Master injector teaches safe botox & filler injection to 11 lines, crows feet & liquid rhinoplasty

Your favorite Allergan manager.

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Hi everyone, we're going to have a little quick anatomy lesson and then we're going to do an injection video, okay? So we have beautiful Heather here. She's actually a manager at Allergan, so she knows the products. She's, she's an expert on this subject, but I'm going to talk about certain things that she may not even talk about in the past. So if you zoom in here, you'll see that this, this 11 mark, 111 mark, 1 mark, it depends on— everybody's a little bit different, but there's— humans get vertical lines between their eyebrows, right? That's a normal part of human life. In some people, it's deeper down the middle, some people form 11, some people form 111, some people have 11, 111, but it's always vertical marks. And 2 things cause that: the corrugator muscle that pushes the eyebrows together and sleeping on your face. So you may get Botox, Perfectly smooth, but if you're a face sleeper and a side sleeper, you're gonna create that mark. Now, if you're 16, 17, 18, 19, you can do all the frowning and side sleeping you want, but the skin is so nice and elastic that those marks don't stay. Beyond age 25, we start to lose skin elasticity. That's why skincare is so important. Microneedling, peels, lasers, etc., Retin-A, all those things are important. You can't just rely on one or two things. You have to have a complete skincare approach. But when the skin is more elastic, it is more forgiving and it doesn't crack in as much. Now, the muscles that create this line are the corrugator. They go like this. They basically go upwards from the eyebrows, and by injecting these, I'll show you in a second, we're gonna relax that. There's a muscle here called the procerus that makes lines that go in this direction. We're gonna inject that as well. Here's the trickiest part, and a lot of people have had this issue. If you look, there are lines above the eyebrow. I have this discussion with patients all the time. We don't like these lines, especially after age 35, we don't like those lines. But if I go ahead and Botox these lines to relax the muscle, what ends up happening, the eyebrows feel heavier. So when somebody comes in after age 35, the conversation always is, do you want more open eyes, more lifted eyebrows, or do you want a smoother forehead? You almost never can have both, no matter what Instagram influencers tell you. It's just not going to happen past age 35 because the eyebrow gets heavier. So typically, we try to go with more lifted because open eyes feel better. Now, we have a surgical solution for it. A brow reset, an endo-style brow reset, sets the brow where it needs to be, gets the weight off of the eyebrow. An upper eyelid rejuvenation, trimming a little bit of that extra skin that happens in every single human being, that takes the weight off the eyes, and then you can actually Botox across the forehead, treat those lines more freely, and not have to worry about things dropping. So those are the things we're gonna do, and a little bit of Botox around the eyes. There's a sphincter muscle called the orbicularis oculi. It squeezes in this direction, creates the dreaded crow's feet. We're not gonna be able to get rid of it completely because even if you Botox that completely, when you smile, the cheek moves up and creates some of those lines, especially in people with thinner skin. So we're gonna soften a little bit, and again, I don't wanna tether the smile. Some people get too much injection of Botox around the eyes and it's too much. That's one of the tricks, never go deep there, because if you go deep, you actually get the muscle that controls the smile and you will block their smile and they look like they have Bell's palsy. It looks terrible. So we're going to show the technique. I'm going to lay her back and I want to show you one of my coolest things, which is fillers to this 11 mark. So if you come up here, you'll see this better from this angle. Come up, come up, come up, get closer. No, not you, our camera lady. So if you look over here, you can see how that line forms, right? We can do all the Botox in the world, but that line itself needs to have something further done. I'm going to show you my technique for fillers, and my favorite filler for here is Volbella. It's an incredible filler that treats this area beautifully. One of the things that makes Volbella so unique is that you can actually go under the skin, the most superficial area of the skin, and you'll see my technique on that. A lot of injectors are afraid to inject the deep furrows here, And rightfully so. I've talked about this before. There's blood vessels that come in this direction, and if you cannulate those blood vessels, you'll have vascular occlusion in this area. But if you follow my technique, it's very safe. I'm going to show you that how that's done. Now, additional skincare and microneedling, etc., all that stuff can be helpful, but the filler— we'll start with the filler first. So the filler we're going to do is Juvederm Voluma. So I start off by prepping, priming the needle. I want to get a little bit of filler to come out of the needle. Now it's ready. I'm going to see exactly where that line's forming. Bring the camera up so you see better. I'm going to draw up in front of your face. Will you see that?

Okay.

