Rita Linkner: “Botox chemicals are addictive.” I think Botox is like dyeing hair or manicure. This is not what you have to do, but you will want it.
Jordana Herschthal: “Botox is very simple, anyone can inject it.” My 2-year-old child can push the plunger, but it is also easy to mess up other people’s faces.
Hi, my name is Dr. Rita Linkner. I am a board certified dermatologist from New York City. I spend most of the day doing injections and lasers.
Herschthal: Hello, my name is Dr. Jordana Herschthal. I am a board-certified dermatologist in Boca Raton, Florida. I like to talk to patients about their aesthetic goals and help them understand the whole picture. We are here today to debunk the myth about botulinum toxin.
Linkner: Botox is recognized by this name. It is the first neuromodulator approved by the FDA, so it is a household name, just like Kleenex and Xerox. So today, when we discuss all the neuromodulators currently approved by the FDA, we will refer to Botox as a general term.
Herschthal: Therefore, botulinum toxin contains a purified protein called botulinum toxin, which is derived from a bacterium that causes botulism, which is toxic to your body. However, the proper use of Botox at the proper dose is very safe and very effective. There are more than 3,000 studies to prove its effectiveness and safety. Another reason it is very safe to use is that we know it stays where we injected it. So this is not to say that you have injected Botox on your forehead, it will spread all over your body. Botox is limited to the injection site and will be safely metabolized and excreted by your body after a few months.
Linkner: I always tell patients whether Botox is dangerous. I really don’t have a pulse. I am a person who injects 100 units of botulinum to my face and neck every four and a half months. I have been doing this for more than ten years.
Herschthal: Therefore, certain medical conditions prohibit the use of botulinum toxin. Therefore, before you receive botulinum toxin treatment, you should have a very thorough discussion with your provider.
Link Na: “Botox is permanent.” So, let’s debunk this. Botulinum toxin is not permanent. Everyone’s metabolism of botulinum toxin is different.
Herschthal: One of the great advantages of botulinum toxin is that if you don’t like its appearance, it will be completely out of your system within three to six months. But this is also the worst thing, because if you like its appearance, you have to do it again.
Linkner: However, there is a super botulinum that is about to come out, and it hopes to be approved by the FDA later this year. The 11s between the eyebrows will be approved by the FDA, and I can confidently tell you that it is effective and there are signs that it will take more than three to five months.
Herschthal: “Some creams and serums work like Botox.” This is absolutely wrong. Botox works at the muscle level, especially at the neuromuscular junction, to prevent muscle contraction. There are currently no serums, creams or facials that can penetrate deep into the skin to work at the muscle level. If this is true, it must be approved by the FDA and cannot be bought over the counter.
Linkner: I totally agree. I like to tell patients that your genes are programmed to move your muscles in a certain way, and over time you will get what we call dynamic wrinkles, which are lines related to muscle movement. The role of botulinum toxin is to enhance resistance so that you can no longer overuse these muscles, nor can you wrinkle them, and it basically helps to smooth everything out.
Herschthal: The pain of a botulinum toxin injection is very small, but it is similar to a stabbed or bitten finger. Everyone experiences pain differently.
Linkner: They are insulin needles. They are as small as possible. And its speed is faster than people think. Although I think the position of the face does have a great influence on sensitivity.
Herschthal: It’s about the importance of your provider’s true understanding of the anatomy when you receive any type of injection on the face.
Linkner: I mean, I can complete the Botox injection on the entire face and the entire neck in less than four minutes. If people really don’t like needles, you can always numb someone locally to help dissipate the pain.
Herschthal: There are other tips, such as vibration devices and ice. Even for very sensitive patients, we will launch Pro-Nox, a half-dose nitrous oxide, which always calms the patient immediately and leaves your system within five minutes.
Linkner: “Botox chemicals are addictive.” I think Botox is like dyeing hair or manicure. This is how I like to explain to patients who ask me, “If I do this once, do I have to continue to do this for the rest of my life?” This is not what you have to do, but you will want it.
Herschthal: So, I always compare cosmetic treatments like Botox, fillers, and lasers to maintaining any organ in your system. You wash your teeth two to four times a year, whatever it is; you will get your cosmetic treatment because you are always getting old. These treatments will not stop the aging process, but they will help you age the way you want.
Herschthal: “Botox is very simple, anyone can inject it.” On the one hand, injection is very easy. Anyone can push the plunger. My 2-year-old can push the plunger, but it is also easy to mess up other people’s faces. Therefore, it is very important that your provider has a deep understanding of anatomy and how these drugs affect anatomy in order to provide you with reproducible and excellent aesthetic results.
