BREAST REDUCTION ST LOUIS-ILLINOIS-SPRINGFIELD

314-984-8331

DR MICHELE KOO, MD, FACS

BOARD CERTIFIED PLASTIC SURGEON

BEFORE BREAST REDUCTION 36 HH

AFTER BREAST REDUCTION 38 C BRA

Have you always wanted shaplier, lifted, lighter perkier breasts?

Did you know that was possible and have your insurance cover the surgery?

Are you sick and tired of your skin sweating under your breasts and getting rashes all the time?

Are you tired of not being able to exercise and walk comfortably? Are you sick of the grooves in your shoulders?

The patient pictured in the photograph is a 36 year old woman from St Louis, Missouri who complained of skin rashes under her breasts, neck, shoulder, and back pain from her very heavy, pendulous breasts.

She underwent a breast reduction by DR MICHELE KOO, MD, BOARD CERTIFIED PLASTIC SURGEON, ST LOUIS, MISSOURI, 314-984-8331 and has been transformed from a 38 DDD/EE to a 36D.

She is ecstatic about her beautiful new breasts and has gained so much self confidence. Her friends keep asking her if she’s lost a great deal of weight. Her shoulders and neck no longer hurt and she is able to walk and exercise comfortably. She loves wearing pretty bras and cute tops and dresses.

She no longer has to spend a fortune on ugly big bras that look like parachutes.

Dr Michele D Koo, MD, FACS, Board Certified Plastic Surgeon, St Louis-Kansas City,Missouri and Illinois can reduce, lift, and reshape your breasts with a breast reduction (reduction mammaplasty) so that your back, neck, and shoulders are relieved of the grooving, pull, and pain.

The breast reduction surgery takes approximately 2 to 2 1/2 hours under general anesthesia and is extremely safe. You may either go home on the day of surgery or stay over night if you choose. You will drive the next day and you will be able to return to a office type of occupation in 1-3 days and in 7-14 days to a physical type occupation.

Your recovery time is minimal.

You will be given a surgical compressive bra after your breast reduction and may have some drains out the side of your breasts when you go home. Dr Koo will see you in the office 4 days after the surgery when the drains will likely be removed. Most patients rarely complain of pain after the surgery and are pleasantly surprised that the recovery is very minimal.

Dr Koo’s patients will tell you that the breast reduction surgery is one of the best things they have ever done for themselves.

The pre- breast reduction patients often feel so trapped by their heavy breasts. They feel they are unable to exercise adequately to loose weight and the more weight they gain the larger their breasts become. They are caught in a vicious cycle that they cannot break themselves.

Dr Koo sees patients from throughout Missouri, Cape Girardeau, Kansas City, Springfield, Farmington, Illinois and the remainder of the United States. Her office will make arrangements for your out of town stay and help you in any way you need.

Dr Michele Koo, MD, of St Louis, Missouri, 314-984-8331, can help you break that weight gain cycle and reduce, lift, and reshape your breasts.

You will have freedom like you’ve never had before and relief of shoulder, neck, and back pain. Your tension headaches should also lessen from the relief of the pull on your shoulders and neck.

You can feel like your breasts are youthful again, lifted, off of your tummy and back on your chest. The areola will be made smaller and shaplier and you will not have to deal with all of that excess breast tissue getting in your way.

Please feel free to call Dr Koo’s office, 314-984-8331, with questions and to talk to other patients who have undergone this exact surgery.

Begin your new life after breast reduction today, DR MICHELE D KOO, MD., 314-984-8331, ST LOUIS, MO.

BEFORE BREAST REDUCTION 40 FFF/GG

If you want to get rid of the rashes under your heavy saggy breasts and if you’re sick and tired of the aching in your back, neck and shoulders…you need to call Dr Michele D Koo, MD, FACS, St Louis, Missouri, Board Certified Plastic Surgeon and a Member of the Aesthetic Society to change your life.

