android barcode scanner api java FIGURE 22-26 Injection sites to treat nasal bunny lines in .NET framework

Print Quick Response Code in .NET framework FIGURE 22-26 Injection sites to treat nasal bunny lines

FIGURE 22-26 Injection sites to treat nasal bunny lines
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FIGURE 22-27 A Patient with a long upper lip B Patient with a short upper lip This patient is a better candidate for Botox injection to raise the tip Differences in pain perception among patients treated with the commercially available toxin preparations have not been studied extensively; however, results from the only comparative study of three available preparations of the toxin showed that the pain induced by Neurobloc (BTX-B) was found to be significantly higher than that induced by Botox and Dysport (BTX-A), between which no significant difference was found The study concluded that the different chemical properties and pharmaceutical adjuvants in toxins A and B likely affect the pain sensation and speculated that the pH difference of Neurobloc (pH 56) and Botox/Dysport (pH 68) influences pain perception Pain sensation during toxin injections is usually fleeting, and simple measures can improve patient comfort78 For facial wrinkles, anesthesia is not necessary unless the patient prefers it The 30gauge needles that are used to inject the medication are the same size as acupuncture needles and cause minimal pain in a calm patient Allowing the BTX to come to room temperature may decrease the level of pain otherwise felt by the patient When the physician approaches the patient in a calm and reassuring manner, not allowing the patient see the needles prior to and during the injections, the patient s anxiety is significantly reduced as is the perception of pain Topical anesthetic creams such as EMLATM or LMXTM can be applied prior to injection to decrease the sensation of pain BTX should not be mixed with local anesthetics because they can alter the pH of the preparation and cause the toxin to lose potency Ice packs can be applied prior to injections, which may decrease the pain and encourage vasoconstriction, resulting in less bruising (see 21) For hyperhidrosis, pain control is a necessity, especially for the palms and soles Although some physicians perform nerve blocks, the primary author uses the following method: at least 1 hour prior to treating for hyperhidrosis, the topical anesthetic Ela-Max or EMLA (eutectic mixture of local anesthetic) is applied to the area to be treated Next, these areas are occluded with plastic bags or gloves when treating hands and feet or with tape when treating axillae Many attempts have been made to decrease the pain associated with the use of BTX for palmar hyperhidrosis These have included topical anesthetics, intravenous regional anesthesia, nerve blocks, ice, Frigiderm spray,79 and others The use of nitrous oxide ( laughing gas ) requires office training and can induce an anxiolytic rather than a pain-diminishing effect79 Ongoing trials to assess the effects of different anesthetics for an optimal injection with minimal pain are needed to establish the full potential of the different approaches of pain reduction with BTX injections
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troversial While a few investigations failed to show a positive effect of Botox in the prevention of migraine or chronic headaches,81 83 BTX may have a role in reducing the severity of headaches experienced by some patients83 Some recent studies specifically designed to target headaches and chronic migraines demonstrated efficacy of botulinum toxins in patients with chronic migraines and suggested further trials to reach an ideal optimal consensus on the safety and efficacy of this toxin in migraine/ headache therapy84
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BOTULINUM TOXIN IN PERSISTENT FACIAL FLUSHING
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Facial flushing is not an uncommon problem in fair-skinned individuals of Celtic and northern European descent A vasomotor phenomenon that results in increased erythema, persistent facial flushing can be accompanied by facial telangiectasias and gustatory sweating Facial flushing is categorized as either autonomic neural-mediated (wet) or direct vasodilator-mediated (dry) The method by which BTX-A works to affect vasodilation is unknown, and the results regarding its efficacy for this indication are inconclusive One theory is that BTX might work through reduction of local subclinical inflammation, which contributes to persistent erythema Moreover, the anti-inflammatory role of BTX-A in blocking substance P, vanilloid receptor 1 (TRPV-1), and calcitonin gene-related peptide (CGRP) is important in decreasing the subclinical inflammation that might present as erythema85 Only Yuraitis et al have described an improvement related to facial flushing in limited case reports86 Alexandroff as well as Kranendonk et al failed to show an effective response to BTX-A for facial flushing in three published cases87,88 Further studies are required to better assess the safety and efficacy of this procedure
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