Botox & Fillers

Book an appointment with Dr. De Los Santos
Dr. Joanna De Los Santos MD, CCFP
Dr. De Los Santos received her medical degree from the University of Western Ontario and completed her residency in family medicine at the University of Toronto. She is also trained in Botox and dermal filler injection.

She has been practising family medicine since 2009 and also offers Botox and dermal filler injections. She believes in prevention from both medical and anti-aging perspectives.

 

Book an appointment with Dr. Walderman

Dr. Kayla Walderman MD, CCFP
Dr.Walderman completed medical school and residency training at McMaster University. She has also trained extensively in the use of Botox for cosmetic and medical uses.

 

 

Botox® Cosmetic And Juvéderm® dermal filler aren’t just for the middle-aged and seniors.
Many in their 20s and 30s can benefit from treatment. Starting treatment in the early stages of wrinkle development can actually be more effective at preventing wrinkles from becoming pronounced with age.
Therefore, you may want to consider starting treatment at the first signs of lines, wrinkles, and volume loss in order to best preserve a more youthful appearance.
Additionally, Botox® has many non-cosmetic uses:

Treatment of chronic migraines
Treatment of excessive sweating in the underarms and palms
Treatment of bruxism (jaw clenching/tooth grinding) and TMJ pain

Botox® Cosmetic Treatments Provided
Elimination or reduction of lines and wrinkles caused by muscle movement:

Frown lines (vertical lines between the eyebrows)
Crow’s feet (lines radiating from the outer eyes)
Horizontal forehead lines
Smoker’s lines (around the mouth)
‘Bunny lines’ on the nose

Non-surgical eyebrow lift
Jaw slimming or tapering (reduction of a muscular or square jaw)
Correcting a ‘gummy smile’

The effects of Botox® Cosmetic last 3-4 months.
For pricing, please call or book an appointment.

Juvéderm® Treatments Provided
Cheek volume augmentation
Filling of laugh lines (which run from each side of the nose to the corners of the mouth)
Filling of hollowness at the corners of the mouth
Uplifting downturned corners of the mouth
Filling of lines and hollowness between the corners of the mouth and the chin

The effects of Juvéderm® last 6-12 months.
For pricing, please call or book an appointment.

Non-Cosmetic Botox® Treatments
Excessive Sweating of the Underarms or Palms
Botox® injections can be used to reduce sweating in the underarms and palms. The effects last about 6 months.
If you have drug coverage (i.e. extended health benefits allowing Botox® prescription coverage for medical use), a prescription for Botox® can be written for you. In this case, you would pay only the injection fee.

Chronic Migraine Prevention
Botox® injections can be used to help prevent migraines in those who suffer from chronic migraines (15 or more migraines a month, lasting 4 or more hours each). It is not known whether treatment of episodic migraine sufferers (14 or fewer migraines a month) is effective. As muscles in the face are treated as part of this procedure, wrinkle reduction is a fringe benefit. More conservative measures (such as migraine medications) should be tried first. The effects last 3- 4 months.
If you have drug coverage (i.e. extended health benefits allowing Botox® prescription coverage for medical use), a prescription for Botox® can be written for you. In this case, you would pay only the injection fee.

Bruxism (jaw clenching or toothgrinding) or TMJ Pain
Botox® injections can be used to reduce jaw pain and tooth grinding. However, more conservative measures (such as mouth guards or physiotherapy) should be tried first. The effects last 3-6 months. For pricing, please call or make an appointment.

BOTOX® Cosmetic (onabotulinumtoxinA) Important Information

Indication
BOTOX® Cosmetic is indicated for the temporary improvement in the appearance of moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity in patients 18 to 65 years of age.

IMPORTANT SAFETY INFORMATION, INCLUDING BOXED WARNING
Distant Spread of Toxin Effect

Postmarketing reports indicate that the effects of BOTOX® Cosmetic and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These may include asthenia, generalized muscle weakness, diplopia, blurred vision, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence, and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening, and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity, but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have underlying conditions that would predispose them to these symptoms. In unapproved uses, including spasticity in children and adults, and in approved indications, cases of spread of effect have occurred at doses comparable to those used to treat cervical dystonia and at lower doses.

CONTRAINDICATIONS
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.

WARNINGS
The recommended dosage and frequency of administration for BOTOX® Cosmetic should not be exceeded. Risks resulting from administration at higher dosages are not known.

