How Preventative botox Works

Hi, Dr. Mo. We talked about earlier when somebody would start to have Botox as a preventative measure. Sometimes coming in younger, in their 20s or 30s. Now, as we age, we've learned from you that our fats in our face break down. So in combination to Botox, is this when you feel the fillers will be used and what type of fillers?

Yeah, great question. So as we age, our faces change structurally, we lose bone mass and we lose some connective tissue and we lose fat in our face, not in the rest of our body because it's covered. So it is the sun that prevents the pre adipocytes from replacing the dying fat cells. And as this happened, our faces start to get a little hollow. We call skeletonized. We can see the skeleton more, we see temple hollowing, hollowing underneath the eyes, hollowing on the jowls. The face starts descending. So it's not the skin got longer, it's actually the soft tissues deflated and it's a drop. So what happens is sun goes through your skin. It sun does penetrate into your fat cells and your fat cells only live about seven years. And as they die, they go through a process called apop. Apoptosis. As they die, new stem cells come in and regenerate and grow them. But the sun to some degree blocks that. So we don't get replacement 1 for 1 of fat cells and they decline also. Again, our bones demineralize over time. So we see a descent of the face. So there's some degree. Fillers are used for augmentation to make things bigger. We might think of, you know, 20 year old girl getting her lips filled or somebody getting their cheeks done. Now they can go awry. You see people with ridiculous looking lips or ridiculous cheeks, they look fake. You know, I see some of these shows on TV where these women look clearly fake. They've had stu. That's really what I think kind of scares people about filler. But that actually takes an addiction to get there. Okay, they didn't get there from one treatment or two or three. They kept going and getting the same thing done until they looked ridiculous. And so your provider can kind of say, hey, you know, enough of that, let's work on something else. But filler ideally is used to restore lost volume. The first fillers were actually, they use things like silicone and paraffin and your own fat. Now, fat still is a suitable filler. Some problems with it, it's not predictable, but that's a common filler. Then out came Collagen products over 20 years ago. And the first collagen actually came from cow skin. They got collagen on the cow skin. We actually back then we had to skin test people, see if they're allergic to cows. Before they got their filler done, we put a little shot in their arm, a little sample of it, and then they replaced that with a human based collagen that was grown by germs, by bacteria and that was called Zyplast Cosmoderm then Zyplast and out came the first FDA approved what we call hyaluronic acid. Even though it has the word acid and it's not acidic, more of a sugar cross link. Sugar. And Juvederm came out in 2000. No, I'm sorry, I said that wrong. Restylane came out first. Restylane was the first one, came out in 2006, Juvederm in 2007. And that family of fillers has really dominated the market for the last 20 years. These hyaluronic acids, or hyaluronans as we call them, there's many different types of them. And as consumer, it's kind of hard to tell a difference. You got to kind of rely on your provider to know the difference. Also what they're carrying. Because there's several families of fillers. And I go over the basic concept of the fillers. So these are called hyaluronic acid or hyaluronans. When you buy a syringe of filler, it's 98% water and 2% hyaluronic acid or hyaluronid. It's not all hyaluronid, only 2%. And that hyaluronans are water loving. We call it hydrophilic. They're water, they pull water in so they may maintain it there. And your body has hyaluronic acid all over the place, but it turns over every 24 hours. So they've taken these hyaluronins and they cross linked them. They put little connections between two strands so that they're not susceptible to breakdown. But when you first inject them, your body does react to trauma and breaks a little bit of it down. So you might need a touch up later on in the properties of the fillers. They change certain things. How much cross linking they put in it, how much lubrication they put in with it, how dense they make it. But they're pretty much all about that 2% hyaluronic acid. There's really no difference from that standpoint. And they have two properties that the companies look at. One's called G prime. Which means its ability to resist force. So some might be like pushing on a balloon and some might be pushing on a basketball or even like a, on a bowling ball. So the higher the G prime, the higher the stiffness. That's the, it's a, it's an elasticity component. Does it compress? The other one is called cohesivity. Does it stick together? And these properties are varied based on individual products. We might want to alter them so they're less stiff and less cohesive. For certain areas, like say under the eyes, you wouldn't want any stiffness or any cohesivity. On lips, we wouldn't want really stiff. We want it to be nice and soft. So the products come in various amounts of cross linking and lubrications in them to create those properties. I would say that there's not a whole lot of difference between the different brands of hyaluronic acids. The companies might compete against each other, but they're essentially pretty similar. So there's not a big, you know, gold rush, the best one. But there is a difference in the characteristics that the provider would understand. So, for example, Restylane is much stiffer than Juvederm. So we'd want to know that advance, know where we're going to place those different products at. I mean, these fillers, we can put those in areas where you've lost volume, just kind of restore your balance. We call the Magic Lift, where we restore the temples, the under eyes, the mid face. And then we also. Some people want to have a little bit fuller lips. We augment the lips. The lips are the one place that the filler tends to break down pretty quickly because you're talking all the time. And that movement gets micro trauma so that your body makes something called reactive oxygen species which eats up the filler. But if you do your fill lips a few times, it starts getting quasi permanent because you're putting filler inside a filler and it stops breaking down so, so fast. So the first time might last three to nine months. Second time, maybe six to 15 months, third time, maybe a year or so. So it starts, you know, leapfrogging up. We do the, what we call a lip club. There's a really good pricing on it. So you can do it a few times. You can afford to do it that three, two or three times the first year, then about once a year, every year after that. But places like the under eyes, it's going to stay there probably a decade or more.