Dr Koo finds breast reductions, breast lifts (mastopexy) to be two of the most rewarding surgeries for her patients. Almost all of her patients say that this surgery is one of the best things they have ever done for themselves and they wish they had done it when they were younger.

Her patients state that having a breast reduction has allowed them to be much more active, thus allowing them to go on and be healthier and to lose weight.

The fear is that after the breast reduction, you will have no breasts remaining but, in fact, your breasts will be lifted, perkier, on your chest instead of pointing down to your toes, and appear so much fuller that you’ll wonder if Dr Koo snuck implants in your breasts while you were not looking!!

The grooves in your shoulders will become less pronounced and less painful after the breast reduction. Your tension headaches from the pull on your neck, shoulders, and back will be gone almost immediately after the breast reduction surgery. 

Call Dr Michele Koo, MD, FACS, St Louis, Missouri (314-984-8331), to begin your new life. You can see many more photographs and talk to so many woman who have had the breast reduction surgery and hear how happy they are.

Breast reduction surgery is covered by many insurance carriers and Dr Koo’s office will help you with this benefit. The criteria is determined by the amount of weight Dr Koo feels she will remove from each breast.

She is an expert on breast reductions in the St Louis, Kansas City, Springfield, Southern Illinois, Cape Girardeau Areas and throughout the United States and will be able to examine you and tell you if she thinks your insurance will cover the breast reduction surgery or not. Her office also will work with you on financing.

Let Dr Michele Koo, MD, FACS (314) 984-8331 of St Louis, MO change your life and remove all that excess skin, fat, and surgical scars on your abdomen and make your tummy flat and your thighs slimmer.

You have been on and off diets all your life and now after children, you can’t remove that excess skin and fat from your mid-section. Everytime you lose some weight, you look down at your tummy and become depressed and frustrated with yourself and you fall off the wagon and your weight bounces back up.

If you’re tired of not being able to stay on a healthy eating regimen and exercise plan because you’re not getting the results you want, let Dr Michele Koo, MD, FACS, St Louis, MO, Board Certified Plastic Surgeon, Member of the Aesthetic Society, change your life with a tummy tuck (abdominoplasty) or a liposuction that will keep you motivated and take you to the next step. You’ll finally see the results and rewards of all your hard work with a flat belly, a slimmer waist and thighs.

This photograph is of a mid 50 year old Missouri woman who was frustrated with her large abdomen after three children and c-sections.  No matter how much weight she lost, she was unable to get rid of her large belly.  Prior to her surgery of a tummy tuck (abdominoplasty) and ultrasonic liposuction of her upper abdomen, waist, hips, and inner and outer thighs, she reports wearing size 14 clothes.  At 4 months after her surgery, she fits into a size 6.  She is able to tuck in her shirts, wear low cut jeans, and wore a 2 piece bikini on her vacation with her husband.  At the time of her surgery, she also underwent a breast lift, completing her entire body makeover.  She has kept her weight off now 2 years after the surgery and continues her healthy lifestyle which she was never able to stay on prior to her surgery, because nothing she ever did previously worked!

Dr Koo performs ultrasonic liposuction at the same time as the tummy tuck (abdominoplasty) and contours the entire trunk and legs to make you look like a new person. She feels that this tummy tuck and liposuction combination is extremely safe and can achieve amazing results all in one surgery and one recovery time. Dr Koo also repairs the split in your rectus abdominus muscles which have become lax with age, weight gain, and possibly children and surgeries. This will cinch in your waist and entire circumference of your trunk, reducing your clothes size!

Do not be discouraged and depressed with your shape and inability to change your waist and abdomen, Dr Michele Koo, MD, will take you the rest of the way to being what you want to be with a tummy tuck, abdominoplasty, and liposuction. 

Call Dr Michele D. Koo, MD, FACS, St Louis, Missouri, Board Certified Plastic Surgeon, 314-984-8331, and talk to many others who have had this and similar tummy tuck (abdominoplasty) and liposuction surgeries and find out how that has changed their lives.

