A clinician demonstration by Dr. Shervin Naderi showing Botox injections for crow's feet and lower eyelids. The transcript explains Botox's mechanism (blocks neurotransmitter release to relax muscle), safety (reversible, low risk), injection technique (superficial subcutaneous micro-injections around lateral canthal area, avoiding intramuscular placement to reduce bruising), common dosing/dilution practices, and expected durations for Botox and Restylane.
Questions this video answers
About three or four months.
Roughly 10 units per side (20 units total).
Roughly 0.4 cc.
With two cc of saline (diluting the vial into 2 cc).
Five, 10, or 15 units per side depending on line severity.
Chapters
Use later. What we're going to show now is the injection of Botox. We're going to talk about Botox. We mentioned how Botox just relaxes muscle function. Basically, it prevents the neurotransmitters from releasing into the synapse, which is a little bit of a gap or trench between the nerve endings and the muscle, so the muscle does not get any signals from the nerve. This process goes on for about three or four months with each injection of Botox, and then it reverses with the nerve growing more endings and the old ones retracting back. So the process is completely reversible. It does not have any downsides. If anything, over time, people require less Botox as the muscle gets slightly weaker. But it's a very safe procedure. Now, the most common area for Botox is the area between the eyebrows. We're getting the frown lines. Kristin has had this area injected in the last several weeks, so it's still working very nicely for her. Her. The second area is the crow's feet area. Now, typically, the company, as well as most doctors place one, two, or three little drops laterally. But once you properly understand the anatomy and you're comfortable with the musculature and you actually operate in that area, you know that it's very safe to actually have the Botox go from all this area, go underneath the eye, and even get some of the cheek. Depending on how strong or how weak the crow's feet area are, most younger patients still require just a few drops. However, as the crow's feet gets a little bit stronger and deeper, by relaxing this entire musculature in this area, you really nicely prevent the formation of the wrinkles. The important thing to consider in that area is that it's very vascular, and you want to make sure that the Botox is placed just underneath the skin and not directly into the muscle to prevent bruising and bleeding. We're going to get started with that. We're ready to do the Botox injection. Kristen actually has never had it to this area. She's usually had it pretty much in the glabella between the eyebrows. So this is brand new for her. Try it back from the Kristen. I take an alcohol wipe, as in any other area, and just wipe a little bit of the makeup off and sterilize the skin here. Now, we talked previously about Botox, and I mentioned how it's not important how many cc's that you have. It's important how many units that you have. Typically, for the crow's feet area, each side requires five 10 or 15 units of Botox, depending again, on the strength and the nature of the lines. What I do is I like to keep the Botox very concentrated, so the actual amount or volume of fluid that's being injected in that area is as least as it can possibly be. So 20 units of Botox means 10 units on either side and roughly equates to about 0.4 cc. And the way I get that is that I dilute my entire vial of Botox with only two cc's of saline. Now, some people choose to do over two and a half cc. Some people choose to do it with four cc's or even more. That just means that you have more saline or salt water that's diluting the Botox. We're going to get started here. The injection basically goes right underneath the skin. It creates a tiny, small, little blood that resembles almost the blood that you get after a TB test. This bleb goes down and goes away in about 10 minutes. The reason you get this blood is that you're putting the Botox directly underneath the skin and not into the musculature. I want you to notice I'm actually coming out more centrally underneath the eyelid, and that is definitely more unconventional, but it works very nicely. And most patients are pleasantly surprised by this, especially if they've had Botox done in the past using different techniques. So several little injections, and I ask my patient to hold a little bit of pressure, put their hand in the area while I go on the other side. That didn't take very long, but the effects of it will last about three or four months. Same thing on this side. I use a little sponge with cold ice water to have the patience hold over the area after the injection. Now, around this area as I'm injecting, I'm actually pushing the Botox in as soon as it penetrates the skin. The reason for this is that I want the Botox to actually push any possible vessels or small capillaries out of the way so there's less chance of the needle hitting these capillaries and creating bleeding or bruising. If you do this carefully, there's almost no problems with bleeding or bruising. She's doing fantastic, and her Botox treatment is over. Go ahead and hold this for me, Kristin. So this concludes our injection for Kristen. She varied it very nicely. The whole thing took less than 10 minutes. And with the Restylane, the results last about six months. With the Botox, the results last about three or four months. And we'll see her back in a few months. Thank you. Thanks, Kristen.
