Our patients who receive Medical Services at PWIC are treated by Dr. Veronica Efros, MD & Jill Moore NP. Some of the conditions they treat and manage include:Knee Pain- Knee Arthritis - Please click on our link to the OsteoArthritis Knee Program above
Shoulder Pain & Bursitis
Elbow Pain & Tennis or Golfer's Elbow- Lateral & Medial Epicondylitis
Wrist Pain & Carpal Tunnel
Hip Pain & Hip Bursitis
Ankle & Foot Pain
And much more...
Some of the procedures we provide to patients:* Hyaluronate Injections/Viscosupplementation Injections of the Knee
* "Steroid" Injections" - You may hear them called cortisone injections, cortisone shots, steroid shots, or corticosteroid injections. Steroids ease inflammation & pain. These are often performed in Shoulders, Elbows, Wrists, Hips, Knees, Ankles & Feet.
* Trigger Point Injections- A trigger point injection can help soothe muscle pain, especially in your arms, legs, lower back and neck. It also can be used to treat fibromyalgia, tension headaches and myofascial pain. Trigger points are painful “knots” in your muscles. They form when a muscle can't relax.
* B12 Injections- Vitamin B-12 injections are commonly prescribed to help prevent or treat pernicious anemia and B-12 deficiency. A deficiency in this essential nutrient can lead to an array of health problems, ranging from fatigue to permanent neurological changes. Vitamin B12 injections (hydroxocobalamin or cyanocobalamin) are effective for raising the vitamin B12 level in the blood quickly. Vitamin B12 helps your body use fat and carbohydrates for energy and make new protein. It is also important for normal blood, cells, and nerves.
Botox & Dysport Injections
Look like you- only better! Enhance and refresh your appearance by smoothing lines and wrinkles. Dr. Efros's methodical and detailed approach will deliver natural looking youthful results without a "frozen" look.
Botox is a neuromodulator that is injected into targeted treatment areas using an ultra-fine needle. It works by blocking the nerve signals needed for contraction of the facial muscles. The repetitious contraction of facial muscles is what causes expression lines and wrinkles. Once injected, the medication works to relax the muscles and decrease their movement. The effect is reduced appearance of lines and wrinkles in the area. You will see your results gradually kick in over 3-10 days following injection.
Botox can be used to soften lines and wrinkles on a number of different facial areas, including (but not limited to) the forehead, scowl (11’s), and eye area (crow’s feet). It may be injected in the lower face to soften dimpling of the chin, and help relax the muscles that pull down on the sides of the mouth (depressors).
Platysmal bands on the neck can be relaxed with neuromodulators, giving a more youthful appearance. Botox can also be injected into the muscles of the jaw to help alleviate pain from teeth grinding or TMJ or for a jaw slimming effect.
Botox can be used to treat migraines and tension headaches as well as hyperhidrosis or excessive sweating in areas such as the scalp, hands, feet, and underarms.
WHAT AREAS CAN BE TREATED WITH BOTOX?
On the day of the appointment, topical numbing will be applied, and local anesthetic may be injected to provide comfort during the treatment. Post treatment, patients can immediately resume normal daily activity. However, it is advised to avoid strenuous activity for 24 hours after treatment, sleep at a 45-degree angle and gently apply ice to the area treated for ten minutes at a time every couple of hours to reduce swelling.
Botox treatments are quick with minimal discomfort. Most patients describe the sensation as a “quick pinch and a sting.” The treatment requires no anesthesia or recovery time although we can provide topical numbing for an additional cost. Many people get Botox during their lunch hours and are able to return to work right after their appointment.
WHEN SHOULD I START GETTING BOTOX
Some patients may wonder if they are ‘too young’ or ‘too old’ to try Botox. There is no right or wrong age to start using Botox. Patients will be assessed by one of our certified injection specialists prior to treatment. Individual patient anatomy and treatment goals are considered when creating a treatment plan. Many millennials are starting to use Botox in their twenties when they first start to notice lines and wrinkles. Sometimes called “baby Botox”, these small doses serve as a method to prevent deep lines and wrinkles from forming.
