Lip Augmentation

Rapidly becoming one of the most popular cosmetic procedures, non-surgical lip augmentation has really come to the fore in the aesthetic world over recent years. Thinning and inversion of the lips, a classic sign of ageing, has become the target of hyaluronic acid (HA) fillers that replace lost volume in order to attain a more youthful smile and fresher appearance. 

Those most likely to benefit from lip augmentation with reversible and non-permanent HA fillers like Juvéderm Volbella® are individuals with thinning out lips that may appear elongated with downturned corners of the mouth. HA fillers can restore the volume of the lips, as well as the youthful definition around the lip border and Cupid's bow. 

Undertaking lip augmentation should not be taken lightly, as there are known potential risks if not performed by an accredited and trained aesthetic healthcare professional, and unfortunately a number of horror stories related to lip treatments have emerged over the years, but it should be noted that most concerned the use of permanent 'silicone' lip fillers that have fortunately been phased out in the UK. All cosmetic lip procedures are carefully carried out by Harley Street-trained Dr. Joseph, who uses premium HA fillers, such as Juvéderm Volbella® and Ultra Smile®, to achieve a natural, youthful and perfectly proportioned result. 

For more information on Lip Augmentation, and for a Free Consultation, please get in touch with the Joseph & Joseph Medical Team.

My Botox Treatment

Hi, I'm Carly, CEO of Joseph & Joseph Medical.

I am 31 years old, mother to a very lively toddler and medical aesthetic nurse practitioner.

This weekend I have had anti-wrinkle injections for the first time. I had been toying with the idea for a while and decided, why wait? After seeing so many of our clients with amazing results, it's my turn!

I feel that since having my son nearly 2 years ago, I have aged significantly. Sleep derivation, lack of exercise and a general shortage of relaxation have led to some major frown and forehead lines. The time has come for some serious rejuvenation, the kind that all of the anti-ageing creams and 'turn-back-time' facials in the world cannot come close to.

Follow my journey on Instagram and Facebook, ask as many questions as you want, I am happy to answer. Stay tuned...

The Science Behind Dermal Fillers

Dermal fillers are products injected under the skin to replace or augment volume with the aim of improving the aesthetics of the face. The market today is dominated by products which contain hyaluronic acid, these products have by far the best safety profile. 

At Joseph & Joseph Medical, we only use  the most premium dermal filler product on the market which is Juvéderm® manufactured by a company called Allergan®. These products have been used safely (when administered by a competent medical professional) with the best efficacy and duration of treatment compared to other products on the market.

So what exactly is hyaluronic acid?

Hyaluronic acid (HA) consists of alternating units of 1,4 linked N-acelylglucosmaine and glucoronic acid. A common carbohydrate, examples of which are found in collagen under the skin and other tissues of the body. It consists of repeating units of N-acelylglucosamine and glucuronic acid and the chains can be extremely long. The HA molecule has some unusual properties - a high degree of elasticity, excellent lubricating properties and the ability to hold around one thousand times its weight in water.

Within the human body, HA is continuously made and then broken down. Production of HA slows as we age, and due to its immense ability to attract moisture, lower amounts of HA results in skin losing its plump, smooth appearance. This is one significant factor accountable for the decrease in skin volume associated with the ageing process.

Due to the short half-life (24 to 36 hours) of HA within the body, Allergan®, the makers of Juvéderm® modified the molecule so that it would would be commercially viable. By cross-linking Juvéderm with a molecule called BDDE 1,4-butanediol diglycidyl ether, the product is able to slow down the natural metabolism of the molecule and instead it can take up to 12 months to be metabolised. The Juvéderm® Vycross® range maximises the placement time within the body for even longer and can last for up to 18 months. At Joseph & Joseph Medical, we typically use Juvéderm Volbella® & Juvéderm Volift® to rejuvenate peri-oral lines, naslobaial folds, the oral commissures, marionette lines and for our lip augmentation treatments.

The soft gel dermal filler easily integrates within the native collagen and elastin molecules within the body giving a natural result and is reversed by using a product called hyaluronidase if no longer required.  The hyaluronidase immediately breaks up and dissolves the long HA chains.

