Botox Gone Wrong – Why Does Bad Botox Happen?

botox gone wrong

When I see new patients who want Botox for the first time, they often bring up examples of Botox gone wrong. So what exactly is Botox gone wrong? And why does bad Botox happen? FYI, I use two types of neurotoxin in my practice – Botox and Xeomin. But for the sake of simplicity I will refer to all neurotoxins as Botox.

botox gone wrongHow does Botox work?

Botox is a neurotoxin produced by the Clostridium botulinum bacteria. The toxin acts at the junction between nerves and muscles, and blocks the nerve from transmitting signals to the muscle.  So injecting small amounts directly into a muscle results in paralysis of that muscle.

Botox only works on dynamic rhytids, meaning those that appear with facial expression. If you have visible wrinkles when you aren’t frowning or raising your eyebrows, you may need fillers or laser resurfacing to get an optimal result.

botox or fillers

Botox is most useful on the upper third of the face. I use it over the forehead, on the frown lines between the eyebrows (affectionately called the “elevens” by Allergen, the company that manufactures Botox), and on the crow’s feet around the eyes.

I will occasionally, and cautiously, inject Botox around the mouth. But because it paralyzes muscles, using too much Botox or putting it in the wrong place can cause difficulty speaking and eating. If you’ve ever seen Christmas with the Kranks, the scene where Tim Allen is drooling after getting botox is a great, although exaggerated, example of what could happen if you were to get Botox injected around the mouth. Granted, it would actually take 5-7 days for the Botox to kick in, but then the movie wouldn’t be as funny.

So why does Botox make people look fake?

There are three common examples I see of Botox gone wrong:

  • If your face is totally frozen. I think we’ve all seen that expressionless person who wouldn’t blink an eye if she had a gun pointed at her face. You know. Because she can’t. I’m a big proponent of a natural result, and I think your face should move at least a little bit after Botox injections. Granted, I have patients who like a more dramatic result. And I’m happy to tailor my treatment to their preferences. But my go-to treatment result is very natural.
  • The Spock eyebrow. When botox is injected only over the central forehead, the lateral brow can arch too much and make you bear an unfortunately resemblance to everyone’s favorite Vulcan. Fortunately this is totally correctable; injecting a little Botox over the lateral forehead will take care of the problem.
  • The eyelid droop. Drooping of the upper eyelid can happen when Botox diffuses into the muscles that raise the upper eyelid. This is thankfully very rare; I’ve actually never seen it happen.  The eyelid droop does go away in a couple of months when the Botox wears off, and eyedrops can improve it in the meantime.

Now that you know what causes Botox gone wrong, how do you avoid it? If you want a good result, go to a good doctor. Plastic Surgeons and Dermatologists have special training in cosmetics and facial anatomy that make them the experts at injecting Botox and facial fillers.

Would you like to learn the differences between Botox and fillers? Click on the link to download my freebie!

botox or fillers

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

4 Reasons Diets Don’t Work

diets don't work

**Let’s be honest with ourselves: diets don’t work. Traditional diets state if you take in fewer calories than your body burns, you’ll lose weight:

Calories In – Calories Out = Body Fat

diets don't workSo if you take in more calories than you burn, the rest is stored as body fat. Seems simple,
right? But if it is that simple, why is it so freaking hard to lose weight? Here is why: because this is WRONG. And today I’m going to explain four reasons the calorie-based method of weight loss does not work.

Reason 1 that diets don’t work: Calories in and calories out are NOT independent of one another.

The traditional teaching (aka “move more, eat less”) is pretty simple: if your body needs 2000 calories a day to live, then cutting your calorie intake to 1500 calories per day creates a 500 calorie deficit. There are 3500 calories in a pound of fat, so a 500 calorie/day deficit means you should lose a pound in a week, right?

Nope. Not even close. When you cut calories, your body actually burns fewer calories to conserve energy. In evolutionary terms this makes sense: if our bodies kept burning calories at the same pace during a food shortage, we would have died off pretty quickly as a species.  Think of it another way: if you suddenly get a pay cut at work, you aren’t going to keep spending money at the same rate. You’ll cut your monthly budget down before dipping into your savings. In the same way, your body will burn fewer calories when access to food is low, rather than burning through fat stores.Download my freebie

Reason 2 that diets don’t work: All calories are not equal.

I think intuitively we know that our body does not treat 200 calories worth of broccoli and 200 calories worth of ice cream the same way. Nobody ever got fat eating a ton of broccoli, right? Yet the concept that we must cut calories to lose weight treats all calories equally. This is another reason diets don’t work; they focus on the quantity (i.e. calorie count) of food rather than the quality of food. Over the past two decades we’ve seen obesity rates surge despite increasing availability of low-calorie foods.

Reason 3 that diets don’t work: You have less control over “calories out” than you think.

Traditional diets focus on exercise as a way to burn calories and increase the calorie deficit, in an attempt to nudge our bodies toward accessing stored fat. On The Biggest Loser contestants spend hours a day exercising in an attempt to burn calories and lose weight. But guess what? It doesn’t work.