WHEN SHOULD I START GETTING BOTOX?
Yes, Botox has been used cosmetically for over 20 years and is an FDA approved treatment for facial lines and wrinkles. However, patients who are pregnant, breastfeeding, or have certain neurological diseases should not receive Botox treatments. Prior to treatment, your health history will be reviewed and approved by one of our physicians.
IS BOTOX SAFE?
A week prior to treatment, the patient may choose to stop consuming alcohol or taking medications or supplements that thin the blood like Aspirin, Ibuprofen, Gingko Biloba, fish oil or Ginseng. This will help reduce the risk for bruising.
HOW SHOULD I PREPARE FOR MY TREATMENT?
Side effects from a Botox treatment may include bruising, swelling, redness, or tenderness around the injection site, all of which will resolve without intervention after a few days to a week.
ARE THERE SIDE EFFECTS?
We offer all of the neuromodulators for treatment including Dysport, Botox, Jeuveau and Xeomin. Here is a comparison of two of our most popular neuromodulators:
The Basics of Botox
Botox is primarily used as an aesthetic treatment to reduce fine lines and wrinkles on the face that are caused by repeated muscle movement like furrowing your brow, frowning, or smiling. Botox is the commercial name for the botulism microbe, which causes food poisoning. This can sound scary, but when Botox is used for cosmetic or medical reasons, the Botox injection is administered in extremely small and safe doses. It has been approved by the FDA for eye wrinkle treatment (crow’s feet) and reduction of frown lines between the eyes.
When injected into the facial muscles, Botox temporarily paralyzes and relaxes the muscles, smoothing out fine lines and wrinkles, especially around the eyes and in the forehead. Botox is also used to treat certain medical conditions like migraines, excessive sweating, painful muscle contractions, or overactive bladder.
When used cosmetically, your doctor will use a thin needle to inject small amounts of the botulinum toxin into the face. Usually no anesthetic is necessary, although a cold compress can help relieve any post-treatment discomfort.
The Botox treatment is done in the doctor’s office, only taking about 10 minutes. You can resume your normal activities after the treatment. You should be able to see results within a few days and can expect results to last a few months.
Plan on returning for additional Botox treatments every 4-6 months. Botox is not a permanent solution for wrinkles. It is best to schedule your next treatment before the results of the previous treatment wear off. Also, getting multiple treatments can help reduce the formation of new wrinkles, as your facial muscles won’t be able to contract as they once did
Botox (Botulinum toxin) or Botox Cosmetic is a wrinkle relaxer that is FDA approved to treat moderate to severe lines such as crow’s feet and forehead lines
Botox cosmetic works by targeting and weakening the muscles that are used when smiling, frowning, squinting, and raising your eyebrows.
Botox became FDA approved for aesthetic treatments in 2002
A study done in 2009 showed that Botox used in the forehead improved mood due to reduced frowning.
Botox cosmetic is FDA approved to treat frown lines, crow’s feet, and forehead lines.
A typical Botox (Dysport) treatment only takes about 10 minutes. Results can last from 3-4 months
Botox can range from $200-$600 depending on how many areas you want to get treated and your Botox provider’s price per unit or price per treatment area.
Botox typically can range from $10 – $15 per unit. It can range depending on the experience of the Clinician and the local market rate.
The recommended treatment for Botox on the forehead can range in price between $100-$400. Some people may need 10 units, while others may require 20 units as each person’s facial expression and level of movement is different. The amount of units may differ in each patient depending on age, strength of facial expression muscles, previous history of treatments and desired treatment outcome.