One study [1] resulted in the finding of two interesting additional benefits of dermal fillers. Firstly, it found that administering HA stretched fibroblasts, which are the most common cells in the connective tissue of all animals. These skin cells make collagen and when stretched with HA filler were found to create new collagen. This new, natural collagen can then contribute to the reduction and appearance of static wrinkles and creases. The study also found that not only do dermal fillers facilitate the body to produce new collagen it also inhibits the breakdown of existing collagen which in turn can dramatically slow down the aesthetic ageing process.

Joseph & Joseph Medical would love to meet with you for a complimentary consultation to discuss how we can help you reduce the signs of ageing. We are now based at Guys & Dolls Parlour, an award winning beauty spot in Shoreditch, East London, and will be running Sunday clinics there each month.

References:
[1] Fisher GJ, Varani J, Voorhees JJ. Looking older: Fibroblast Collapse and Therapeutic Implications. Arch Dermatol 2008 May; 144(5): 666-672.

Feature in TimeOut London & Collaboration with Guys & Dolls Parlour

I am pleased to announce our collaboration with the amazing Guys & Dolls Parlour, Shoreditch, London.

We will now be running fortnightly aesthetic clinics providing bespoke rejuvenation packages including anti-wrinkle (Botox®) injections and dermal fillers. We are taking bookings for our Sunday clinic now. 

Please have a look at our feature in TimeOut London…...

https://www.timeout.com/london/shopping/guys-and-dolls-parlour

 

Botox® In The Treatment of Depression

Depression affects more than 350 million individuals worldwide and is known to be one of the greatest medical challenges of our time [1]. The current options for the treatment of depression including psychotherapy and pharmacology but these are often ineffective which is why further studies are being carried out to investigate different treatment options.

Jeffrey Borenstein, MD, president and CEO of the Brain and Behavior Research Foundation in New York City, said at the press conference that pursuing new treatments for depression is "crucial."

An emerging novel approach to the treatment of depression is the injection of Botulinum Toxin A into the glabella (frown muscles) of the forehead. This treatment was initially discovered in June 2014 by investigators at the Hannover Medical School in Germany. A total of 30 patients with high levels of chronic and treatment-resistant depression were enrolled in the study. Patients were randomly assigned to receive a single injection of Botox® or a single injection of saline placebo.

Six weeks after a single treatment, the Botox® group had an average 47.1% reduction in symptoms of depression vs. 9.2% in the placebo group. The investigators found that the effect size was even larger at the end of the study.

The study investigators described seeing positive effects on mood in patient’s who had just a single Botox® treatment for the frown lines in the area above the nose and between the eyebrow (Glabella Region).

Study investigator Professor Tillmann Kruger said at a press conference at the American Psychiatric Association’s 2014 annual meeting, "Our emotions are expressed by facial muscles, which in turn send feedback signals to the brain to reinforce those emotions. Treating facial muscles with Botulinum Toxin A interrupts this cycle”.

A second study by Magid & Kruger et. Al in New York, 2015, conducted 3 independent randomized, controlled trials and consistently showed that a single glabella treatment with Botox® reduces symptoms of depression [2] [3] [4] [5].

Treatment of frown lines for cosmetic reasons is an approved indication for Botulinum A toxin and is the most frequent intervention in aesthetic medicine [6]. “Several studies have shown that this particular cosmetic treatment may exert psychological effects, which may contribute to its popularity [7] [8] [9] [10] [11]. Those who received Botulinum A toxin in the forehead reported feeling less depressed, irritable, and anxious, as compared to the control group, despite both groups feeling “equally attractive” after the intervention”. This indicates that Botulinum A toxin in the forehead has positive mood effects above and beyond the euphoria you would get solely from improved appearance.

The study paper says that; “The mood-lifting effect of such a Botulinum A toxin treatment may be explained by the facial feedback hypothesis, which dates back to Charles Darwin and William James in the 19th century and has been substantiated in several experimental studies [12] [13] [14]. In theory, contraction of facial muscles sends a message to the emotional centres of the brain. Smiling can reinforce and maintain feelings of well-being, whereas frowning can lead to the opposite. It is assumed that by paralysing the injected frown muscles interrupts a proprioceptive feedback loop from the face to the emotional brain, therefore reducing the ability to feel negative emotions [15] [16] [17]. In depression, there is a relative over-activity of frown muscles, which has been confirmed electrophysiologically, and whose elimination by Botulinum A toxin treatment could potentially soften the correspondent experience of fear, anger, and sadness [18] [19]”.