BREAST LIFT

(MASTOPEXY)

AND

BREAST

AUGMENTATION

FOR FULLER

SEXIER  BREASTS

Before Breast Lift and Breast Augmentation

DR MICHELE D KOO, MD, FACS is a Board Certified Plastic Surgeon and a Member of the Aesthetic Society located in St Louis, Missouri. She is an expert on breast lift and breast augmentation surgery in the United States and especially in St Louis, Kansas City, Columbia, and Springfield, MO and throughout the midwest.

Dr Koo is often asked by her patients what can be done about their breasts after childbirth, weight loss, or breast feeding.

After weight loss, just as after breast feeding, the breast volume decreases but the amount of skin most often stays the same. Therefore, the breast skin sags and the breasts are smaller and without any remaining fullness. The breasts also may lose shape. Many women experience this after breast feeding when the breasts become very full and the skin stretches.  After breast feeding just like after weight loss, the breasts lose volume and the skin sags.

Dr Michele Koo who specializes in returning breasts to a natural full shape and position can help you feel better about yourself.  She will perform a breast lift (mastopexy) alone or a combination surgery of a breast lift (mastopexy) and breast augmentation (breast implant) to achieve the perfect results for her patients.

Depending on how much weight loss or loss of volume of breasts one experiences, most women will need either a breast lift (mastopexy) alone, a breast augmentation (implant) alone, or a breast lift (mastopexy) with breast implants (breast augmentation) to regain  the sexy full breasts with nice full cleavage. Some of Dr Koo’s patients will experience significant change in shape of their breasts with only a 5 lb weight loss some will not experience significant change in shape until they have lost at least 20 or more pounds.  

Dr Michele Koo approaches the breasts with the patients’ goals in mind of whether they wish to just have their breasts lifted back into position so that the nipple is not pointing downward or whether they wish to have a little fullness in the upper portion of their breasts with some cleavage. If the latter is their goal then certainly a breast augmentation (breast implant) is absolutely necessary.  

Dr Michele Koo performs the breast lift (mastopexy) and breast enhancement in one surgery which takes  approximately 1 ½ to 2 hours and the recovery is minimal. It is an outpatient surgery under general anesthesia and her patients return to driving the next day and an office occupation in 1-2 days but wait approximately 2 weeks before any kind of a cardiovascular workout.  

Dr Koo gives her patients the option of saline or silicone breast implants and they make the decision together taking into account the patients’ level of comfort with the types of breast implants and their age.

Dr Koo, St Louis, MO will recommend the different types of profile of breast implants depending on the patients’ anatomy and ultimate cosmetic desires. She makes the recommendation for the location of the incision, type of breast implant, and the exact nature of the surgery depending on what her patient wants her breasts to ultimately look like.

If the patients’ breasts only have to be lifted very slightly, a breast implant alone will achieve the breast lift (mastopexy) and breast augmentation (enhancement) with a minimal incision. If the breasts have to be lifted a significant distance then that determines the length of the scar. Dr Koo only creates the smallest incision possible given how much re-shaping she has to achieve and what the patients’ desires are.

A breast augmentation with or without a breast lift is a very frequently requested and performed procedure by Dr Michele Koo and she will make you feel extremely comfortable with all your questions and concerns. Dr Koo feels that this is a very common and very safe procedure which she performs on a regular basis and these patients are some of her absolutely most satisfied patients.

Dr Michele Koo, MD, FACS

Board Certified

Plastic Surgeon

Fraxel® Laser Treatment is a unique, non-invasive laser therapy designed to dramatically improve skin texture and pigmentation, allowing you to once more enjoy the fresh and healthy skin of your youth. Its patented “fractional” technology penetrates deep within the skin for maximum rejuvenation while promoting fast healing and stimulating the production of new, firm tissue to smooth out imperfections.

