BOTOX® - Mesa, Arizona.

BOTOX® Special $8.00 per high-potency unit with a minimum purchase of 100 units. This special requires units to be used on same day - may be shared with a buddy. Buddy deal requires that one client be new and both clients come together. East Valley Ophthalmology discount or special offers are available for a limited time only, may not be combined with any other offer, and may be revised or discontinued at any time without notice. Other restrictions may apply. Please call our office for details. 480-981-6111.

Dr. Nirenberg and BOTOX®

At East Valley Ophthalmology, Dr. Neal Nirenberg is a Board Certified Ophthalmologist (M.D.) who specializes in performing state-of-the-art BOTOX® Injections.

In our office, BOTOX® is used to eliminate the wrinkles in the forehead, brow area and crow's feet around the eyes. With BOTOX®, you can achieve a smoother, more youthful appearance without the bruising, swelling and downtime of invasive cosmetic surgery. You'll truly be amazed and delighted to see what BOTOX® can do to rejuvenate your appearance!

Dr. Nirenberg has become an expert at administering BOTOX® since it first was approved by the FDA for use around the eyes. He takes the time and interest in each patient to achieve the desired effect for the treatment of lines and wrinkles. Dr. Nirenberg would be delighted to discuss your procedure with you in great detail.

If you’re considering BOTOX®, you want to be as educated as possible. You should always do your own research. If you’re well-informed, you can help to ensure the safety of your treatment and your satisfaction with the results. You need to be aware of exactly what is being used in your treatment, whether the person administering your treatment is qualified, and last but not least, if you are even a candidate for BOTOX®. We invite you to call and have your questions answered or to make an appointment: 480-981-6111.

Frequently Asked Questions About BOTOX®

Quality/Quantity - What Are You Getting?

Unfortunately, the BOTOX® you get at one practice may not be exactly what you get at another. The old adage is still true..."if it sounds to good to be true...it probably is." Do not shop for the cheapest price for BOTOX® treatments. Poor results are not a bargain...at any price.

BOTOX® is a medical grade toxin that is derived through a safe process that will never give you Botulism. However, it is extremely important that you go to a reputable M.D. that purchases BOTOX® from Allergan, made specifically for BOTOX® treatments.

What regulations? ? ?

There currently are NO regulations concerning how much solution is mixed with BOTOX®. Many physicians dilute the BOTOX® by quite a bit in order to lower the cost, sometimes at the expense of reducing the effect to near zero. Although there is a great variation in toxin dilution used by practitioners, in our opinion this particular aspect of the technique remains very important: using the appropriate amounts of BOTOX® in very low amounts of saline solution that reduces side effects while maximizing results.

Ask: "How much BOTOX® is diluted prior to treatment?"

Dr. Nirenberg mixes your BOTOX® solution himself, so you get the medically appropriate amount and are never short changed. When you receive BOTOX® injections from Dr. Nirenberg you are assured of getting the absolute most value for your dollar: minimum dilution means less volume is needed for the results you want - every precious drop works for you.

Dr. Nirenberg prepares and administers your BOTOX® the same day. No patient of ours ever receives BOTOX® that has been stored for days or even weeks. Though this may not be the most convenient for office scheduling, it assures the maximum and best results for our patients. You are guaranteed fresh, maximum-quality BOTOX® treatments.

Why is BOTOX® diluted?

Clostridium botulinum toxin type A is supplied in a manufacturers’ vial containing 100 units of the vacuum-dried neurotoxin complex. In order to be able to inject these active units of BOTOX®, a physician must add saline to get it in "liquid form." This process enables the BOTOX® to be extracted from the vial into the syringe.

There are 100 units of BOTOX® in every vial. As you can see in the table below, the more saline (in mL) added to the BOTOX® vial, the less active units present in each 1/10 mL extracted into the syringe. Some may refer to this is as the dilution process, but it is actually called “reconstitution.” So now, while each practice gets the same product from the manufacturer, when they reconstitute it to make it possible to inject, they can add saline at the recommended standard or they can add more saline than recommended.

Recommendations for Reconstitution and Handling**

Diluent (saline) added to BOTOX® vial (0.9% sodium chloride injection)	Resulting dose/ Units per 0.1 (1/10) mL
1.0 mL	10.0 U
2.0 mL	5.0 U
2.5 mL	4.0 U*
4.0 mL	2.5 U
8.0 mL	1.25 U

* Approved dose is 4 units per 0.1 mL at each of the 5 injection sites for a total dose of 20 units in 0.5 mL.
** Data from the Supplement to Plastic and Reconstructive Surgery, provided by the American Society of Plastic Surgeons.

You may think you are getting a "good dose" of BOTOX® because the physician is injecting a large amount, but don’t confuse the units of saline with the units of actual BOTOX®. Physicians who add more saline than suggested by the manufacturer or the American Society of Plastic Surgery are giving you a less effective injection of BOTOX®. Always ask this question: “What is your reconstitution ratio?”

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Who should administer BOTOX®?