There would be many potential benefits to using Botulinum A toxin as a treatment for depression. It is a one-off dose and the effect scan last for months. It has an excellent safety and tolerability record and is already approved as a treatment for the glabella frown lines. [20] [21].

 

References

1. Marcus M, Yasamy MT, van Ommeren M et al. Depression: a global public health concern. World Health Organization (WHO); fact sheet on depression 2012.

2. Finzi E, Wasserman E. Treatment of depression with botulinum toxin A: a case series. Dermatol Surg 2006; 32: 645-649 discussion 649–650.

3. Wollmer MA, de Boer C, Kalak N et al Facing depression with botulinum toxin: a randomized controlled trial. J Psychiatr Res 2012; 46: 574-581.

4. Finzi E, Rosenthal NE. Treatment of depression with onabotulinumtoxinA: a randomized, double-blind, placebo controlled trial. J Psychiatr Res 2014; 52: 1-6

5. Magid MR, Reichenberg JS, Poth PE et al. Treatment of major depressive disorder using botulinum toxin A: a 24-Week randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2014; 75: 837-844

6. Winter L, Spiegel J. Botulinum toxin type-A in the treatment of glabellar lines. Clin Cosmet Investig Dermatol 2009; 3: 1-4

7. Heckmann M, Teichmann B, Schroder U. Pharmacologic denervation of frown muscles enhances baseline expression of happiness and decreases baseline expression of anger, sadness, and fear. J Am Acad Dermatol 2003; 49: 213-216

8. Sommer B, Zschocke I, Bergfeld D et al. Satisfaction of patients after treatment with botulinum toxin for dynamic facial lines. Dermatol Surg 2003; 29: 456-460

9. Lewis MB, Bowler PJ. Botulinum toxin cosmetic therapy correlates with a more positive mood. J Cosmet Dermatol 2009; 8: 24-26

10. Davis JI, Senghas A, Brandt F et al. The effects of BOTOX injections on emotional experience. Emotion 2010; 10: 433-440

11. Havas DA, Glenberg AM, Gutowski KA et al. Cosmetic use of botulinum toxin-a affects processing of emotional language. Psychol Sci 2010; 21: 895-900

12. Ekman P, Levenson RW, Friesen WV. Autonomic nervous system activity distinguishes among emotions. Science 1983; 221: 1208-1210

13. Adelmann PK, Zajonc RB. Facial efference and the experience of emotion. Annu Rev Psychol 1989; 40: 249-280

14. Larsen RJ, Kasimatis M, Frey K. Facilitating the furrowed brow: an unobtrusive test of the facial feedback hypothesis applied to unpleasant affect. Cogn Emot 1992; 54: 321-338

15.Hennenlotter A, Dresel C, Castrop F et al. The link between facial feedback and neural activity within central circuitries of emotion-new insights from botulinum toxin-induced denervation of frown muscles. Cereb Cortex 2009; 19: 537-542

16. Finzi E. Antidepressant effects of botulinum toxin A: scientific rationale. J Psychiatry Neurosci 2013; 38: E29

17. Finzi E. The face of emotion: How botox affects our moods and relationships. Macmillan; 2013

18.Schwartz GE, Fair PL, Salt P et al. Facial muscle patterning to affective imagery in depressed and nondepressed subjects. Science 1976; 192: 489-491

19. Greden JF, Genero N, Price HL. Agitation-increased electromyogram activity in the corrugator muscle region: a possible explanation of the “Omega sign”?. Am J Psych 1985; 142: 348-351

20. Cavallini M, Cirillo P, Fundarò SP et al. Safety of botulinum toxin A in aesthetic treatments: a systematic review of clinical studies. Dermatol Surg 2014; 40: 525-536

21. Young SN. Single treatments that have lasting effects: some thoughts on the antidepressant effects of ketamine and botulinum toxin and the anxiolytic effect of psilocybin. J Psychiatry Neurosci 2013; 38: 78-83

About Botox®

Wrinkle Reduction Treatment (BOTULINUM A TOXIN)

Botulinum A toxin is a sterile, purified protein produced in the laboratory from the bacteria Clostridium botulinum. This protein is injected in very small amounts into the face to target prominent frown lines and crows feet around the eyes. It works by binding to the nerve endings supplying the muscles and preventing nerve impulses being sent to the muscle. The overall effect is relaxation of the targeted area, which in turn reduces wrinkles and prevents new wrinkles from forming.