Fraxel Laser Treatment is most effective for:

·         Improving texture and tone

·         Shrinking pore size

·         Erasing age spots / brown spots

·         Smoothing wrinkles around the eyes

·         Smoothing acne scars

·         Rejuvenating the neck, chest and hands

How does Fraxel technology work?

Fraxel Laser Treatment utilizes fractional resurfacing technology, where only a small fraction of the skin receives the laser light at any given time. The treatment delivers a series of narrow but deep microscopic laser spots to reach the innermost layers of skin and stimulate collagen growth while leaving the surrounding skin unaffected. The healthy cells in the untouched spots promote rapid healing of the entire area, resulting in faster recovery time and minimal side effects. Think of this “fractional” technique as being like restoring a painting one tiny area at a time, or altering an electronic image pixel by pixel.

Fraxel Laser Treatment combines the effectiveness of traditional ablative lasers with the rapid healing of non-fractional non-ablative lasers.

What is the Fraxel Laser Treatment like?

Fraxel Laser Treatments can be performed right in your doctor’s office. First, your doctor will cleanse the area being treated and apply a topical anesthetic.

Your doctor may also apply an FDA-certified blue tint to your skin. This tint darkens the tiny folds and imperfections on the skin’s surface, increasing the contrast against the skin and allowing the laser handpiece to more effectively map the contours of the treatment area. A full-face Fraxel Laser Treatment typically takes 20-25 minutes.

What can I expect after a Fraxel Laser Treatment?

After treatment, the blue tint and anesthetic are washed off. You may be asked to clean the skin thoroughly but gently with a Fraxel foaming cleanser and water, followed by an antioxidant infusion from your doctor as well as a special Deep Hydration Mask to seal in moisture.

Your skin may feel as if it has been mildly sunburned for about an hour after a Fraxel Laser Treatment. After that, discomfort should be minimal. Mild swelling should subside within two to three days, and pinkness—an indication that the skin has been deeply treated—usually fades over five to seven days. There is limited, if any, risk of infection or scarring.

New epidermal skin develops within 24 hours. This new skin may be bronze-tinged for a few days to two weeks. It will likely flake and exfoliate as old skin sloughs off and new skin takes its place. The new skin is also highly sensitive and requires adequate sun protection for several months after treatment. Fraxel Daily Moisturizer (SPF 30) is ideal for this purpose.

Is there any downtime?

While individual results vary, Fraxel offers the benefits of speedy healing and little to no downtime. Many patients return to routine activities and can shave or apply make-up soon after treatment.

When will I see results? How long do the effects last?

Results are immediate and progressive, with optimal improvement usually visible in about two to three months and gradual improvement for up to a year. Each session shows marked improvement in skin quality, resulting in a high level of patient satisfaction.

How many treatments will I need?

Treatment plans vary from patient to patient; your doctor will recommend the number of treatments needed to achieve your personal goals. Clinical studies suggest that an effective treatment plan is three to five sessions spaced about two to four weeks apart. Each session targets a certain percentage of the skin’s surface. By the end of the treatment plan, the entire treatment area will have been covered.

Let Dr Michele Koo, MD, FACS, Board Certified Plastic Surgeon, St Louis, Missouri rejuvenate your face by removing wrinkles and frowns in the office in a matter of minutes. 

Let’s start with some background on dermal fillers. This market has been growing rapidly, and we expect the growth to accelerate with the introduction of a new entry into the hyaluronic acid segment. Baby Boomers are fueling growth as they more actively fight the aging process. What they’re seeing in the mirror is a loss of volume under their facial skin; that’s a visible sign of aging. The role of dermal fillers is to reduce lines, restore volume, and contour facial folds to restore a more youthful appearance.