First, you just cannot burn that many calories with exercise. Run a marathon and your body burns a whopping 2600 calories. But you can consume 1300 calories eating your average dinner at Olive Garden. And I’m guessing most of us eat dinner at Olive Garden far more often than we run a marathon.

Second, your body responds to exercise in a way that actually prevents weight loss. Exercise triggers increased hunger, which most of us have probably noticed at some point. (full disclosure: I thought the increased hunger after a run meant my body needed that deep-fried French toast!) But what you may not have noticed is that your body also compensates for exercise by being less active throughout the day. So the average number of calories burned stays the same. This has been shown in studies that followed kids with increased gym class time; the kids were more sedentary the rest of the day, so their average activity remained the same. That old adage to eat less, move more? It just doesn’t work.diets don't work

Reason 4 that diets don’t work: We have less control over hunger than we think.

Hunger is hormonally regulated. Our bodies send signals to tell us when we’re hungry, and to tell us when we are full. Over thousands of years the human body has evolved mechanisms for homeostasis, i.e. maintaining a stable equilibrium. This includes body weight. And our bodies are very, very good at this. Which means part of the reason diets don’t work, is that you’re literally fighting your body when you cut calories. You may have noticed that trying to cut calories results in ravenous hunger. Your body is telling you it needs more food. And as I’m sure you’ve noticed, extreme hunger is pretty hard to ignore.

After reading this post, you’re probably thinking two things:

  1. No kidding I’ve never been able to lose weight! Cutting calories and exercising has doomed me to fail! (i.e. diets don’t work).
  2. Wait- does that mean losing weight is impossible?

I assure you, losing weight is possible. I have lost over 45lbs in the past year and a half, diets don't workso I know it can be done. Want to learn a little more?

diets don't work




You can also read more diet myths on a previous post.

** This information is for general knowledge only, and is not intended as medical advice.





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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Be More Productive in 3 Easy Steps!

be more productive be more productive be more productive

We all want to be more productive, right? But I often feel like there just aren’t enough hours in tips to be more productivethe day to get everything done. And if you have kids, you know what I mean! I recently listened to a fabulous podcast of an interview with Michael Hyatt, a guru in leadership and getting things done. Amy Porterfield did the interview as part of her regular business podcast. If you’re not familiar with her, she is a fabulous source of expertise in running an online business. Today I want to share some of the great tips they offered to my readers today so we can all be more productive.

Tips to be more productive:

List all your tasks

This means every last thing you have on your plate, from folding laundry to creating a presentation for work. Now you’re going to divide this list into two categories: things that have to be done, and things that don’t. Be ruthless in deciding what doesn’t actually need to be done. For example, about two years ago I stopped sending Christmas cards. (Full disclosure: I actually stopped sending them about five years ago, but two years ago I decided to stop feeling guilty about it!) I just don’t see them as a necessary part of my life, and my friends and family all still speak to me.

Decide what must be done by you, and what you can delegate.

You can delegate way more than you think! There are so many things we continue to do because teaching someone else how to do it seems harder. But in the interview Michael Hyatt talks about hiring a virtual assistant to outsource. He initially started at five hours a week. Within a month he was up to 20 hours a week, because he’d found so many things he could take off his plate and delegate.

Decide what is most important, and schedule time for this in your calendar.

Notice I didn’t say what’s most urgent, but what’s most important. Work will expand to fill the gap. So it’s important we set aside time for the things that mean the most to us. This might be hanging out with our kids, taking the dog for a walk, or going to a yoga class. Taking breaks like this allows you to recharge, and actually helps you be more productive in the end.

If you’d like to listen to the full interview (which I would highly recommend!) you can catch it on the Amy Porterfield website. But even making these three small changes can help you be more productive!

Want to learn more about my crazy life as a mom, wife, and Plastic Surgeon? Check out my home page!

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Setting Goals in 5 Simple Steps

<how to achieve goals how to achieve goals how to achieve goals

The New Year is nearly upon us, and a new year means setting goals! Over the past 15 years I’ve completed medical school, trained in Plastic Surgery, and set up my own practice. So I’ve got quite a bit of experience with setting goals and completing them. But this process has really gelled for me over the past couple of years, and today I’m going to share with you the tips I found most helpful for setting goals and completing them.

Choose one goal.

Or maybe two at the very most. I know that it’s tempting to make several goals. I’ve even heard advice to choose a personal goal, professional goal, spiritual goal etc. But I’ve found that focusing on a single goal is like magic. You have a finite amount of time, willpower, and energy. And the more you try to accomplish, the thinner those resources are spread. Focus all that how to set goalsenergy in one place and you’ll see bigger results.

Make your goal measurable.

For example, say you want to get stronger. That’s a great goal, but how do you know when you’ve achieved it? Setting a goal of being able to do 10 pushups is much clearer. Or what if you want to spend more time with your friends? Setting a goal of meeting with a friend two times a month for dinner or lunch has a clear end point, so you’ll know when you’ve met the goal.