At Joseph & Joseph Medical London we use Allergan® Botox® which is the safest and most premium product on the market. We strive to ensure complete customer satisfaction and excellent results.

Frequently Asked Questions

What will happen at my consultation?

You will meet with the Joseph & Joseph Medical team and agree on a bespoke treatment plan for you. We will ensure you have a clear understanding of the treatment and that we can meet your expectations.

What does the treatment involve?

We will ensure that you are as comfortable and relaxed as possible prior to the treatment. Very small amounts of Botulinum A toxin are injected into the desired areas of the face using a tiny needle. We only use the most premium products on the market recognised to yield the best results. 

The treatment takes approximately 15-30 minutes.

Will it be obvious that I’ve had treatment?

At Joseph & Joseph Medical we strive to achieve the most natural results. We want you to look and feel rejuvenated and fresh. Normal facial expressions including smiling or looking surprised will be unaffected as we target the small muscles that are responsible for the unwanted wrinkles only. 

Is the treatment safe and what are the most common side effects?

Yes, in the small amounts used for the treatment. Botulinium A toxin treatment has been approved by the FDA and used safely in medical and cosmetic treatments for over 20 years. All of our treatments are carried out by an accredited Doctor or Nurse. 

The most common side effects are mild redness of the skin and localized bruising which is temporary.

Is the treatment painful?

As the needle used is very fine and only a tiny amount of product is used, any pain that is experienced is minimal.

No sedation or local anaesthesia is required for these treatments.

When will I see results and how long will they last?

Improvements will be noticed within 1-2 weeks, and typically last between 3 to 6 months.

Book an appointment with Joseph & Joseph Medical now and arrange a consultation at one of our Central London Aesthetic Clinics.

What Are Dermal Fillers?

Dermal fillers are products injected under the skin to replace or augment volume to improve the aesthetics of the face. At Joseph & Joseph Medical London we use Juvéderm® which is the the finest quality and safest product on the market. Juvéderm® contains hyaluronic acid which is a carbohydrate found within the human body. As we age production of hyaloronic acid slows and we see a decrease in the skin’s volume. Juvederm® products feel natural, last between 6 to 12 months and are reversible if required.

An interesting additional benefit that has been recently discovered is that it enables the skin to create new collagen, which in turn, further reduces the appearance of creases and wrinkles. Our most popular treatment areas are the nasolabial fold, melolabial fold (Marionette lines) and the upper lip (smoker’s lines).

Dermal fillers are a great way to feel rejuvenated, fresh and ten years younger in under an hour.

The treatment is quick, minimally invasive and the results are wonderful.

Book an anti-ageing appointment with Joseph & Joseph Medical at one of our Central London Aesthetic Clinics today.

 

 Frequently Asked Questions

 

What will happen at my consultation?

You will meet with the Joseph & Joseph Medical team and discuss a bespoke treatment plan for you. We will ensure you have a clear understanding of the treatment and that we can meet your expectations.

 

What does the treatment involve?

We will make sure that you are as comfortable and relaxed as possible prior to the treatment.  Very small amounts of hyaluronic acid are injected into the desired areas of the face using a small needle. The treatment itself takes approximately 30 minutes but can take up to one hour if topical anaesthetic cream is applied.

 

Will it be obvious that I’ve had treatment?

At Joseph & Joseph Medical we strive to achieve the most natural results. We want you to look and feel rejuvenated and fresh. 

 

Is the treatment painful?

As the needle used is very fine and only a tiny amount of product, which also contains an anaesthetic, is used any pain that is experienced is minimal.  No sedation is required for these treatments, topical anaesthetic cream is usually applied.

 

When will I see results and how long will they last?

You will typically see immediate results and the treatment typically lasts for 6 to 12 months.

Kybella® Treatment

So, I'm sure lots of you have heard of a new and exciting treatment called Kybella®? It is the only FDA-approved injectable treatment for fat cells under the chin. It is not yet available in the UK (where it will be called Belkara®) but here at Joseph & Joseph Medical headquarters we are eagerly awaiting the release date which may be as early as Spring 2017.