The generally accepted signs of aging in the face are the thinning of the dermis layer and the atrophy of fat pads underneath. As a result, there is greater visibility of some unattractive features such as bony areas, blood vessels, wrinkles, and furrows. Because of their placement on either side of the mouth, the nasolabial folds become more prominent and deeply grooved. Some people think of the NLFs as parentheses that call extra attention to the area around the nose and mouth. Others think of them as smile lines. They’re not always welcome, and they can be corrected.

 Let’s stop a moment and note that wrinkles can have one of 2 origins. Either they are “dynamic,” meaning they are visibly highlighted when the underlying muscles are in motion. Think of the lines that appear when you smile or frown. Or the wrinkles are classified as “static,” meaning they appear when the face is at rest or not moving. Dermal fillers are used in the treatment of static wrinkles of the face.

 In contemporary practice, the physician and patient have a choice of many different types of filler. One of the primary distinguishing features is whether a filler is temporary or semipermanent. Among both varieties of fillers, there is considerable variability in duration. There is a broad spectrum of choice among fillers, with animal, nonanimal, human, and synthetic all available. The physician and patient must weigh a range of risk-benefit scenarios in making a choice, and value must also play a role. Finally, fillers are quite versatile, with products developed that are suitable for many areas of the face: fine lines, deep rhytides, folds, lips, and contouring of the face.

Beautiful Breasts

by Dr Michele Koo 

Board Certified

Plastic Surgeon

St Louis, Missouri

314-984-8331 

Before 34 small B

Safe pain free minimal recovery breast augmentation can be performed by Dr Michele Koo, MD, FACS in St Louis, Missouri.  Dr Koo will determine the perfect breast implant and size for your body after you tell her what you want your breasts to be. 

In November 2006, the FDA approved the return of the silicone breast implant for elective breast augmentation after lifting the 1992 moratorium on silicone breast implants for cosmetic breast enhancements.  The implants are now multiple and varied and have different projections and sizes and textures. 

Dr Michele Koo understands the safety of the different implants and will explain all the options available to you whether it is saline or silicone, or whether you need a lift or not, and the projection of the breast implant that is perfect for you. There are so many choices from which to choose, she understands what it is you want your breasts to look like and what to do to achieve those results.

Visit Dr Koo’s website at:  www.drmkoo.com for more information and pictures.

After Injection

 

Before Injection

    

BEFORE JUVEDERM INJECTION

AFTER JUVEDERM INJECTION BY DR MICHELE KOO

Signs of Aging in the Face

• Thinning of skin dermis and loss of volume of

     the face

• Greater visibility of bony  landmarks, blood

     vessels, and furrows

• Prominence of the nasolabial folds () around

    the mouth and nose

• Prominence of marionette lines () around

     corners of the mouth and chin also known as

     smiles lines

Dynamic vs Static Wrinkles

•  Dynamic wrinkles in the facial skin appear or

     are more noticeable when the underlying

     muscles are in motion, for example when you

     smile or frown

•  Static wrinkles appear when the face is at

      rest or not moving

Fillers—Background 

 Hyaluronic Acid (HA)

•   ^{Now approved as a dermal (skin) filler}
•   ^{Creates volulme in any tissue}
•   ^{Naturally occurring in the body}
•   ^{Attracts water and thus continues to         “plump” after the injection for a beautiful natural fill}

What Is JUVÉDERM^™? 

