Botox– The Quintessential Botulinum Toxin!

One thing I have learned in opening a medical spa is that Botox or I should say botulinum toxin A, is the one service that people will come out to get. I’ve often wondered is it because it’s from $10-15 per unit, is it because it is only temporary, or is it simply because people, and I mean ALL PEOPLE, hate wrinkles? I have come to believe it is the latter. As an injector, injecting botulinum toxin is my least favorite procedure. Let me elaborate… I truly believe that people who frequent medical spas are those individuals who enjoy instant gratification. I know this because I too am a person who wants instant results. If I am paying to visit a medical spa, when I leave, I want to be able to tell I had something done. That’s why of all the procedures we offer at Landy HE, I will neglect to get my botox before I neglect any other procedure that I use as a part of my beauty maintenance. However, I realize, by doing this, I am not setting a good example for my clients. If you make the effort to consistently get botox injected as a means of ridding your face of unsightly wrinkles, you are taking part in a very beneficial habit for your skin in the future. When you have botulinum toxin injected, the main purpose is to paralyze muscles to prevent wrinkles. It is a known fact that if you do not use a muscle, you lose it. The muscle will atrophy and be much less noticeable, in return, you end up with less visible wrinkles.

In case you haven’t figured out the purpose of this blog, I hope that it will thoroughly educate you on those aesthetic procedures you are interested in. So my wish is that the next few sections of this blog will educate you on things you have always wanted to know the answer to regarding botulinum toxin.

What is botulinum toxin? Onabotulinumtoxin A by Allergan is called Botox. Galderma’s onabotulinumtoxin A is called Dysport. Merz has produced incobotulinumtoxin A that is better known as Xeomin and now there is a new one called Jeuveau or prabotulinumtoxinA-xvfs made by Evolus. Botulinum toxin is only contraindicated, absolutely cannot be given to, those who have a known allergy to the product or if they have any type of skin infection directly over a site that is likely to be injected. If you are one of the unlucky individuals with ALS or myasthenia gravis, you can be injected with botulinum toxin, as long as the MD clears you. If this happens, you will likely be warned that you are going to be more prone to the possible side effects of muscle weakness or trouble swallowing.

There are a few things that I would like to try and explain to you before getting any more in-depth on botulinum toxin. In the face, muscles are generally either classified as elevators or depressors. If you inject toxin into an elevator, you will DROP something and the opposite is true of depressors. If injected with botulinum, a depressor will RAISE something. I say all of that to express to all the ladies and gentlemen who get injected with Botox, or BRO-tox for the men (we aren’t chauvinists here) who get injected, the frontalis muscle (the large muscle in the forehead) is an elevator. If your injector isn’t careful, an eyebrow can easily be dropped while the forehead is being injected with botulinum toxin. If given in the wrong spot OR rubbed after injected, botulinum can also cause an eyelid droop.

Botox/Bro-tox at Landy HE, because that’s what you will get, we do not inject any other type of neurotoxin at the moment. Why? Once I became savvy with injecting Botox, I decided that there are too many potential negative adverse effects, and the units for other toxins on the market are not interchangeable with Botox meaning I have to inject different amounts depending on the toxin I choose to use. There are times I am unable to visualize the number of units I am injecting in each site, but because I have been injecting Botox for so long, my injecting hand muscles are trained now to almost inject the same amount every time in each site without actually looking at the syringe. Any patient who’s been to our spa for Botox injections will tell you that I ALWAYS under-inject when it comes to Botox and fillers. My motto is, “you can always add botox, but you can never take it back.” So, when injecting botulinum toxin, I always start with the lowest effective dose in each site I inject, this has proven to give me the least side effects (i.e. eyebrow or eyelid droops). If I am injecting for the “lip flip” I usually inject 2-4 spots along the top lip border.

Another negative aspect of the other botulinum toxins is that they all: Xeomin, Dysport, and Juveau only have the FDA indication of treating glabellar lines, otherwise known as the “11’s” between your eyebrows. Botox has the FDA indications to treat glabellar lines, forehead lines, and lateral canthal lines (crows feet). Botox can also be injected for those with dimpling in the chin, a downward turned smile, a gummy smile, and for a brow lift or to help diminish the appearance of hooded eyes.

The most important thing I can stress to you is botulinum toxin spreads into surrounding tissue, if you assist in that process, you can end up with unwanted side effects. I cannot tell you how many patients I have seen who said to me, “I had my eyebrow dropped once,” or “can you please try not to drop my eyelid?” Adverse events like this are the number 3 reason that medical spas/plastic surgeons’ offices get callbacks with requests for follow up appointments due to unwanted side effects.