Kybella® is used to zap the fat cells and dramatically improve your profile, eradicating your double chin forever. It can work on people who have a moderate fullness or significant fullness (double chin). This article will explore the treatment and aims to answer some of the questions you may have about the treatment.

What Does Kybella® Treatment Involve?

Multiple injections of Kybella® (deoxycholic acid) are administered under the chin by a certified medical professional (Doctor or Nurse) during each treatment. A local anaesthetic cream is initially applied to numb the area and minimise discomfort. Clients may require up to 6 treatments in total and these treatments must be spaced at least 1 month apart. A clinic trial showed that 59% of patient's treated required 6 sessions.

The Treatment is tailored to every individual and depending on the amount of fat under the chin and personal aesthetic goals. 

How Does Kybella® Work?

The active ingredient is a synthetic deoxycholic acid which is a naturally occurring molecule in the body. The molecule aids in the breakdown and absorption of dietary fat. When injected into the fat, in particular below the chin, it destroys those targeted fat cells. Once these cells have been destroyed they cease to accumulate or store fat.

Is Kybella® right for me?

If you are affected by the fat under your chin (also know as sub mental fullness), or you feel that your chin makes you appear older or heavier than you truly are and despite diet and exercise you are unable to shift the fat, this could be a great treatment for you. 

Joseph & Joseph Medical will be providing Consultations and Treatments as soon as the product is released. We will keep you posted.

 

 

Combined Treatment With Botox® and Dermal Fillers

When thinking about what makes the perfect pair, the first things that spring to mind are: movies with popcorn or cheese with wine. In the world of aesthetics we believe that Botox® and Dermal Fillers are a match made in heaven.

Why Do Botox® and Dermal Fillers make the perfect pair?

Independently, Botox® and Dermal Fillers have their own very specific duties. Botox® is a neurotoxin used to temporarily paralyze the muscles which cause certain facial lines and creases. Dynamic wrinkles, caused by repetitive expressions, are temporarily relaxed and smoothed with the toxin. Botox® can eliminate frown lines, crow’s feet, and forehead lines for between 3 to 6 months. However, the benefits of Botox® only solve half of the wrinkle equation.

Dermal Fillers (at Joseph & Joseph Medical we use Juvèderm®) work differently from Botox®. Fillers are used to restore moisture and volume to the tissues and plump out lines caused by ageing skin. This means that fillers work best when addressing static wrinkles, or those that occur as skin loses its elasticity and shape. Dermal Fillers are excellent for filling in nasolabial folds, smokers lines, adding contour to the lips, and erasing acne scars. Additionally, fillers can decrease hollow areas under the eyes and improve volume along the cheeks or jawline.

So, individually Botox® and fillers can contribute to a smoother, more youthful appearance. However, when combined, Botox® and Dermal Fillers are the best way to fight the signs of early ageing.

While some of us may experience either dynamic creases or static wrinkles, the majority of us will see a combination of the two as we get older. Used simultaneously, Botox® and Fillers form the perfect nonsurgical facelift, addressing the volume loss, skin laxity, and deep wrinkles that come from years of facial expressions. Botox® and fillers are truly two peas in a pod and together can create amazing results.

Curious about combined Botox® and Dermal Filler treatment?  Contact Joseph & Joseph Medical for more information. 

Interview With A Client: JG, Nottingham

Why did you decide to have an aesthetic treatment?

I decided to have Botox as I am getting married in 2017 and wanted a fresher look for the big day.

Is this your first Botox® treatment?

 Yes it is.

What led you to Joseph & Joseph Medical?

A good friend of mine had a treatment with Joseph & Joseph Medical in August this year and was really pleased with her results. She recommended Joseph & Joseph Medical to me.

Were you happy with the clinic space?

Yes, I thought the Bay Therapy Centre was a lovely space. It is in a great location, easy to find, quiet and very clean and modern.

Can you tell us a little bit about how you felt about the initial consultation?

I was greeted in the reception area by Carly who is really warm and friendly.  She introduced herself and led me into the clinic room. My appointment was at 10am and the clinic was running on time. I was welcomed by Doctor Amer and offered a drink (coconut water).

We discussed what I would like to achieve from the treatment. I said that I wanted a younger, fresher look and to smooth out wrinkles around my forehead and eyes. We discussed how this could be achieved with Botox. 

Doctor Amer and Carly are a great team. They are both very attentive and kind and I felt immediately comfortable in their company. We agreed on a treatment plan and I felt very happy to proceed.