• ^{Juvederm injectable is a smooth gel dermal filler}

• ^{For the correction of moderate to severe facial folds and wrinkles}

• ^{Nonanimal-sourced hyaluronic acid (HA)}

 JUVÉDERM^™

•   ^{Not collagen}

•  
  • ^{Injected into facial folds and wrinkles}
  • ^{Fills the skin area just below the surface}
  • ^{Cross-linking of Hyauronic Acid extends duration of the product and longevity of results}
  • ^{Cross-linking is chemical processing of HA to}
  • ^{More cross-linking means more resistance to enzymatic degradation and}
  •   ^{Two formulations}
  •   ^{JUVÉDERM™ Ultra - optimally formulated for versatility in contouring}
  • ^{JUVÉDERM™ Ultra Plus - robust formulation for volumizing and correcting deeper}
  • ^{JUVÉDERM™ Ultra Plus is a robust formulation with a 20% thicker gel for deeper folds}
  • ^{JUVÉDERM™ injectable gel is the first smooth-consistency gel HA}
  • ^{Smooth formulation}
  • ^{Smooth, natural look}
  • ^{Smooth feel}
  • ^{JUVÉDERM™ injectable gel is made with proprietary HYLACROSS™ technology}
  • ^{Creates a smooth-consistency gel}
  • ^{Combines a high concentration of hyaluronic acid (HA)}
  • ^{With the highest amount of cross-linked HA per mL}
  • ^{Results in a smooth, natural look and feel for patients}
  • ^{Uniquely produced by proprietary HYLACROSS™ technology}
  • ^{Clinically proven to persist up to 12 months or in both formulations}
  • ^{Smooth-consistency gel and not a granular- consistency gel}
  • ^{Overwhelmingly preferred by patients over study control}
•  ^{JUVÉDERM™ injectable gel is a hyaluronic acid (HA)}

 

• ^{Naturally occurring in the body}

 

• ^{Not animal-sourced}

 

• ^{Cultivated from bacteria}

 

• ^{Pure, free from animal contaminants}

 

 

 

 

 

 

 

 

 

 

How Does JUVÉDERM^{™ Work?}

 

 

 

 

 

      ^{bind strands of polymers to each other}

 

      ^{therefore longer lasting in the body}

 

 
 

^{1. Data on file, Allergan, Inc., 2006.}

 

JUVÉDERM^{™ Family of Products}

 

 

        ^{and volumizing wrinkles and folds}

 

      ^{wrinkles and folds}

 

 

 

How Is JUVÉDERM^{™ Different?}

 

 

 

 

 

 

 

How Is JUVÉDERM^{™ Different?}

 

 

 

 

 

 

 

^{1. Data on file, Allergan, Inc., 2006.} 

 

So JUVEDERM^{™ Is…}

 

 

 

 

 

 

 

 

 

AFTER 38 C/D

BEFORE 42 DDD/EE

Are you tired of your heavy sagging breasts rubbing the skin of your abdomen and being too low?

Dr Michele Koo, MD, FACS, Board Certified Plastic Surgeon, St Louis, Missouri 314-984-8331 can lift them and make them perky and put them back on your chest instead of sitting on your abdomen.

Dr Michele Koo, St Louis, MO, lifts the breasts, makes them shaplier and smaller relieving the pain and pull in your shoulders, relieving the tension in your neck that causes the constant headaches and back pain.

Dr Koo, preserves the nipple areolar complex attached to the underlying breast tissue thereby allowing the best chance of preserving the sensation of the nipple. She lifts the breasts and removes the excess skin and reshapes the breasts to give you comfort and allow you to go on to be more active and to allow you to try to be healthier and more active.

The patient that is pictured was able to go on to lose 25 lbs slimming her waists and hips which can be seen in the after picture.

You do not have to live with the constant skin rashes and sweat under your breasts.

They will be shaplier, lighter, and, of course, prettier. Your friends will ask if you have lost weight, and you will think your neck, back and shoulders feels so much better. You’ll have shaplier breasts that you may never have had with a breast reduction which is often covered under your medical insurance. 

Dr Koo’s staff is extremely experienced and helpful in obtaining insurance approval of your breast reduction. Dr Koo will be able to determine if she thinks that insurance will cover the procedure after she examines you to see how much breast tissue she feels she can remove safely and in keeping with the size you ultimately want to become. If she does not think that you will qualify for insurance coverage, her office will help you obtain financing should you still decide to go forth with the breast reduction surgery.

Dr Michele Koo utilizes the most delicate surgical techniques and newest sutures so as to minimize the appearance of your scars. She also tries to hide them in the natural folds of your skin and breasts, disguising them to the optimal locations.