I'd like to know, in your opinion, what is the Ideal sweet spot for a patient to come in and start having these treatments for preventative maintenance. Would you say it's in the 20s and the 30s? Is it ever too young or too old when they first began the regimen?

So to answer that question, I want to bring up a little about the history of Botox or botulinum toxin. And it used to be called oculinum. It was actually called oculinum and it was used for eyelid spasm. So it gets like a winky eye. And there was an oculoplastic surgeon who had been using it, an ophthalmologist using it for eyelid spasm. And this Jean Carruthers, who is a oculoplastic, she's a plastic surgeon in the eye in Vancouver, was married to a dermatologist, Allison Alastair Carruthers, at the time and still is. And she noticed that her patients that had eyelid spasm never got wrinkles on that side of their face, and they started experimenting using it for wrinkles. What's interesting is now she didn't own the patent for the the oculime. Another doctor did. But 1996, that patent was sold to the company owns it now for $9 million, a product that produces billions of dollars a year in revenue, which is interesting. So the 96, that's how soon. And then in 2003, the first Botox was FD for cosmetic uses change link oculine into Botox. But they noticed that these young kids had eyelid spasm, never got wrinkles. So I wouldn't say there's an ideal time to start, is more in personal preference. But we're seeing young women and men, but more women doing Botox or any kind of neurotoxin at a very young age. And they'll never get the wrinkles that their mother did that need to be corrected. I mean, you know, my bias is my girls, my daughters started very young, before they were 20. So it's, it's a personal preference, but it is preventative. It is also anti aging. So say there was a couple twin studies done where they looked at twins that had Botox. Botox was the only toxin available until about 2009. There's other ones now, but they looked at patients that were treated Botox for about a year or so and then they stopped and they followed them a few years later. The one that had toxin, the Botox treatments for about a year still looked younger than her twin years later. Because you've actually anti aged the muscle. It truly is an anti aging treatment. So what happens? We get wrinkles in our face. It's caused by muscles. We call them dynamic, right tid or dynamic wrinkles. And the muscles squeeze and crunch and eventually create little like almost like little scars in the skin or wrinkles in the skin that when we treat with Botox, those muscles sort of de age. They actually go backwards in size. And if you look at the thickness of a muscle as we age, maybe peaks out in our teens and then gets a little smaller as we age. But the muscles of our face, we call mimetic muscle, muscles of facial movement, continue to grow as we age. Because we're using so much facial, we're exercising our faces all the time. A good example, somebody clenches their jaw, gets these big masseter muscles, Somebody that furrows their brow, gets a big deep line between your eyes. So it is anti aging where if you do it periodically and then stop, you actually get some good durability. The other thing that happens with with these toxins, Botox and others, if you do it for about two years, the muscles atrophied sufficient that you can actually start spreading it way, way, way out. So some people would do it. If you do it like every four months for a couple years, you'll get some permanence to the results that might last a few years after you stop. So I don't think there's a special ages started. There's issue regarding finances and you know, does it these things really bother you? How concerned are you about your appearance? But there's not any specific age. I would say that we're seeing younger women than ever getting. When I started doing this, I started doing botox a year got FDA approved and it was really people with advanced wrinkles. And now we're seeing people with really nothing. And they're trying to keep nothing. They're trying to keep no wrinkles in their face. So that's. That's a great question. I'd say that don't have an opinion on that right age to start it. It's when you want.