So it's a vertical injection. The Naderi 11 fill is a vertical injection all the way down to the bone. I am touching bone. I'm on top of bone. I'm feeling the bone. I'm injecting retrograde, pulling back, and then massaging. And it's micro droplets down to the bone, inject retrograde, pull up, smooth it out. Down to the bone, feel the bone, inject retrograde, pull up, massage it out. It's never this way, ever, and never in midpoint. It's always on top of bone. The needle tends to sometimes dull out because I'm hitting bone. To confirm it, So you may have to change the needle after a few pokes. I will guarantee you, as a facial plastic surgeon who's done brow lifts, forehead lifts, facial reconstruction, there is no blood vessel in this area sitting on top of the bone. I've seen Instagram commentators be like, but you didn't, you didn't aspirate, how dare you inject without Why are you pulling back? And I'll tell you, it's because we know the technique and there's no reason to aspirate in this area. It's a vertical injection right down to the bone and always retrograde. I talk a lot about the benefits of anterograde injection by pushing blood vessels, little blood vessels out of the way. This is a situation that you're not going to do that. It's going to be retrograde. I love Vobella for this because I'm going to fill all the way to the epidermis. There's no other filler on the market that can do this, that can go this superficial. If you do this with some of the other fillers, it'll leave a little blanch mark in the skin.

How long does it take to fill the face?

So it's true microdroplet. How many times did I poke her? Did you count how many times, Heather, I poked you? You counting?

About 12.

12? Okay. Now let's look at the needle, the syringe. How much did it move? Like not even 0.05. I mean, it's just, that's how little it is. It's literally microdroplets. So you have to have incredible control over your thumb. You cannot put it in there and just like squeeze it. You have to have crazy control over your thumb. And not overfill and then start to panic and massage and massage and massage. That's it. Look how smooth that area is now. Obviously it's red right now, but it's— that 11 mark is gone. I'm trying to squeeze it, it just doesn't want to squeeze anymore. Come on, Deanna, take a look. You can see better.

Oh yeah, it looks good.

Look how good that looks.

It's so smooth.

Like, that line's gone. If you try to crack it, everything else cracks around it, but that doesn't want to crack.

Oh yeah, you're gonna be so happy.

Yeah, that's gone.

Yeah, even from like the side.

Yeah.

Awesome.

Cool. Now I'm gonna show you the mirror.

Where's the mirror?

Oh, yeah, it's got the mirror. Give her the mirror.

Oh wow, incredible.

See, you try to do this and it just doesn't— that line doesn't crack anymore.

Yeah, that's awesome. Wow.

And it's super smooth. And look, the pressure, like lines want to form here but not that area anymore.

Yeah. Wow. Wow.

So, and when we do our Botox— so we're not done, we're gonna do some other stuff. Now we're gonna talk about the anatomy of Botox and everything else. So come around this side, our camera expert, and show how I do Botox. So Botox is gonna start with the procerus, the depressor supercilii, Now Heather is a manager at Allergan. Deanna is actually right there too. We've got Allergan's top guns right here. But when they teach injectors for the first time, they try to stay in safe places. They don't teach this area, the depressors. It's extremely important. So if you've had Botox— do you want to show me? So I get— I want to do Botox. And then you see people get like this Angry Bird look where like the head of the eyebrow drops down and the tail of the eyebrow comes up, and that's the telltale sign of Botox, and everybody who's on social media, on sitcoms making fun of people that get Botox, it's because of that. If you go ahead and inject these muscles, you don't get that look. The eyebrows open up, the head of the eyebrow doesn't drop down, the tail doesn't shoot up, and you don't get that Angry Bird look, so you get a really natural look.

Okay.

And nobody, not even your mother, will be able to tell you got Botox. We're doing the medial head of the corrugator. We're gonna come up this way a little bit. This is still the corrugator. Stay low, but don't hit the bone here. If you hit the bone here, you're gonna have some Botox basically dissipating through the orbital septum potentially and causing ptosis. We don't want that to happen. So again, you have to have control over your thumb and your needle and what you're doing. So corrugator, staying low. If you go higher, if you go in this area, you'll drop the eyebrow. So we're staying in the corrugator. All right, that's that. Now, if I stay here and I don't go laterally, her eyebrows will come up more. But then the lines here will be deeper and deeper, and we don't want that to happen because it gives a telltale sign of Botox. So there's going to be a small drop here. This is not the corrugator anymore, this is the frontalis. A small drop here, and same thing on the other side, getting a little bit of the frontalis to prevent that Spock look. That's what's happening. Now I'm going to examine everybody uniquely. Raise your eyebrows for me. All right, so look, she's not forming any lines up here.

No.

So there's no reason for me to be up here. There's zero reason for me to be there. So I'm going to go where her frontalis is more moving. I'm going to go here and a small drop here. Again, very little because she needs the frontalis to raise her eyebrows. If I go ahead and knock that muscle completely out, the eyebrows will be heavy. She's going to be really upset when she's trying to put makeup, eyeshadow, things like that on. She's not going to be happy. So that's the extent of my forehead Botox on her. If you start doing 2 or 3 rows of Botox on this patient, she's gonna be like, I hate Botox, I'm never gonna do Botox. She'll go tell everybody, never get Botox again. It's not the Botox, it's the injection technique. Then we're gonna go around the eyes, lifting the tail of the brow all the way up so that it's out of the bony orbit. This is the bony orbit. Look how much space I have, almost an inch. You got to be out of it not to drop her. Then I'm going to do this on her. This is called the lateral canthus. I'm only doing these 2 drops. I'm not going to go all the way around her eyes because I want this look on her. I don't want the eyes frozen. I want everything to come up a little bit. So that's the look we're going to create. So everybody's different. Stay on this side, you'll see better.

