Dr. Shervin Naderi demonstrates Botox injection technique, showing how to assess facial muscles, choose injection sites, and dose the procerus, corrugator, and frontalis to soften lines while preserving forehead movement. Redness fades in about 20 minutes.
Chapters
Hi. We're going to do another one of the video series on Botox injections. We have a brand new patient here that we're going to inject Botox on. But the first thing is, as I've said over and over again, we got to evaluate each patient's musculature. We're going to look at their expressions. Everybody's got a different expression. Me, her, Jim Carrey. Everybody else can do different things with the exact same musculature. So we got to look at the expression, especially the eyebrow position. So when I look at her, the first thing I want to do is have her frown. So go ahead and frown. And you can see that there's not a lot of muscle movement with the frowning. So she doesn't need a lot of Botox there. But you can start seeing some of the lines developing. And this is from the unconscious subconscious elevation of the eyebrow that happens during time when the brow starts feeling a little heavier. If you raise your eyebrow, you can see that the lines go across the entire brow. But she does still have a nice arch. In younger patients, Botox works very nicely to prevent these lines from getting deeper or preventing getting them in the first place. It's much nicer in younger patients. As older and older you get, you need other options. Botox by itself is just not going to do it. You may need a brow lift where you can see my partner, Dr. Kulak. For that, you may need laser resurfacing. There's other options that you may need, but for this age group, Botox is beautiful. Works very nice to. So we're going to do some Botox injections and I'll show you how. So I start off by taking a little alcohol wipe. I don't take off women's makeup. They're just not really happy when you take all their makeup off. Just a little bit of dabbing with alcohol is enough. It doesn't need to be completely sterile. It's not a sterile procedure, but it's nice to just be able to see a little better. I've used different types of needles and syringes in the past. I've showed you how I like the BV needles with syringes. They do have a hub. The hub loses some Botox in it, but the needles are really sharp and they're less painful. The sharpers, it's less painful. We do have another type of needle and syringe as well. This is kind of a typical insulin or TB needle and syringe that almost 90% of doctors and surgeons Use. The nice thing about it, there is no hub. You don't lose any of the precious valuable Botox. When I'm doing less, meaning a lower amount. And the hub is really important, I don't want to lose much of the Botox. I'll go to this because I'm just doing a few little pokes and the needle is not going to dull out as quickly. If I'm going to do a large area, then I'm going to use the other needle and syringe because it does dull out normally with this one, and I prefer the other one is injecting the procerus. I grab it between my fingers. This is the muscle that creates the lines that go across the root of the nose. I put in about four or five units right there. And you can see that's all that was over there. Then we got the depressor superciliae. It's the muscle that most, most, most doctors miss. It's right in this area. And what this does, just one or two units of this, it prevents the eyebrow from going down. I would say 90% of doctors don't do this. So when they Botox up here, the brag goes down and it just looks aggressive and it's not a good look. By injecting the depressor supercilia right here, what you're doing is slowing down the muscle that pulls the medial head of the brow down. And by paralyzing that muscle, it actually raises the medial head of the brow or at least doesn't allow it to go down anymore. Hold a little bit of pressure here and we continue with the corrugator. So the corrugator starts here in first injection, and then the lateral corrugator is over here. The second injection. Then I don't want her to have a hyper arch, so I put a small little dose right here. This is about a unit, not a very high dose. This is so the brow doesn't go up too much and she doesn't get that Spock eyes that a lot of people don't like seeing. Then what I'm going to do is go back here. So we're going to do it again. The medial corrugator right here, the lateral corrugator, which we're going to do over in this area. And then my third dose, which was equivalent to the lateral part of the orbicularis, which I'm coming over here, make a very small dose right there. Now we go to the forehead, the medial frontalis. Don't paralyze the forehead totally. We don't want to paralyze forehead. Another little drop right here to the frontalis. You want to try to kind of use your X ray vision, look through the skin and see if you can see big blood vessels. My last dose, I have some left over, is right down here in the middle. And what this is going to do is it's going to open up the eyebrows and lift the medial head of the eyebrows and just soften up the forehead a little bit, but not paralyze her. We don't want to be totally paralyzed. It's not a good feel, it's not a good look. She can be paralyzed here, but the forehead still needs to be mobile and movable. And that's pretty much it. No bruises. The redness and the pinkness goes away in 20 minutes, and that's it.
