Dr. Mehra Interviews Dr. Naderi | Part 2

And on to our final segment. This is called the World of Medicine. The Host here is Dr. Rajesh Nandan Mehra of Chantilly Family Practice center located in Chantilly, Virginia. Please be sure to catch Dr. Mehra with another interesting topic in the field of medicine on Chitramala at 11am today. For now, Dr. Mera's guest is a well known rhinoplasty and cosmetic surgeon, Dr. Naderi. Dr. Naderi is from the Naderi Center. This week he will share his expertise with us on Botox and fillers. Let's share these two doctors in their conversation. Good morning. This is Dr. Rajesh Mehra on the Capital Forum bringing you the world of Medicine. This is when we'd like to bring on guests with interesting topics, subjects that you'd want to learn more about and whatever is happening in the world of medicine. That's new, new, exciting and I'm honored and privileged as the last few weeks to have with me in our studios Dr. Shervin Nadiri, a well renowned facial plastic surgeon of the metro area and also all over the world. Thank you for joining us today. I know you're very busy and it's very nice of you to come and enlighten our viewers about things related to the face, the nose and the last couple of segments we've been talking about rhinoplasty which you have told us quite a few interesting things about. But today I want to touch on a topic about office procedures. And the buzzword these days seems to be Botox and fillers. And I don't even know all the different names of the new chemicals restylanes of the world that have come out. So let's talk first just about Botox because that sort of seems to be the most well known amongst our audience.

I like to affectionately refer to Botox as Vitamin B. Vitamin B. Pretty much everybody at some point in their life can benefit from it. Now I started my own wife, my own sister, my own staff in Botox in their 20s. The company can't advertise that. The company basically talks about people needing it at later points in their lives due to the FDA approval. But really Botox, all it does is it prevents muscles of facial expression from contracting. So certain parts of the face, with the most common being the 11 marks in the frown lines and some of the crow's feet, the smile lines around the eyes and then a little bit of the lines on the forehead. Those three are the most common places for Botox injection. Now Botox can be injected elsewhere. Some of the lines in the Neck, some of the lines around the mouth, but really comes down to the upper face.

Not to interrupt you, but first of all, tell me, what is Botox?

It's botulinum toxin, right? It's botulinum toxin. It's a synthesized botulinum toxin. And that sounds scary, right? So that's why I don't want to go directly into the fact that it's a toxin. But all it's doing is it prevents from the nerve from releasing its transmitters to the muscle. So the muscle sits there quietly for three or four months while you've had the Botox. But it is a substance, it's a medication, it's FDA regulated, and it is a neurotoxin, which gained approval by the FDA in 1989. And since 1989, millions of people have had it. And there's been never a single serious side effect of cosmetic Botox. Despite the fear of it, it's just never happened.

Never happened. It's pretty safe, right? But wasn't it initially, though, not approved for plastics? It was more a neurological reason.

In 89, when it gained approval from the FDA, it was actually for blepharospasm, which is spasms of the eyelid. And then the doctors that were using it, the eye doctors that were using it realized, wait a minute, people are losing some of their wrinkles. They look better.

They look more rested, younger rested. I don't have this frown like you're upset all the time.

So it started becoming used off label, if you will, in 2002, it gained actual FDA approval for cosmetic uses. And it was basically, again, for the Glabella. But doctors for decades have been using it all over the face. Most recently, it just gained approval for the crow's feet again. And the reason it gains approval by these companies is so they can advertise it. But the crow's feed has been used for 20 to 30 years very safely, but now it's officially approved by the FDA for that use. There's other substances as well. There's Myobloc, that's been around for a long time, but not really used in cosmetics. And more recently, in the last several years, Dysport, which was available in Europe under a different name, came to the United States under the name Dysport. And people may call it Dysport or things like that, but essentially it's the same type of toxin. And when people ask me, what's the difference? I tell them it's like Pepsi and Coke. Pepsi and Coke are very similar, but there's certain distinction Right. So the same thing with these two substances. They do the same thing, but some people notice a slightly different response.

Here's what I don't understand about Botox and Dysport and these other things, though. The effects, the beneficial effects, though, only last X amount of months.

Sure.

Then you have to have it again, which is good for you.

Well, if you think about it, any good lunch or dinner or haircut was only going to last a certain time. Right.

Well said.

So there are certain things, or changing oil in the car. There are certain things that we have to repeat over and over again.

If you want the effects, if you want the effects.

Now, relatively, compared to a facelift, for example, it's less expensive. And honestly, a facelift will never ever be able to stop you from frowning. So you can spend 10, $20,000 on a facelift and still get frown lines, or you can spend $300 on some Botox three times a year and have a nice relaxed look. People won't think that you look angry or mean at them. Right. That's the beauty of Botox. It works. It truly works.

Okay, good. It's not a gimmick.

It's not a gimmick? No. Okay, now here's the thing. It's dose dependent. So it comes in a vial. You draw out whatever you need, 10, 15, 20, 30 units of it. And let's talk about just the frown lines. And on the average, 20 units of Botox is what we like to inject for patients. Some need more, some need less, but 20 is average. A lot of places don't tell you how many units you're getting. They charge you by area. They'll tell you this area, we're charging you this amount, but you don't know what you're really getting. So I always tell my patients, insist on knowing how many units you got, because even if you go from doctor.

To doctor to doctor, it may vary.

You can compare apple to apples and say, okay, I got 15 units here, but I got 20 units here and I got a better result. Well, obviously, because the 20 units is stronger than 15 units.

Right, right. And they think it's driven by the doctor.

Right, right.

But it's really not that. It could be the units.

So the units is a part of it.

Because the technique is very similar, it doesn't take a lot to inject it.