Dysport -different brand name-similar neurotoxin -was FDA approved in 2009 in the United States. Dysport may act quicker in some patients than Botox in seeing results. The biggest difference between Botox and Dysport is the quantity of units needed due to the potency of Dysport. Dysport requires 2-3 units to 1 unit of Botox so if an area requires 25 units of Botox, you may need 50 plus units of Dysport. While Dysport maybe cheaper than Botox, the quantity of units of Dysport physicians need to use is more than Botox and thus there is not a big difference in price. In addition, Dysport has been shown to drift more than Botox causing relaxation of neighboring muscles. Unlike other toxins, Dysport contains cow milk protein and therefore cannot be used for those that are allergic to milk.
Yes. Men and Women get Botox. More men are getting Botox now.
According to the American Society of Plastic Surgeons, in their 2018 Plastic Surgery Report there was a 381% increase in men getting Botox since 2000.
How Is Botox Used?
The most common reason doctors use Botox is to reduce the appearance of face wrinkles. But getting a Botox shot can help treat other conditions, such as:\
· Chronic migraine
· Severe underarm sweating (hyperhidrosis)
· Cervical dystonia, a neurological disorder that causes severe neck and shoulder muscle spasms
· Blinking that you can’t control (blepharospasm)
INDICATIONS AND USAGE
1. Chronic Migraine BOTOX is indicated for the prophylaxis of headaches in adult patients with chronic migraine (≥15 days per month with headache lasting 4 hours a day or longer). Important Limitations Safety and effectiveness have not been established for the prophylaxis of episodic migraine (14 headache days or fewer per month) in seven placebo-controlled studies.
Chronic Migraine BOTOX was evaluated in two randomized, multi-center, 24-week, 2 injection cycle, placebo-controlled double-blind studies. Study 1 and Study 2 included chronic migraine adults who were not using any concurrent headache prophylaxis, and during a 28-day baseline period had ≥15 headache days lasting 4 hours or more, with ≥50% being migraine/probable migraine. In both studies, patients were randomized to receive placebo or 155 Units to 195 Units BOTOX injections every 12 weeks for the 2-cycle, double-blind phase. Patients were allowed to use acute headache treatments during the study. BOTOX treatment demonstrated statistically significant and clinically meaningful improvements from baseline compared to placebo for key efficacy variables
Chronic Migraine recommended doses for treating chronic migraine is minimum 155 Units administered intramuscularly 5 Units injections per each site. Injections should be divided across 7 specific head/neck muscle areas; all muscles should be injected bilaterally with half the number of injection sites administered to the left, and half to the right side of the head and neck. The recommended re-treatment schedule is every 12 weeks.
1.2 Spasticity Upper Limb Spasticity BOTOX is indicated for the treatment of upper limb spasticity in adult patients, to decrease the severity of increased muscle tone in elbow flexors (biceps), wrist flexors (flexor carpi radialis and flexor carpi ulnaris), finger flexors (flexor digitorum profundus and flexor digitorum sublimis), and thumb flexors (adductor pollicis and flexor pollicis longus).
Lower Limb Spasticity BOTOX is indicated for the treatment of lower limb spasticity in adult patients to decrease the severity of increased muscle tone in ankle and toe flexors (gastrocnemius, soleus, tibialis posterior, flexor hallucis longus, and flexor digitorum longus).
1.3 Primary Axillary Hyperhidrosis The recommended dose is 50 Units per axilla. The hyperhidrotic area to be injected should be defined using standard staining techniques, e.g., Minor’s Iodine-Starch Test. Repeat injections for hyperhidrosis should be administered when the clinical effect of a previous injection diminishes.
1.4 Cervical Dystonia BOTOX is indicated for the treatment of adults with cervical dystonia, to reduce the severity of abnormal head position and neck pain associated with cervical dystonia.
1.5 Blepharospasm For blepharospasm, reconstituted BOTOX is injected using a sterile, 27-30 gauge needle without electromyographic guidance. The initial recommended dose is 1.25 Units-2.5 Units (0.05 mL to 0.1 mL volume at each site) injected into the medial and lateral pretarsal orbicularis oculi of the upper lid and into the lateral pre-tarsal orbicularis oculi of the lower lid.