Apr 10

Natural Looking Botox

The term is somewhat of a misnomer but the effect can be achieved.  Subtle administration with amounts deposited in correct dosage can achieve a softer look of expressive wrinkles.  Patients who haven’t had Botox or Dysport or believe before hand that they will be unable to move their face.  This is not true.  For a new patient who has not had either product I always start off with very light amounts or dosages or what we call titrations.  “Newbies”, what I call first time patients, I feel should always get  just “laced” very lightly with the product.  For the dreaded “11’s” between the eyes, 18 units to start is ideal for a female patient.  These are given in deposits 1 2 4 4 4 2 1 unit amounts starting from between the eyes from the middle area going laterally to the outside.  This amount will give what I like to call the “Kardashian flair” with a little lift to the eyebrow corner.  Most doctors are taught to give the product centerally at the mid most portion of the eyebrow and some additional product above the eyebrow directly over the pupil.  This titration amount may work with many patients.  However, if a lot of muscle activity is present in the tail of the muscle towards the outside, some patients get a chevron in the middle of the eyebrow.   This will be particularly evident upon expressive “surprise” type movements.  This gives unfortunately what I refer to as “the Spock eyebrows”  NOT A GOOD LOOK!   Just the addition of one or two units far to the outside laterally and a little higher than the eyebrow will correct this.  Ladies want their eyebrows to look like Kim Kardashian’s not Leonard Nimoy’s character.  The other very common fault I seel being committed with products are some clinicians do not go high enough on the crown of the patient’s forehead.  This will leave a lot of corrugation to the patient’s brow just at their hairline, not good as well.  Coco (aka Nicole Austin), from Coco and Ice, and Kelsey Grammer’s ex-wife, Camille  from Beverly Hills Housewives, have this Botox faux pas.  I am afraid they are paying top dollar for this unflattering look.  The point being is the movement should be even and not just in one spot.  Some patient’s will request no movement or want to be frozen.  This of course can be achieved as long as their eyelid tissue has no hooding.  When titrating to this amount it is important not to leave one zone entirely active because then this oddly makes the look fake.   When I place Botox, I use a small eyebrow pencil as a template marker and assess muscle girth or size and the parameters of its activity.  I once treated a patient in an office with a general surgeon physician who was also on staff their.  When he saw me mapping a patient with the eyebrow pencil, he asked “what do you do that for?”  I stated so I can see how the product needs to be placed.  His response was “I do the same thing with everyone. I don’t need a map”.  Oddly, his patients seem to require more touch-up follow up units to “correct” things.  Hmm, I wonder why?  Botox can also be given around the mouth.  But thats another blog on another day.