School of Medicine at Mount Sinai, discusses the ABCs of Botox and other brands, including how they work, how long they last and how to know if this is the right treatment for you.

How does Botox work?

Botox is a brand.  It’s like saying Kleenex or Coca-Cola. It’s a type of neurotoxin or neuromodulator. This neurolmodulator comes from bacteria called Clostridium botulinum. We use the toxin that it makes to temporarily paralyze or control muscles.

The way that it works is that the neurotoxin prevents the nerve from activating the muscle by preventing the release of acetylcholine, which is a neurotransmitter that stimulates muscles to contract. It’s simply blocking the signaling that allows the muscle to contract. Other brands besides Botox are Dysport®, Xeomin®, Jeuveau®, and Daxxify®.

Patients will sometimes come in and ask me for Botox, but they don’t actually mean the brand Botox, they want a neurotoxin. It’s better to speak to your provider about which one would be best for you. Your doctor can determine the best treatment for by evaluating the individual patient, including the area to be treated and the patient’s goals.

What are the conditions you typically treat with Botox?

We use it for mostly for cosmetic purposes. The most common use is for the upper face, including the forehead, the glabellar area including the 11 lines between the eyebrows, and the lateral canthal lines, which are around your eyes.

Patients often say “I have these lines on my forehead” or “I look angry.” Those are some of the most common concerns. But there are many other cosmetic uses for neurotoxins. We use them in the mid face for areas like bunny lines; for correcting a “gummy” smile that shows more of your gum; and for a subtle lip enhancement with a lip flip. We can also prevent a downward turning of the mouth, which is common as we get older.

In addition, we can treat the neck. The platysmal bands can pull down on the neck, and we can get horizontal lines in the neck—we call this tech neck or necklace lines and they are becoming quite common from all the screen time. We can use neurotoxins for facial slimming by injecting the masseter muscles. We can also treat the masseters for bruxism for patients who grind their teeth or clench their teeth.

How long does Botox typically last?

In most people, these injections will last about three to four months. This can range from two to six months when patients will feel like it’s either started to wear off, fully worn off, or worn off enough to the point where they feel like another treatment is indicated.

The duration depends on the individual patient and product used. Different people have different metabolic rates of how fast their body metabolizes the injections or how it is degraded by the body. Different toxins also can last different lengths of time in different people. Over time, some people can develop antibodies to a specific toxin, and that one will not last as long or won’t be as effective. There are also certain areas where it will not last as long. For example:  if you’re correcting those lip lines, because the lips are moving so much it tends to be metabolized quicker in that area. It’s possible that people who exercise a lot tend to metabolize faster as well.

Duration also depends on the product used, dose of neuromodulator, and the concentration. For example, Daxxify lasts closer to six months and higher doses of any neuromodulator will last longer.

How soon do patients see the results?

Everyone may react a bit differently, but there are some overall trends. Daxxify works fast. It usually kicks in within 24 hours. Dysport usually kicks in within one to three days after treatment. Jeuveau is also on the quicker side, usually two to three days. Botox is a little bit slower. It can kick in at three days, but often it takes a bit longer about five days. All of the neurotoxins should have their full effect two weeks after the treatment.

At what age do you recommend patients begin these treatments?

I generally do not do these treatments on patients under the age of 18. I think anyone over 18 can be eligible. What I tell my patients is that when you start seeing lines that are staying in the skin and lingering after you make an expression, that’s the optimal time to start.

Once the lines are already etched in the skin, we can’t promise that the toxin will erase those lines. We can soften and smooth them. Over time, they may fade.  You want to catch it before those lines become etched in the skin permanently.

What are some of the potential side effects of these treatments?

Generally, these neurotoxins are very well tolerated. You can expect a little bit of discomfort with the injections. There could be a little bit of localized discomfort or temporary swelling. Bruising isn’t uncommon, but it’s not something that happens every time and it may happen just at one injection site. Some patients do develop a headache afterward, but it’s usually mild and does not last long.

Some patients  may have brow heaviness, and this is more common for a first timer, but this usually would resolve within the first few weeks and occurs from over treatment. Also, improper preparation can cause an infection at the injection site. Improper technique can cause a symmetry drooping; temporarily paralyzing a muscle not intended for treatment, which can either lead to asymmetry. All of these side effects would be temporary, so it’s still very safe.

What makes someone a good candidate?

Neurotoxin treatment is great for everybody who is not pregnant or needle phobic. It’s obviously not necessary, but I think it is a wonderful treatment for most patients.

Can you stop treatments once you start?

Completely. The effects are temporary. There’s no evidence of long-term changes or atrophy. The biggest downside is that neurotoxin treatments can be very addictive because it looks so good. You may not want to stop. In fact, many patients will do it recurrently for a long time, stop when they get pregnant, and then pick it right back up after.

What other treatments are popular?

Upper face cosmetic treatments are by far the most popular. More patients are asking about other cosmetic uses. We’re using it a lot in the lower face and in the neck. These subtle changes can actually give you the cosmetic look without being an obvious change.

Many people may not know these treatments are very versatile. Neurotoxin is covered by some insurances for underarm hyperhidrosis. But we can also use neurotoxin on the scalp to reduce sweat and allow for extended time between washes.