BOTOX® is available only by prescription. The Food and Drug Administration (FDA) has issued statements warning of the possible hazards of "BOTOX® parties." BOTOX® injections are medical procedures that should be performed in a controlled medical environment by a qualified physician. According to the FDA, administering this treatment during a cocktail party greatly diminishes the gravity of this medical procedure. There is always a risk of adverse reactions or side effects after a BOTOX® injection, so patients need to be in a capable medical setting that is equipped to handle such a situation. The ingestion of alcohol at or around the time of injection could worsen any bruising at the injection site.

Why choose an ophthalmologist for BOTOX® treatments?

BOTOX® was originally introduced to the world in the 1980's by ophthalmologists as a treatment for uncontrollable facial and eyelid spasms, as well as for eye muscle dysfunctions, such as crossed eyes (strabismus). As a remarkable side benefit of these treatments, many patients noticed that the wrinkles around their eyes were diminished and began asking for further treatments specifically to achieve this effect.

More than any other medical specialty, eye surgeons are specifically trained to address the eye and the delicate tissues surrounding the eye, which is exactly where BOTOX® Cosmetic treatments are given. Plus, Dr. Neal Nirenberg is Board Certified, with extensive experience in plastic surgery involving the eyes. You can be certain you are in highly skilled hands.

Your BOTOX® procedure here at EVO

At East Valley Ophthalmology, BOTOX® treatments are performed as an office visit where a fine gauge needle is used to place a small amount of the diluted BOTOX® under the skin next to the muscle responsible for creating the targeted wrinkle. The BOTOX® that is injected then causes the muscle to relax and the wrinkle to be softened or removed. BOTOX® treatments are quick, safe and effective in the hands of an experienced physician like Dr. Neal Nirenberg.

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What is BOTOX® Cosmetic?

BOTOX® Cosmetic is a purified protein produced by the Clostridium botulinum bacterium, type A (onabotulinumtoxinA). It is a prescription medicine, non-surgical, physician-administered injected treatment that can temporarily reduce moderate to severe crow's feet lines and frown lines between the eyebrows in adults.

BOTOX® has been used in the field of ophthalmology since the 1980's, and over a million people have been treated with BOTOX® Cosmetic since its FDA approval in 2002. Today, BOTOX® is at the forefront of the ever-evolving field of non-surgical aesthetic enhancements. This simple procedure, accomplished in a matter of minutes, can restore the youthful appearance of your face. While the results vary according to your unique physiology, typically results are seen within 3-7 days and can last up to 4 months or longer. Plus, unlike cosmetic surgery, BOTOX® is safe and virtually non-invasive.

BOTOX® sounds like magic - is it?

BOTOX® Cosmetic is not magic. It's medicine. BOTOX® will not radically change your appearance or make you look 20 years younger. Because it's highly localized and administered intramuscularly, its effects are usually confined to the region of injection, and BOTOX® does not remain in your body indefinitely.

However, if doing all you can to look your best is important to you, BOTOX® may be an excellent choice. If reducing those lines between your brows would make you feel more attractive, BOTOX® is here for you. Thousands of appearance-conscious women and men are discovering the benefits of BOTOX®. And not just models and movie stars! Everyday people — teachers, mothers and business people, BOTOX® is now affordable and accessible to people from all walks of life.

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Is BOTOX® affordable - What will this cost me?

Like other appearance-related investments, such as hair coloring and cuts, teeth whitening and chemical peels, the cost must be weighed relative to your expectations. When considering facial aesthetic options, BOTOX® is quite affordable relative to other treatments. According to an American Society for Aesthetic Plastic Surgery survey, BOTOX® Cosmetic is one of the least expensive facial aesthetic procedures in the United States.

We charge by the unit for BOTOX®, so you only pay for the exact number of units you receive. Also, we follow the American Society of Plastic Surgery (ASPS) guidelines on "reconstitution," so you are assured of the efficacy of the product. Dr. Nirenberg will discuss with you which areas on your face should receive injections to best meet your concerns, and he will tell you how many units of BOTOX® you will need to attain your desired result.

Beware of "bargains"

You should be cautious when practices offer BOTOX® at bargain prices. Everyone pays the same price to get the product from the vendor (Allergan). So how can prices vary so much? That’s where the “reconstitution” question becomes very important. Below, Diagram A illustrates the recommended starting doses of the frequently injected areas.

Beware of pricing by "the area"

Also, many facilities quote a price based on a particular area. Now, besides your "reconstitution question," you need to ask, "How many units do you inject in that area?" And that begs the next question—what is their definition of an "area." For instance, a practice may advertise $99 per area, but may be actually breaking up the crow’s feet area into two areas when in most practices, it is considered one area.

Dosage per manufacturer (Allergan):

CROW'S FEET 24 UNITS

GLABELLAR LINES 20 UNITS

Crow’s feet lines can be treated either alone or with glabellar lines. Pivotal studies show 44 Units, simultaneous treatment.

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How does BOTOX® work?