Lack of Interchangeability Between Botulinum Toxin Products
The potency Units of BOTOX® Cosmetic are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, Units of biological activity of BOTOX® Cosmetic cannot be compared to or converted into Units of any other botulinum toxin products assessed with any other specific assay method.

Spread of Toxin Effect
Please refer to Boxed Warning for Distant Spread of Toxin Effect.

No definitive, serious adverse event reports of distant spread of toxin effect associated with dermatologic use of BOTOX® Cosmetic at the labeled dose of 20 Units (for glabellar lines) have been reported.

Injections In or Near Vulnerable Anatomic Structures
Care should be taken when injecting in or near vulnerable anatomic structures. Serious adverse events including fatal outcomes have been reported in patients who had received BOTOX® injected directly into salivary glands, the oro-lingual-pharyngeal region, esophagus, and stomach. Some patients had pre-existing dysphagia or significant debility. (Safety and effectiveness have not been established for indications pertaining to these injection sites.) Pneumothorax associated with injection procedure has been reported following the administration of BOTOX® near the thorax. Caution is warranted when injecting in proximity to the lung, particularly the apices.

Hypersensitivity Reactions
Serious and/or immediate hypersensitivity reactions have been reported. These reactions include anaphylaxis, urticaria, soft-tissue edema, and dyspnea. If such reactions occur, further injection of BOTOX® Cosmetic should be discontinued and appropriate medical therapy immediately instituted. One fatal case of anaphylaxis has been reported in which lidocaine was used as the diluent and, consequently, the causal agent cannot be reliably determined.

Pre-existing Neuromuscular Disorders
Individuals with peripheral motor neuropathic diseases, amyotrophic lateral sclerosis, or neuromuscular junctional disorders (eg, myasthenia gravis or Lambert-Eaton syndrome) should be monitored particularly closely when given botulinum toxin. Patients with neuromuscular disorders may be at increased risk of clinically significant effects including severe dysphagia and respiratory compromise from typical doses of BOTOX® Cosmetic.

Human Albumin
This product contains albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases. A theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD) also is considered extremely remote. No cases of transmission of viral diseases or CJD have ever been identified for albumin.

PRECAUTIONS
Caution should be used when BOTOX® Cosmetic treatment is used in patients who have an inflammatory skin problem at the injection site, marked facial asymmetry, ptosis, excessive dermatochalasis, deep dermal scarring, thick sebaceous skin, or the inability to substantially lessen glabellar lines by physically spreading them apart.

Information for Patients
Patients should be counseled that if loss of strength, muscle weakness, or impaired vision occur, they should avoid driving a car or engaging in other potentially hazardous activities.

Drug Interactions
Co-administration of BOTOX® Cosmetic and aminoglycosides or other agents interfering with neuromuscular transmission (eg, curare-like nondepolarizing blockers, lincosamides, polymyxins, quinidine, magnesium sulfate, anticholinesterases, succinylcholine chloride) should only be performed with caution as the effect of the toxin may be potentiated.

The effect of administering different botulinum neurotoxin serotypes at the same time or within several months of each other is unknown. Excessive neuromuscular weakness may be exacerbated by administration of another botulinum toxin prior to the resolution of the effects of a previously administered botulinum toxin.

Pregnancy
Administration of BOTOX® Cosmetic is not recommended during pregnancy. There are no adequate and well-controlled studies of BOTOX® Cosmetic in pregnant women.

Nursing Mothers
It is not known whether BOTOX® Cosmetic is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when BOTOX® Cosmetic is administered to a nursing woman.

ADVERSE REACTIONS
General
The most serious adverse events reported after treatment with botulinum toxin include spontaneous reports of death, sometimes associated with anaphylaxis, dysphagia, pneumonia, and/or other significant debility.

There have also been reports of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal outcomes. Some of these patients had risk factors including pre-existing cardiovascular disease.

The most frequently reported adverse events following injection of BOTOX® Cosmetic include blepharoptosis and nausea.

JUVÉDERM® XC Important Safety Information

JUVÉDERM® injectable gel (including JUVÉDERM® Ultra, JUVÉDERM® Ultra Plus, JUVÉDERM® Ultra XC, and JUVÉDERM® Ultra Plus XC) is indicated for injection into the mid-to-deep dermis for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds).

Side effects are usually mild to moderate, lasting 7 days or less, and include temporary injection-site reactions such as redness, pain, firmness, swelling, and bumps. JUVÉDERM® is not for people with severe allergies.

For more information, please click on the About Safety link at www.juvederm.com or call the Allergan Product Support line at 1-877-345-5372. JUVÉDERM® injectable gel is available by prescription only.