So the technique here, here's the beauty of the technique. Majority of people kind of follow this flowchart. And for example, I've got videos online on YouTube and not only patients watch it doctors watch it. I've had doctors from Iraq, you think, wait a minute, Iraq has more serious issues right now. But I've had a plastic surgeon from.

Iraq say, fly in to see.

Yeah, no, they saw my video online and they fine tuned their technique and.

Then they flew fly in to see how you do it.

So while most of the time it's done a certain way, I tell my patients, I can do your Botox in probably six different ways. Because when you understand the musculature and you're not just following some chart that somebody gave you, you can actually fine tune it. I examine my patients and see how their muscles are. Me, you, and the actor Jim Carrey, we all have the same muscles. But I bet you the things that he can do with his muscles, you and I can't, at least I can't. So. So when you look at that, you can fine tune the muscle movement and see, okay, yes, it's the same muscle, but in this person it's laying this way versus this way, it's stronger, weaker. And then you can fine tune the technique and not treat everybody the same exact way.

Which kind of brings me to a point about what's your opinion about so called the paraprofessionals doing this?

So the biggest growing population of cosmetic providers, or the paraprofessionals, as you call it. You know, I think there's about 6,000 plastic surgeons in the country doing Botox and there's about 40,000 paraprofessionals doing it. Right. Obgyns, primary care doctors, dentists, nurses. Right. I mean, and in some places I've seen people go to gyms and get the owner of the gym doing stuff like that. So everybody's doing it. People are doing Botox parties in their kitchens and in restaurants, and they think it and treat of it as a very simple thing. And honestly, at its core, it's fairly simple. No matter how badly you inject it, even if you completely distort somebody's face, three months later, you're back to square one.

However, there has been complications.

There has been complications. And people don't like walking around for three months with a dropped eyebrow, with an eyelid that looks like they just had a stroke. So there's variations. Or with the Spock eye, I don't know, you may have seen people that walk around and their eyelid has gone up a little bit too much. So you have to understand the anatomy and do Botox in a natural way. And, you know, you can adjust things as needed. And I see people come Back. And after I do the Botox and say, I want to see you back in a couple weeks, see how you responded. And you don't want to treat this as a bam, bam, bam type of thing. I mean, it's another medical procedure, right?

It's not a cookbook.

Exactly.

Now, of course, Botox is the most well known, but there's Restylane and tell us a little bit about these other ones and what the difference is and what part of the face they're used in.

Right. So Restylane, Juvederm, Perlene, Radiesse, Artifil, these all fall in a different category called fillers. Dermal fillers. Now, Botox and Dysport are neurotoxins. They don't fill anything. What they do is they prevent muscles from moving. And actually, physicians used in other places of the body, doctors inject it into the salivary glands of children that drool too much, doctors inject it into the vocal cords of people with vocal cord spasms, people with GI issues, and irritable bowel syndrome can get Botox injury.

It's really like an antispasmodic, right?

It basically works on a specific nerve, and wherever that nerve is functioning, you can modify it. But fillers are different. They fill and there's various forms of them. The safest fillers are the ones that are hyaluronic acid based. We already have hyaluronic acid in our body. It's a part of our skin, part of our actual core architecture. So Restylane, Juvederm and Perlene are the big known compounds. They're essentially these substances that are clear gels that we can use to plump up the lips, plump up the cheeks, improve the dark circles under the eyes, the tear troughs. People come in here, and that's one of the things that I do more and more these days than anything else. I mean, the smile lines, a lot of dermatologists are doing them. But when it comes to doing the dark circles under the eyes, there's been some serious complications known throughout the world. So these dermatologists and other surgeons that don't feel comfortable, they send the patients to me and I do what I call tear trough injections. And by doing that, you can just plump up the eyes and the cheeks, and within a matter of minutes, it makes somebody look like they got the best sleep of their life and makes them look like they're 15 years younger.

There you go. I'm gonna make an appointment on air right now, next Wednesday at 4 o'. Clock. I'm coming in.

We'll do it. We can do it right here.

We can do it right here. Well, next time, we're gonna bring this stuff and do it on air and you can demonstrate it on me. So I'll get a free treatment?

Well, definitely. I mean, seeing this stuff is important. And again, I've got plenty of videos online that patients and surgeons refer to. My father is an obgyn, and his partner decided I wanted to start doing Botox injections, and he took a course. There are these, like, you know, the.

Weekend thing that I've been tempted to do.

Right, exactly. And then he turned around to my father and said, listen, I've watched your son's videos, and I learned more from his videos and these weekend classes. So I do teach. I go around. I want to make sure everybody's doing it right. Right. I mean, you can't stop other paraprofessionals from doing it, but I want to make sure they're doing it safely and doing it properly. Right.

I mean, in all fairness, I guess these days, different specialists, different people, you know, it's what it is. Even though I sort of believe that the people that are trained properly should be the one doing this stuff. So let me ask you, what percent of your practice is the office versus the rhinoplasty, and how does that work?

So, for me, my surgical practice is almost 100% rhinoplasty. That's all I do when I. When I'm in scrubs in the operating room, I'm not doing breast augmentation. I'm not doing tummy tucks. I don't know. I stopped even doing facelifts and eyelids. I have a partner that does those. I do rhinoplasty, but in my office, office space, I'm doing tons and tons and tons of fillers and Botox. We have one of the biggest accounts in the country. And I'm actually instructor for both companies, both Allergan and Medicis. They've hired me as a consultant, and they send me around different places to teach.

Excellent.

That's a big part of the practice.

Well, fantastic. Well, there's no dearth of topics we can keep going on and on, but unfortunately, our studio personnel tell us we're out of time. So we will pick up on this next week. Join us again for more interesting topics. And who knows, next time around, you may see an actual demonstration on the host here. Make him look younger. Thank you.

Thanks again.