Doctor Amer then took a very detailed medical history and discussed all of the risks and side effects of having Botox. He then asked me if I was happy to proceed with the Botox treatment, which I was, I then signed a consent form.

How was the treatment itself?

Doctor Amer marked out the areas which he was going to treat with Botox on my face. I had to smile, frown and look surprised.

The Botox treatment took place on a very comfortable massage table with me sitting upright with my head back. Carly advised me to close my eyes and relax. She explained everything to me and made me feel reassured and comfortable throughout the Botox treatment.

Doctor Amer performed the treatment, and it was actually quite painless. The Botox treatment was over within ten minutes.

What happened after your treatment?

Carly discussed aftercare with me and provided a leaflet to take home. I was advised to avoid applying make up for 6 hours, avoid alcohol and sunbeds for 48 hours, and avoid pressure when cleansing my face.

Doctor Amer said that initial results usually start to show within the first 2 to 5 days but should be most clear after 2 weeks. I was advised that the treatment usually lasts for 3-4 months. Carly assured me that she would follow up with me 2 weeks after the Botox treatment to see if I was happy with the results. She said that I could call or text anytime if there were any issues.

Were you happy with your results?

I was absolutely thrilled with my results. I started to see an improvement in my wrinkles after 5 days and by the 2 week mark there was a dramatic improvement. People commented that I looked fresher but I think the results were very natural.

Would you recommend Joseph & Joseph Medical?

Absolutely, I would highly recommend them. They are professional, kind and really care about you. I would definitely return and will book my next Botox treatment with them in the new year.

 

Introduction to Botulinum Toxin in Aesthetics

Botulinum toxin type A, which is marketed commercially under the brand name Botox®, is commonly used around the world today as the foundation of minimally invasive aesthetic procedures particularly in anti-ageing treatment and the treatment of dynamic facial wrinkles. Dynamic facial wrinkles are those caused by the action of the facial muscles, for example the lines that appear when frowning or smiling.

Several studies have shown that when administered by accredited medical professionals, these neurotoxins such as Botox®, are an effective and safe treatment. Patient-reported outcomes, tolerability and overall satisfaction are all very high. At Joseph & Joseph Medical our aim is to design a bespoke care package for each individual client. We always carry out a full aesthetic review and all products and procedures are selected in the context of individual expectations and aspirations.

At Joseph & Joseph Medical we understand the vital role that facial expressions play in the way we view ourselves and the way we are perceived by others. The way we look and feel about ourselves can heavily impact on our emotional wellbeing, friendships, relationships and how we perform at work. One of the most common treatment areas for Botox® is the glabella, also known as the frown line. An observational study demonstrated that patients who received Botulinum Toxin A (BTX-A) treatment for their frown lines exhibited significantly improved mood. (1)

Another pilot study suggested that treatment of the glabellar frown lines with BTX-A may alleviate depression. (2)

Many clients have complained about ‘looking angry’, or ‘permanently frowning’, which they feel has affected the way they are treated by others, typically acquaintances, colleagues or strangers. After treatment with Botox® some have described feeling ‘happier’, 'more approachable' and ‘more included’. 

Throughout history individuals have always sought to improve their appearance. Recent medical advances have made it possible to maintain a more fresh and desirable appearance. At Joseph & Joseph Medical we offer minimally invasive non-surgical procedures including anti-wrinkle treatment (using Botox®) and Dermal Fillers to help you achieve this. We only use the highest quality products – Botox® and Juvederm® Dermal Fillers - both produced by the pharmaceutical company, Allergan. These products are approved by the United States Food and Drug Administration (FDA). Their safety has been supported and documented by a number of clinical studies.

The majority of clients conclude that following treatment of the glabella with Botox® they can see significant results after 2 weeks and this usually lasts for around 3 months. At Joseph and Joseph Medical we follow-up with you 2 weeks after treatment to check that you are satisfied with your results and offer a complimentary top-up, if required.

References

1. Lewis MB, Bowler PJ. Botulinum toxin cosmetic therapy correlates with a more positive mood. J Cosmet Dermatol. 2009;8(1):24–26. 

2. Finzi E, Wasserman E. Treatment of depression with botulinum toxin A: a case series. Dermatol Surg. 2006;32(5):645–649.