Add a timeline for completion.

Without a deadline, it’s very easy to push things into the future. You may need to adjust your deadline to account for the real world (e.g. you have a weight loss goal with a deadline, but come down with the flu for two weeks). But a goal without any sort of timeline just doesn’t hold you accountable in the same way having a finite deadline does.

Write out the actions you must take to accomplish your goal.

If your goal is to grow your business, these steps might include attending networking events, improving your website, or increasing your presence on social media. If your goal is to run a half marathon, these steps would include starting with shorter training runs and adding in long runs once a week. Break each action down into its component parts until you have a large list of individual tasks. So attending networking events may entail 1) doing an internet search for events in your area. 2) signing up. 3) Actually attending the event. As you break your goal down into individual action steps you may need to go back and adjust your timeline.

Schedule those action steps into your calendar.

If my goal is to increase my social media presence this year, I need to make time each week to achieve the tasks needed to complete that (e.g. learn more about Instagram, or take an online workshop to increase Facebook followers). When the time comes around to do what you scheduled, do it even if you don’t feel like it. The more you build the habit of doing things when you’ve scheduled them, the easier it becomes to hold yourself accountable.

The bonus step – celebrate when you achieve your goal!

So often we make vague promises to ourselves, and start off strong only to lose motivation over time. But to actually set goals and achieve them requires that you focus your energy on a single clearly-defined goal, then break things down into manageable parts.

My goal this year is to grow my medical practice, so I can help more women look and feel amazing. Click on over to learn more about what I do. And I’d love to hear your goals in the comments!

Dr. Greer is a plastic surgeon in Cleveland, Ohio. Her passion is helping moms regain their confidence by getting rid of sagginess, wrinkles, and stubborn fat using surgery, laser, Botox and fillers. Check out her website for more information, or to download a FREE copy of “The Busy Mom’s Guide to Plastic Surgery.


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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

3 weight loss myths to ignore, and what to do instead.

The internet is full of weight loss myths; everything from you should exercise to lose weight (caught you off guard there, didn’t I?) to juice cleanses will somehow rid your body of toxins. But there are some more pervasive and common weight loss myths that I think most of us still believe.

weight loss myths

Here are my top three weight loss myths:

Weight loss myth #1: If you eat fewer calories than you burn, you’ll lose weight.

The human body is a complex machine. Body weight is regulated by a plethora of weight loss mythshormonal cascades, which are affected by not only the quantity of food we eat, but the type of food as well. This weight loss myth also relies on the concept that the amount of calories we burn is independent of the calories we take in. And that’s just not true. So please, STOP counting calories.

What you should Do instead:

Focus on high-quality food like fresh or frozen vegetables, fruit, full-fat dairy, and whole grains. Avoid processed foods that contain flour and sugar. Rather than counting calories, your goal should be to stop eating when you are full, but not uncomfortably so. Your body has mechanisms to tell you when to stop, but they get out of whack when we eat a lot of processed food containing flour and sugar.

weight loss myths

Weight loss myth #2: Eating low fat food is good for you.

There is very little science to support a low fat diet. There are three main areas where dietary fat has been labelled “bad”. First, dietary fat, and especially saturated fat, has long been taught to be a cause of heart disease. Yet decades of research have not found evidence to support this. Second, we have also been taught that dietary fat increases cholesterol levels. But 80% of the cholesterol in our blood is actually made by our bodies. It does not come from dietary fat! The last reason fat is thought to be “bad” is because it has more calories than protein or carbohydrates, the other two macronutrients. But here’s the thing: our bodies evolved to eat fat. They release hormonal signals that we’re full after eating fat. This is not true for eating flour and sugar, which are relatively new food sources on the evolutionary scale.

What you should do instead:

Eat plenty of saturated and unsaturated fat. Fat-containing foods such as olive oil, butter, coconut oil, and avocados will keep you feeling full longer. But this does not extend to trans-fats. Trans-fats are artificially created saturated fats, and unlike natural saturated fats such as lard, they do increase the risk of heart disease.

Weight loss myth #4: Breakfast is the most important meal of the day.

We’ve long been taught that eating breakfast increases your metabolism. Like the myth of the low-fat diet, there really isn’t much evidence to support this. The other big problem with breakfast is that most common breakfast foods in the U.S. are total junk disguised as healthy food. Cereal, muffins, instant oatmeal, and even yogurt all contain loads of sugar.

What you should do instead:

If you’re hungry first thing in the morning, choose unprocessed foods like eggs, regular oatmeal (not instant or quick oats, as these are processed into smaller particles that the body handles differently from a hormonal perspective), cheese, or bacon. A veggie omelette is a great start to the day. And if you’re not hungry, simply don’t eat. I promise you this will not slow down your metabolism or make you gain weight.

weight loss myths

I hope you’ve enjoyed learning about my favorite weight loss myths. If you’d like to learn more about how our bodies respond to food from a hormonal perspective, I highly recommend the Intensive Dietary Management website by Dr. Jason Fung, a Canadian kidney specialist who treats obesity.





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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.