Linkner: So, Jordana and I are board-certified dermatologists. It took more than ten years for each of us to put the syringe in our hands and use the medicine in it to create facial aesthetics. Jordana and I, to this day, we have all participated religiously in courses, learning from the best international patients and conducting anatomy courses. We are still reading every day to truly become the best teacher we can serve patients.
Herschthal: “Botox and fillers are the same.” I like this myth because I might solve it at least once a day. Almost every line on your face can be solved with fillers, but not every line can be solved with Botox. Botox works at the muscle level to relax the contracted muscles. It is preventing and reducing those static lines or static lines. On the other hand, fillers are used to solve the volume loss that appears on our faces as we age. Therefore, we all have fat compartments on our faces. As they age, they shrink and fall over time, so we use fillers to restore the lost volume and make the face younger.
Herschthal: The only problem with botulinum toxin is if you have bruises, but there really is no downtime. About an hour after the operation, you will see small bumps under the skin. This is the solution to the botulinum toxin placed under the skin.
Linkner: You take a needle and pierce it into your skin, so you just want to make sure that you are not doing anything to really thin your blood, which increases the chance of bruising. So ideally, not drinking alcohol the night before, or even coffee in the morning, is really helpful. If you bruise very easily, oral arnica is good.
Herschthal: I always know when I will inject the patient. I call it rosacea. Like a slow oozing after an injection, I know they had a glass of wine or martini the night before.
Herschthal: My only rule is not to touch Botox, because I don’t want you to apply it to the forehead or other areas of the glabellar area, because you may get trouble by dropping someone’s eyelids. Therefore, the muscles that keep the eyebrows raised will drop, and then the patient’s eyelids will appear heavier. Again, these are not permanent side effects, but bad side effects.
Linkner: Your botulinum toxin will gradually decrease every week. It’s not like it just shuts down overnight. I will tell you that during this pandemic, I noticed that people exercise more, which makes their botulinum toxin metabolize faster. So I am often asked this question. You know, “How do we make my Botox last longer?” It is dose dependent. Therefore, if you invest more, the first few weeks may not look so natural, but it should last you for a few weeks compared to when you use a lower dose.
Herschthal: A myth in popular culture. “Botox will make you look emotional.” I heard hatred, but I didn’t see hatred. Rita, can you say I am happy now?
Herschthal: So, I think using the word “relentless” to describe the effect of Botox is a bit strong. If you have an open conversation with your provider about your expectations for Botox treatment, you can easily get a more natural-looking treatment while still retaining some movement of the upper face.
Linkner: It has been eight days since Jordana injected my Botox. It hasn’t reached its peak yet, but it has started to become tighter and tighter to me every day. Do I like the way it looks? I mean, I do. I like my kids, don’t you know what I’m thinking? I like that. So you really have to figure out which spectrum you want to run on.
Herschthal: “Botox is only used for beauty.” Therefore, Botox was actually first approved by the FDA in 1989. It is used to treat two eye diseases called strabismus and blepharospasm. In fact, it was not until 2002 that Botox was first approved by the FDA for cosmetic indications.
Linkner: Well, thank goodness, those ophthalmologic surgeons were trying to treat these over-exercised eye muscles, because at that time they found that the size 11 between the eyebrows was disappearing. So it is because of strabismus that all of us no longer have wrinkles on our faces.
Herschthal: So, Botox has actually been around for more than 30 years, and it has more than 27 indications, most of which are medical.
Linkner: A very common use is sweating. So in the armpits, hands and feet are places, because Botox does attack the small muscles on each sweat gland that help you sweat. It can turn it off so you can reduce sweating. I also use it medically to treat migraines. The FDA has a long list of indications for medical botulinum.
“Only older women get Botox.” Ah! No, that’s too fake. I was 27 years old when I first put botulinum toxin into crow’s feet. I will tell you that this is something I have done religiously, doing it every four and a half months for the past ten years.
Herschthal: So, I want to say that Botox has nothing to do with gender, and it has nothing to do with age. The number of male patients who came in also increased significantly, especially their crow’s feet. People want to look their best and feel their best. Therefore, botulinum toxin has nothing to do with age or gender.
Linkner: So, to be honest, Botox can be taken and it will take a few days to be effective. So suppose your Botox starts on Friday; you won’t really feel these results starting on Sunday or Monday. It takes two full weeks to reach the peak. In these two weeks, you will gradually resume a little exercise every week. Everyone metabolizes these things in different ways.
Linkner: We have code words to each other. Therefore, if Jordana tells me the password, then I know that I have crossed the line.
Post time: Oct-08-2021