After the breast reduction, you will wish you had done this so much sooner. You will be able to return to an office type of work in 4 days and you may return to a more strenuous type of job between 2-3 weeks. You will wear a compressive surgical bra continuously for 4 days after the surgery and then will be able to switch to a tight sports bra thereafter for the next 2 weeks.

Call DR MICHELE D KOO, BOARD CERTIFIED PLASTIC SURGEON (314) 984-8331 TO CHANGE YOUR LIFE.

BOTOX® Cosmetic and BOTOX® (Botulinum Toxin Type A) By the Numbers

• 3,181,592: Number of BOTOX® Cosmetic treatments administered in the United States in 2006
alone

• 1,000,000s: People who received treatment with BOTOX® for medical and aesthetic purposes
around the world

• 300,000: Number of men who received treatment with BOTOX® Cosmetic in 2006

• 10,000: People in clinical trials

• 3,000: Publications on Botulinum Toxin Type A in scientific and medical journals

• 100: Years of study into botulinum neurotoxins

• 97: Percentage of people satisfied with their BOTOX® Cosmetic treatment based on a survey of
   approximately 1,000 patients

• 75: Countries around the world who have approved use of BOTOX®

• 20: BOTOX® indications approved by regulatory authorities around the world, including the aesthetic 
   indication

• 18: Years since U.S. Food and Drug Administration (FDA) approved BOTOX® to treat excessive eye 
   blinking and crossed eyes

• 11: Descriptor for the glabellar (vertical) lines between the brows which can be treated with BOTOX®
   Cosmetic, that can help improve one’s overall facial appearance

• 8: Years since FDA approval of BOTOX® for the treatment of cervical dystonia (painful neck twisting
   condition) in adults

• 6: Years since FDA approval of BOTOX® Cosmetic for the treatment of the moderate to severe
   glabellar (vertical) lines between the brows in adults 18 to 65

• 4: Years since FDA approval of BOTOX® for the treatment of severe primary hyperhidrosis (excessive
   underarm sweating) inadequately managed with topical agents

• 1: Rank of BOTOX® Cosmetic on list of “Top 5 Surgical & Nonsurgical Physician Administered
   Cosmetic Procedures,” according to American Society for Aesthetic Plastic Surgery

About BOTOX® (Botulinum Toxin Type A)

BOTOX® is a medical product that contains tiny amounts of highly purified botulinum toxin protein refined from a bacterium. The product is administered in small therapeutic doses by injection directly into the affected area, and works by blocking the release of acetylcholine (a neurotransmitter that signals the
muscles to contract) at the neuromuscular junction.

BOTOX® neurotoxin therapy was granted approval by the FDA in 1989 for the treatment of strabismus
(crossed eyes) and blepharospasm (uncontrollable eye blinking) associated with dystonia, including benign essential blepharospasm or VII nerve disorders in patients 12 years of age and above. The efficacy of BOTOX® treatment in deviations over 50 prism diopters, in restrictive strabismus, in Duane’s syndrome with lateral rectus weakness, and in secondary strabismus caused by prior surgical over-recession of the
antagonist has not been established. BOTOX® is ineffective in chronic paralytic strabismus except when
used in conjunction with surgical repair to reduce antagonist contracture.

BOTOX® neurotoxin has since received approval in December 2000 for the treatment of cervical dystonia in adults to decrease the severity of abnormal head position and neck pain associated with cervical dystonia.

In 2002, with dosing specific to treat frown lines between the eyebrows, the product was approved by the FDA for the temporary improvement in the appearance of moderate to severe glabellar lines (the vertical “frown lines” between the eyebrows) in adult men and women aged 65 and younger, under the name BOTOX® Cosmetic. More recently, in July 2004, BOTOX® was granted FDA approval for the treatment of
severe primary axillary hyperhidrosis (excessive underarm sweating) that is inadequately managed with
topical agents.