Category Archives: Face

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.

Is there a way to prevent skin cancer?

I think we all understand that skin cancer is caused by sun exposure, and that the best prevention is using sunscreen.  But what if you’ve missed the boat on that option? Every day I see patients in their 40s, 50s and older who have already been subjected to many years of sun damage. Wearing sunscreen moving forward is certainly important, but is there a way to improve some of the damage that’s already been done? Thankfully there is.

Topical retinoids may help reduce chronic sun damage. I’ve covered how to use these products in a previous post, so we’ll skip over that here. Two other options are also effective:

  1. Skin resurfacing. Skin resurfacing includes treatments such as dermabrasion, laser peels and chemical peels. These treatments remove the outer layers of the skin, which is where most of the sun-damaged cells reside.
    Pros:

    1. Skin resurfacing will improve fine lines and pigmentation as well as reduce the risk of skin cancer.
    2. The recovery time is only about a week, and these procedures can be done in the office.
      Cons: Skin resurfacing is usually considered cosmetic, and thus is not covered by insurance.
  2. Topical medication. Efudex (fluorouracil) is actually a chemotherapy drug used to treat cancer, which was formulated into a skin cream. It kills abnormal cells, such as those at risk of turning into skin cancer. The medication is used for a few weeks until most of the abnormal cells have been killed.
    Pros:

    1. Efudex is covered by most insurance plans.
    2. Efudex will remove sun-damaged cells that are not visible to the naked eye.
      Cons: Efudex causes skin irritation, rash, and redness, which may persist for up to two months after you stop the treatment.  No makeup can be worn during the treatment period. The photo below is what a typical patient looks like during treatment.

      Side effects of Efudex. From: http://alaneg1948.blogspot.com/2012_05_01_archive.html

      Side effects of Efudex. From: http://alaneg1948.blogspot.com/2012_05_01_archive.html

 

If you are interested in pursuing Efudex or skin resurfacing, I would recommend seeing a board-certified Plastic Surgeon or Dermatologist in your area who has experience treating skin cancer with both of these treatment options.

 

Questions? Leave them in the comments section and I’ll do my best to get back to you.

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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.

What is the difference between Botox and fillers?

I perform many minimally-invasive procedures to treat wrinkles in my office, and I’ve noticed that there is often a lot of confusion about exactly what the difference is between a neurotoxin such as BOTOX, and a filler such as Juvederm or Restylane. My blog post today is written with the intent of clearing up that confusion.

Confusion is understandable, as the two treatments do share many similarities. Both neurotoxins and fillers are injected in the office. Both treat wrinkles. And both are temporary, meaning the results wear off over time. But the two products actually work quite differently.

As I mentioned before, Botox is a neurotoxin. This means it is actually toxic to nerves, thereby preventing muscles from contracting in the areas where it is injected. Muscle contraction is responsible for what are called “dynamic wrinkles”, i.e. wrinkles resulting from motion. Dynamic wrinkles are commonly seen between the eyebrows, over the forehead, and around the eyes. Preventing the muscles from moving stops the wrinkle from forming. Because neurotoxins cause localized muscle paralysis, I do not like to use them around the mouth as this may result in drooling or difficulty speaking and eating.

Fillers do what their name implies: they fill volume. Volume loss in the soft tissues contributes to an aging appearance. This is partially responsible for the formation of the “smile lines” which run from the nose to the corner of the mouth, and the marionette lines which run from the corner of the mouth to the chin. Ptosis or droopiness of the overlying tissue secondary to gravity is the other main contributing factor, and this can be corrected surgically. But adding volume directly under a wrinkle can significantly soften the appearance. Unlike neurotoxins, which require several days to take effect, the results from fillers are immediate.

If you’d like to learn more, check out my previous posts on Botox and other neurotoxins as well as fillers.

Any questions? Leave a comment and I’ll do my best to get back to you.

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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.

What if my family doesn’t want me to have Plastic Surgery?

Having Plastic Surgery is a big decision, and it is common for families to want to weigh in on the topic. But what do you do if your family is against you having surgery? This is actually a scenario that I see a few times a year. Before I delve in to how I help patients through this type of situation, let’s talk first about the financial aspect. Cosmetic surgery can be expensive. If your family or spouse doesn’t support your decision because they don’t think you as a family can afford it, you need to approach this like you would any big budget decision. Finances affect the entire family, so this is definitely an area where you and your spouse need to be in agreement. But if you’re single, and you are responsible for your own finances, it really doesn’t matter what other people (e.g. your grown children, friends, you parents) think. Your finances are your decision.shutterstock_325360154

With that out of the way, there are two other common objections that I see family and friends make.

  1. They worry about your health and safety. Whether you are medically a good candidate for surgery is a decision that should be made by your surgeon, possibly with input from your primary care physician. I have had family members tell me that they don’t think their mother or father is medically healthy enough to have surgery, but when I review the patient’s medical history, there is actually nothing concerning that would increase the risks of surgery. The only thing you can do here is to reassure your family that your doctor thinks you are medically healthy enough to have surgery. Seeing your family doctor for additional input may put your family’s mind at east, as this information would be coming from a trusted and known source, rather than a doctor you’ve just met.
  2. They don’t think you need surgery. This objection comes up quite frequently. And this isn’t really surprising, because it’s a value judgement. If something bothers you, that is all that is important. Now granted, people do sometimes obsess over an area of the body that actually needs minimal improvement. And this is where your surgeon’s judgement is important. If I think that I can make a visible improvement that will make a patient happier, then I recommend surgery. But if I think that no improvement is possible or that the patient won’t be happy regardless of the results, that is not a patient I offer surgery to.

