Office Notes: Botox
July 21st, 2009
Today I will be injecting Botox ®. Comments I hear frequently are, “My last Botox ® did not last as long as I would like. The Botox ® did not work as well as I had hoped.” Patients with these complaints usually had their last injections elsewhere. Often times, the injectionist is a non-physician and sometimes an individual with little or no medical training.
Botox ® is packaged in 100 unit bottles. This “unit” measurement is determined through a physiologic assay. The Botox ® package insert recommends 20 units for the frown lines. When the full 20 units is used in this one area, the results are consistent and should last for the full 3 to 6 months. It has become common practice in salons, med-spas and some physicians offices to inject less than 20 units of Botox ® into the frown lines. Injecting less saves money. Reducing the dosage leads to decreased effectiveness and decreased longevity. Patients return for “touch up” injections to get the result they desire.
My advice for the increased likelihood of a obtaining a professional and lasting result, is to consider having the full dosage recommended by the manufacturer (20 units for the frown lines) and consider having your Botox ® done by a physician.
Over Plumping
May 5th, 2009
Foster Farms vintage ad campaign for their chicken products uses a parody of over-plumping with artificial fillers. In their television commercial, chickens are seen in a plastic surgeon’s office receiving injections to make them plumper. It is quite obvious that they are way too plump.This situation is underscored by the distorted facial appearance of the surgeon’s nurse when she finally reveals her face to the camera. This crazy parody pokes fun at the sometimes over-zealous use of fillers in Hollywood.
I see over-plumping all the time, especially in the lips. The individuals, usually women, lose all of their natural lip shape. The over-injection usually masks all natural proportion. The television commercial effectively uses this phenomenon for optimum comedic effect. However, I agree with the tagline, “over-plumping” is never good.
A word of caution, the over-injection of any area of the body can lead to skin loss and terrible, uncorrectable scarring. The large volume of material simply reduces the blood flow to the treated area in such a way that the skin, muscle and fat die. Fortunately, this complication is very rare when only modest amounts of filler materials are used.
Finally, please avoid all silicone injections for cosmetic reasons. The risk of chronic long term inflammation which arises is not worth it. Fat Grafting is a natural technique used more commonly now for facial rejuvenation and avoids the use of artificial fillers. See more on fat grafting injections.
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