Moderate to severe wrinkle lines form over time as the result of muscle activity. BOTOX® Cosmetic is injected directly into the muscles. It works by blocking the transmission of nerve impulses to the injected muscles; this reduces the activity of the muscles that cause those persistent lines to form.

During treatment, very low doses of BOTOX® Cosmetic are administered via a few tiny injections directly into the muscles that cause those stubborn lines. When BOTOX® Cosmetic is injected into the muscles surrounding the brow area for instance, those muscles cannot "scrunch up" for a period of time. They are paralyzed. Any wrinkles in that area, often referred to as furrows or frown lines, temporarily go away. The treatment is usually done in about 10 minutes and no recovery time is needed.

When will I see results from a BOTOX® treatment?

Within days, you may see a marked improvement in the moderate to severe frown lines between your brows. Lines continue to improve for up to a month, and results can last for up to 4 months. In clinical trials, nearly 90% of men and women rated the improvement in their appearance as moderate to better 1 month after treatment. Results may vary.

How long does BOTOX® last?

Results from treatment with BOTOX® Cosmetic can last for up to 4 months. If you discontinue treatment, the frown lines between your brows gradually will look like they did before treatment.

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Is treatment with BOTOX® painful?

Discomfort is usually minimal and brief. The entire procedure takes approximately 10 minutes. Many people return directly to work or normal activity following BOTOX® Cosmetic treatment.

Who should not use BOTOX®?

BOTOX® is approved for use in adult patients 18 to 65 years of age. However, BOTOX® should not be used if you are pregnant, or think you might be pregnant, or in the presence of infection at the proposed injection site(s) or by any individuals with known hypersensitivity (or allergies) to any ingredient in the formulation. Patients with neurological disorders such as ALS, Myasthenia Gravis or Lambert-Eaton syndrome may be at increased risk of serious side effects.

Tell Dr. Nirenberg if you have any diseases that affect your nerves and muscles. These diseases may increase your chance of side effects with BOTOX® Cosmetic treatment. Also tell Dr. Nirenberg if you are breastfeeding or are planning to become pregnant soon.

Be sure that Dr. Nirenberg knows the names of all the medicines you are using, including: antibiotics used to treat infections, such as gentamicin, tobramycin, clindamycin, and lincomycin medicines used to treat heart rhythm problems, such as quinidine and medicines used to treat different conditions, such as myasthenia gravis or Alzheimer's disease. As with all prescription medicines, you should also notify Dr. Nirenberg if you are taking any over-the-counter medicines or herbal products. This is not a complete list of medicines that can interact with BOTOX® Cosmetic, so be sure to discuss everything you are taking with Dr. Nirenberg.

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Will I experience any side effects with BOTOX®?

BOTOX® Cosmetic is contraindicated in the presence of infection at the proposed injection site(s) and in individuals with known hypersensitivity to any botulinum toxin preparation or to any of the components in the formulation. Possible side effects include headache, respiratory infection, flu syndrome, temporary eyelid droop, and nausea. Less frequently occurring (<3%) adverse reactions include pain in the face, erythema at the injection site, and muscle weakness. These events are thought to be associated with the injection itself rather than the BOTOX® and occurred within the first week. For detailed information on the risks and side effects, please go to BotoxCosmetic.com

Will my face look natural after BOTOX®?

Although the results are visible, a treatment with BOTOX® Cosmetic will not radically change your facial appearance or make you look as if you "had work done." After treatment with BOTOX® Cosmetic, you may look in the mirror and see a marked improvement in the moderate to severe frown lines between your brows. The muscle activity that causes frown lines between the brows is simply reduced, so you can still frown or look surprised without the wrinkles and creases between your brows.

What if I choose not to continue BOTOX® injections?

BOTOX® Cosmetic works by temporarily reducing the contractions of the muscles that cause those persistent frown lines that have developed between your brows over time. Within days, you may see an improvement that can last up to 4 months, sometimes longer. Results vary according to your unique physiology. If you do not continue treatments, the frown lines between your brows will gradually look like they did before treatment.

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Who makes BOTOX®?

BOTOX® is the result of years of careful research and testing by the Allergan Corporation. Allergan BOTOX® product is the only one of its type. No other company manufacturers anything like it.

ALL MEDICAL PROCEDURES CARRY SOME UNCERTAINTY AND RISK

Possible Side Effects Include:

Temporary eyelid droop
Upper respiratory-tract infection
Headache
Flu syndrome
Bruising/soreness at injection site
Nausea

FOR MORE INFORMATION:

• FDA
• Allergan

BOTOX® - Mesa, Arizona.

If you would like further information, please call our office at:

480-981-6111

East Valley Ophthalmology

Eye Doctors - Mesa, Arizona

The Best Possible Skin Care

At East Valley Ophthalmology, Dr. Nirenberg performs plastic surgery and anti-aging skin care treatments, as well as taking the time necessary to provide each patient the personal education needed to fully understand their condition, care and options, and to get the best possible outcomes for his patients. Please take a moment to Request an Appointment.