To summarize, the financial aspect of surgery is a decision that should be made as a team if you are married or otherwise share finances with someone. But if finances are solely your decision, then the opinions of other family and friends don’t matter. The other aspects of the decision to have surgery are 1) whether you are medically healthy enough, and 2) whether you’ll be able to achieve the results you want. Those parts of the decision should be made in collaboration with your surgeon and your primary care physician.

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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.

What is the difference between a neck lift and a face lift?

Face lift and neck lift are two procedures that are nearly always done in a single operation. Today I’m going to talk about the difference in the two operations, and when you might only need one vs. both.

  • Face lift: addresses only the mid-face, which is the area from your jawbone to your cheek bone (outlined in blue on the photo below). I’ve spent time in another post discussing exactly what happens during a face lift, but to summarize, the skin anterior to the ear is elevated using an incision that starts just in front of the ear and continues around to the back of the earlobe. The underlying layer of muscle and connective tissue is then tightened using suture. This is the actual “lift” that occurs. Then the skin is re-draped and any excess removed before closing the incision. face lift and neck lift locations
  • Neck lift: addresses only the anterior neck, from the just behind the ears to the midline (outlined in purple in the diagram to the left. A neck lift is done through nearly the same same incision as a face lift. The only difference is that the incision continues further behind the ear to remove the excess skin over the neck. There is also an additional incision under the chin. This incision is used to tighten the muscles along the front of the neck, and to remove any excess fat. The excess skin is then removed and the incision is closed.

From the description, I think you can see why face lifts and neck lifts are usually done together. If you have laxity (loose skin) along the jawline, then you very likely have laxity under the chin as well. I do see the rare patient, often younger, who only has laxity along the jawline. And in this patient, it may be appropriate to only do a face lift. The other time I will do only one of the two procedures is in a patient who has had prior surgery. In this case, it is common for only the neck or only the face to need a touch up.

 

Do you have a question about face lifts or neck lifts? I would love to answer your questions in the comments section.

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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.

What gives away your age?

We all know that wrinkles and sagging skin on the face are dead giveaways of our true age. But there are two other body parts that indicate your age that you may not even aware of.

1) Your neck and décolletage. Most women focus on the face when applying skin care products, sunscreen, and makeup. But the neck and décolletage receive as much sun, if not more. Fine lines and brown spots in this area are a dead giveaway of age. There are several treatment options for this area:

  • Skin care products: The same skin lightening creams (e.g. Lytera) that work on the face work on the chest and neck as well.
  • Resurfacing: Although a traditional laser peel is too harsh for the delicate skin in this area, more mild chemical peels and Profractional laser treatments can both be done on the neck and chest. These options will improve both texture and pigmentation.
  • Fotofacial or BBL: The primary goal of a fotofacial treatment is to even out the pigmentation, and it is very effective over the décolletage.

    BBL treatment of the chest

    BBL treatment of the chest

  • Skin tightening treatments: Marketed under many different brands (Venus, Skintyte, Ulthera, Thermage), these treatments heat the skin, which stimulates collagen remodeling and tightens skin gradually over a 4-6 month period. This is a great option when skin on the neck develops a crepey texture.

2) Your hands. Hands are subject to the same pigmentation issues as the rest of the body. And although skin on the hands does not develop wrinkles in the same way, the soft tissue does thin out (atrophy) over time, making the hands appear bony or gaunt.

  • Skin lightening creams and fotofacials are both great options for achieving more even pigmentation out on the hands.
  • There are two options to treat volume loss in the hands. Radiesse® has been used to add volume to the face for many years, and was recently approved by the FDA to add volume in the hands. Radiesse® is composed of hydroxylapatite, a mineral found in bone. It is injected under the skin to add volume, and lasts about 9-12 months. The other option for adding volume to the hands is fat grafting. This procedure takes fat from the abdomen or thighs, and injects it under the skin. Unlike Radiesse®, fat-grafting is permanent.

What body area shows your age the most? I’d love to hear from you!

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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.

IPL fotofacial for black or Asian skin?

I’ve written about IPL, aka BBL treatments in previous blog posts, as well as the difference between an IPL and a fotofacial. IPL treatments are traditionally reserved for people with lighter skin tones. This is because unlike a laser, IPL produces all wavelengths of light, and then uses a filter to block out the wavelengths of light we don’t want to use. Filters aren’t perfect, so what results is a narrow range of wavelengths, as compared to a laser which produces only a single wavelength. The end result is that IPL devices have a tendency to heat the skin up more than a laser would. Darker skin tones (which have more melanin), heat up more, which means there is a risk of burning the skin.

photo credit: shutterstock.com

photo credit: shutterstock.com

Despite this risk, a fotofacial actually can be done on darker skin types. To reduce the risk of burning the skin, I use lower energy settings and different wavelength filters on patients with dark skin. More treatments may be needed to see a result because of this. If you are considering having a fotofacial and you have darker skin, I definitely recommend seeing a physician who has significant experience performing fotofacials on both light and dark skin types.

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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.