If you live with allergies, also referred to as allergic rhinitis, you know how annoying the symptoms can be. The itchiness, congestion, trickle in the throat—they can make it difficult to do the things you need, or want, to do.

It can also be difficult to determine the cause of your allergies (allergic rhinitis). For example, you could be allergic to airborne or environmental factors, such as ragweed or something in your home. Or it could be a seasonal condition. Whatever the cause, Alexandra Demeglio, a Physician Assistant in the Department of Otolaryngology at Mount Sinai Doctors – East 85th Street, says patients can get relief.

“Knowing what you are allergic to is helpful because there are ways to manage or eliminate the symptoms you are experiencing,” she says.

To make an appointment with Alexandra Demeglio, PA, call 212-241-9410.

Understanding your airborne and environmental triggers starts with a simple, rapid skin prick (also called a puncture or scratch) test. The test takes about two minutes to administer, and in as little as 15 minutes you can get results that can be used to develop a treatment plan. In this Q&A, she explains how that process works.

What are common allergy (allergic rhinitis) symptoms?

The most common allergy symptoms include:
• Nasal congestion, which may be accompanied by clogged ears
• Itchiness in the eyes, nose, ears, or throat
• Watery eyes or nose
• Post-nasal drip—mucus from your nose or sinuses that drips down your throat
• Red eyes or dry eyelids
• Worsening asthma symptoms
• Fatigue or brain fog

What is causing my allergy symptoms?

Many environmental and seasonal factors can trigger allergy symptoms. These include:
• Pollen (grass and trees in spring and summer; ragweed, pigweed, and mugwort in fall)
• Mold and mold spores
• Pets and other animals
• Pests, such as mice and roaches
• Feathers
• Changes in humidity
• Dust mites

Some causes are not just seasonal but also regional in nature, such as mold, which is relatively common in some states, including New York, but virtually nonexistent in other states, such as Arizona. Also, your home furnishings and décor can contain months—even years—of allergens, so keeping them clean will help to reduce or prevent symptoms.

Should I be concerned about my symptoms?

If over-the-counter medications are not providing relief from allergies and your symptoms are worsening or severe enough that they affect your quality of life, you should see an otolaryngologist about testing and treatment options.

Untreated allergies can lead to conditions such as nasal polyps, eczema, and asthma. To prevent that from happening, it is important to desensitize your immune system to affecting allergens. That starts with getting a better understanding of what you are allergic to.

A consultation with an otolaryngologist usually begins with a review of your medical history and symptoms followed by a nasal endoscopy of your nose and sinuses. Based on the findings, the otolaryngologist may prescribe an over-the-counter medication and lifestyle changes, recommend further consultation with a rhinologist, or refer you for a skin prick test.

What is a skin prick test?

The skin prick test is designed to deliver quick insights about the seasonal or environmental factors that are triggering your allergic symptoms. It is typically performed using the forearm among adults.

Before the test begins, the health professional will clean the forearm skin with alcohol. Using a device with multiple small needles, the professional will make gentle scratches along the skin and apply 40 different allergen extracts, such as pollen, cat hair, and mold. In cases involving suspected food allergies, a referral will be made to an allergist for the skin prick test.

The process typically takes two minutes. During the test, the health professional will apply two other substances to measure patient reactions to the allergens—histamine, which is released by the body during an allergic reaction, and a glycerin saline solution, which typically produces no reaction.

How do I prepare for a skin prick test?

To prepare for a skin prick test, you should:
• Stop taking prescription and over-the-counter antihistamine medications, including sprays, at least one week before the test. This will ensure that the test is accurate in identifying allergies and the degree of severity.
• Discontinue oral acid reflux medications up to three days before the test.
• Delay taking any blood pressure medication until after the test.

Patients who are taking steroid-based nasal sprays or other medications to treat asthma or allergic asthma can continue to do so.

Skin prick tests are not recommended for patients who are not able to suspend medications that can interfere with the outcomes of the test. In these cases, a blood test will be performed. Skin prick tests are also not recommended during pregnancy to prevent the risk of a bad reaction that affects blood flow to the fetus.

What happens after the test?

Once the allergen extracts have been applied to the skin, the health professional will wait 15 minutes and then check the patient’s forearm for reactions. They are looking for anything that resembles a mosquito bite, which is a positive. They will also look at the degree of sensitivity, which they measure using a scale from one to four, with four meaning a large hive. That tells providers what a patient is very allergic to.

The results, which are revealed the day of your appointment, will determine treatment recommendations. Patients who demonstrate a mild reaction are typically prescribed a six-to-eight-week regimen of over-the-counter antihistamines. Patients who demonstrate a severe reaction, or whose symptoms are not controlled, or worsen, during antihistamine treatment, are referred to an allergist or immunologist for further assessment and, in some cases, allergy immunotherapy shots. Patients whose test results are negative despite displaying symptoms will be referred to an allergist for intradermal testing, in which the allergens are injected under the skin.

Ultimately, once you have a better idea of what is causing your symptoms, you have options that can provide relief from allergies. Mount Sinai’s team of otolaryngologists, allergists, and immunologists are available to help you.

“Our otolaryngology program spans everything from head and neck to rhinology,” Ms. Demeglio says. “Our clinicians are on the cutting edge in treating people efficiently and effectively. We know the appropriate treatments, and we can individualize them so that we can improve your quality of life.”