Can I have Fraxal and Botox?

Dr. Dean Kane Q & A.

Q. I had Fraxal around the eye area but can I have Botox as well 9 days later when I'm booked in for Botox.

A. ​Botox is a protein than can be denatured and therefore lose its potency with heat. The fractionated CO2 laser penetrates the skin to heat the tissues and can therefore reduce the effects of Botox or like muscle relaxers. Current understanding is that Botox has linked irreversibly to the nerve ending and performed its job within an hour of injection.

​The swelling associated with laser therapies will also increase swelling in the area performed. While I know of no studies to the effect, I can anticipate that the added fluid in the area may dilute the muscle relaxer and possibly cause diffusion effects depending on injector technique.

If you do plan to have both a laser procedure like Fraxel and Botox performed, I prefer they be separated by a day with Botox on the first day followed by laser the next day. ​ Your best results when combining such procedures would be inject Botox and wait for its maximal effects 10-14 days later, then have Laser.

​Please discuss this concern with your injector / laser specialist.

​I wish you well.

Facelift six-hour surgery with local and oral sedation?

Dr. Dean Kane Q & A.

Q. I am planning to have a facelift, cheek lift, fat transfer, and laser in one operation. The doctor favors local with oral sedation. I am concerned that a six-hour procedure may have me aware and exceed my tolerance level. I'd love to hear from others who have gone through six-hour facial procedures under local with only oral sedation.

A.  ​​​​​I prefer local anesthetic and intravenous sedation with monitoring by a anesthesia provider. Most surgeons request general anesthesia provided by an anesthesia provider too.

​Local anesthesia with oral sedation does not provide you the same level of monitoring or anesthetic risk / benefit ratio.
​Due to the length of the procedure, under local / oral sedation, the surgeon must perform the procedures during which he / she is also monitoring your vital signs ( heart rate, blood pressure, respiratory rate, oxygen saturation and level of consciousness). Longer procedures will expose you to greater levels of local anesthetic risk whereas a "cocktail" of mixed sedatives or inhalant anesthesia reduces this concern.

In the December 2014 article “Local Anesthesia and Plastic Surgery: Marketing or Reality?” (http://drdeankane.com/ok-conduct-open-rhinoplasty-local-anesthesia/) , Heather J. Furnas MD states:

“An increasing number of patients ask to have their surgery done with local anesthesia   “because it’s safer.” Guess what? That isn’t always the case.
​
​The Mayo Clinic has weighed in on the use of general anesthesia, explaining it should be considered if your operation:

1.  Takes a long time
2.  Exposes you to a cold environment
3. Affects your breathing, such as chest or upper abdominal surgery.
4. They also state that: “Most healthy people don’t have any problems with general anesthesia. Although many people may have mild, temporary symptoms, general anesthesia itself is exceptionally safe, even for the sickest patients. In general, the risk of complications is more closely related to the type of procedure you’re undergoing, and your general physical health, than to the anesthesia itself.”
5. ​She also notes the increasing concern amongst properly trained surgeons and patients alike that MD's offer this marketed advantage at the disadvantage of the patients health.”
6. It is also noted in another physician comment, that such an option should raise flags of concern that the facility in which the procedures are performed may not be fully accredited / certified by a state / or national regulatory agency and the physician may not have been properly credentialed. I desire to provide my full concentration on the performance of the procedure and not distracted from this which is the full time job of a anesthesiologist or certified nurse anesthetist.
7. Or more hours of potentially listening to others conversing or should there be a concerning occurrence during the procedure, become aware of and develop anxiety from correction of this event, restlessness or discomfort / pain; I believe is not in your best interest.

I hope this is helpful. All the best!