Dr. Shervin Naderi (Washington, DC facial plastic surgeon) explains minimally invasive cosmetic injectables, focusing here on Botox: its history, mechanism, preparation, dosing strategy, common treatment areas, expected onset and duration, typical frequency of treatments, risks (small pinpoint bruises) and practical cost/administration considerations. He emphasizes Botox is a temporary, quick, and effective treatment often dosed by units and typically repeated 2–3 times per year.
Questions this video answers
1989 (for ophthalmologic use—blepharospasm).
2002.
About three to four months.
Approximately three to ten days; maximum effect around ten days.
About two to three injections per year.
Chapters
Hi. We're going to talk a little bit today about cosmetic surgery and namely minimally invasive procedures such as Botox and the various fillers. They are amongst the most popular procedures sought out by patients looking to improve their appearance, either young, middle aged or even older individuals who are trying to avoid undergoing surgery. The main classes of injectables are Botox and the fillers. Botox is the most popular procedure in the country today. Over 4 million procedures were done last year. It's extremely safe, it's extremely effective. I often get asked, is this a quick fix? Yes, it absolutely is a quick fix. It's a temporary fix, but it's relatively cost effective. Each injection lasts about three to four months. It's relatively quick, it's very effective. And nothing really replaces what Botox does as far as effectiveness and its action. It was initially FDA approved in 1989 in the United States for use by ophthalmologists for blepharospasm, which is a condition of the eye muscles. Back in 2002, it was FDA approved for use in cosmetic surgery. But it's been used widely and effectively by many specialists in different parts of the body. From ENT physicians and surgeons who have placed it into the voice box for voice disorders, from surgeons who place it into salivary glands of young children with cerebral palsy who suffer from excess drooling and infections and pneumonias from drooling. It's used for the treatment of migraines, for excess sweating and various other conditions. Very safely. Basically, it prevents the release of the neurotransmitter from cholinergic nerve nerves from responding on their target organ or tissue. In cosmetic surgery, the target is muscles, striated muscles, just like the muscles of the arm and the biceps and chest, striated muscles of the forehead and around the eyes and other places of the face where we have control over the contracture of these muscles. And by preventing the release of neurotransmitters, their nerves do not get a chance to tell the muscles what to do. And so the muscles will stay dormant and not contract, thereby reducing wrinkles and lines. This is basically what Botox essentially comes in. It's a small box. It comes in as a powder. And the most common mistake that a lot of young physicians and nurses make is that they look at the actual bottle and it looks empty. There's really in this. But if you look carefully, there is a tiny little stain at the bottom of this that is essentially what the Botox is. And the way you prepare this is by putting saline or medical Salt water and reconstituting this. And you can keep it as concentrated or as diluted as you want it to be. Therefore, what's important is finding out how many units of Botox you need and how many units of Botox you've had in the past. The volume, the cc's, is irrelevant because you could have as little or as much Botox in that specific volume as you desire. I like to keep the Botox as concentrated as possible because I don't feel that there's a necessity for a lot of saline and water to swish around around the eyes and the forehead that I've done this. I've never ran into a problem with droopy eyelids or droopy eyebrows because the Botox is concentrated, it stays in the place that I injected and it doesn't move. The only thing I ask patients is not to rub the areas aggressively for two hours. And that's the only thing I ask of my patients. So the Botox stays right where I put it and prevents it from getting into the muscles that I don't want it to get into. Botox the effects last, like I mentioned, about three to four months and about two to three injections a year are necessary. Typically, the cost can vary as little as $200 to $300 to as much as 5 to 6 per treatment, depending on how many units of Botox each patient is having done. Many doctors charge by area. For example, the glabella, which is between the eyebrows, the forehead and the crow's feet area, are the most common areas, and they charge by area. However, what's important is to know how much Botox you're getting and how much Botox you need. Therefore, I've always believed in charging by the unit of Botox and the amount of Botox, because no two patients the same amount of Botox. Furthermore, the effects are not immediately apparent. It takes about three to 10 days to see the effects of Botox, and the most significant risk of any of these injections is the possibility of small, little pinpoint bruises. So my suggestion to my patients is that if you have a big party, a social event coming up in the next few days, avoid doing it right now because you may potentially see a small bruise. However, you will not see the benefits of it for some time. The maximum effect is reached at about 10 days, and it lasts about three to four months. The most common area for injection of Botox is the glabella, or the frown lines. It does a wonderful job with reducing that angry appearance in the lines between the eyebrows. The second most common area are the crow's feet or the lines that form around the eyelids. And the third most common area is the mid forehead, although around the lips, even in the neck. For banding of the neck, correction of asymmetries of the face can be done with Botox.