Actually, the lighting's better here.

Okay, so look, grabbing the eyebrow, lifting it all the way up, superficial. This is a part of the orbicularis oculi right there, a little tiny drop. And then, and when you go around this area, you want to create blebs, almost like a TB test, a PPD test for those who know. You create little blebs, almost like a little insect bite. This will be gone in 20 minutes. It absorbs, it's gone. But this is important so you don't hit the muscle, you don't get a big bruise. So that's our extent of this area. Now you want to show the other part on the— we didn't numb it, did we?

We didn't numb that.

How painful was this?

Not painful. Yeah, that was okay.

Okay, let's do that part.

What part?

She didn't know.

You're in for a treat. Yeah.

Come up here for a copy of this bag.

You look great on camera. Thank you.

Shoot from up here, see if you can get that. Look up here.

You wanna talk first?

Uh, yeah. So I'm gonna take again the Volbella that we use, and I'm going to improve a little bit asymmetry on her nose for her, something that's been there Pretty much your entire life. Nose is developed in your teenage years, but we can improve certain things non-surgically. Certain things require surgery. Obviously, surgery can fix this issue as well, but this is a situation where non-surgical is beautifully useful. So I'll show you how we do this. If you look straight up from the nose, the axis of the nose is fairly straight. Lines up with the middle of the mouth. It's fairly straight, but the right mid vault here pinches in, goes in. Which then makes everything look like it's more crooked. So it's really this zone right here that could use a little bit of filler. So if I put a little bit of the Vobella right here, it'll make the nose look straight, and that's what we're going to do on her. All right, come on this side. You ready?

Okay.

This is getting so much better.

Okay, ready?

So shoot. So when I do this injection, again, it's a very low-pressure injection technique. There is no significant pressure I'm putting on the plunger on the needle. Why? Because high-pressure injections in the nose can cause vascular occlusion. I have seen injectors make videos on Instagram Which makes me cringe and worried because I know that technique eventually will come back and haunt them. And then usually a few months to a few years later, I get a message on Instagram from an injector who says, how do I deal with this vascular occlusion? And the reality is filler injections can be very safe. If you use low-pressure technique and not stay in the same spot. Look, the needle is not staying in the same spot the entire time, it's moving. If you hit a blood vessel, you're in and out within a matter of a nanosecond. You're not going to cause vascular occlusion. There is no reason for ultrasound, there is no reason for aspiration in these areas. I'll show you an area where you do aspirate. If you're aspirating the nose, it's really the tip of the nose. If you're going all the way down through the columella to lift the tip, you must aspirate that. The rest of the nose, as long as you use proper injection technique and low-pressure injections, constantly moving in and out. And this is an area where you are going to use anterograde and retrograde, so pushing and pulling the filler, the needle, back and forth. It's not staying in the same spot. Low pressure, microdroplet, constantly moving and not going in directions of blood vessels. So that's what's going to happen. Now, in this situation, we're trying to create improvement, not perfection, because I don't want her nose to get too thick or too wide. Surgically, I can actually narrow the bones, which gives her more definition. And do other things as well to offset some of the structure that she needs in this area. But non-surgically, that can't happen. So we're just going to create some of this improvement. She's being a really good sport because this area is not numbed. She's not even crying. I don't see a single tear. How you doing, Heather?

Yeah, you're very gentle.

Thank you. Holding a little pressure so it don't bruise.

Doing well.

What are you doing after this? Where you gotta go?

I'm gonna do a dinner. Going out to dinner.

Okay. Did you bring any makeup or no?

I did. Okay.

Just got better and better as the swelling went down.

I'm so excited about that.

Honestly, yours was not that bad. Like, you're not the typical person that I say let's put fillers in it, because for you, just keeping up with Botox and doing some microneedling and skincare would have taken care of that. But there are people with much, much deeper furrows.

I am self-conscious about that though.

Yeah, it's gonna be less of an issue now.

This looks so good.

Looks so much better. Way straighter. Cool. I'm gonna clean her up a little bit. That will show it. Let me get a little wipe wipe. And I still barely use any of the syringe. Well, how much did I use in the syringe? 0.2? Did I even use 0.2?

I don't think I even used 0.2.

So let's hold a little pressure and then we'll do a picture from up here.

A little video from up here. Cool.

I'm gonna come up here, lift it off, take a video, and then— Taking video already?

Good to go. Straight up.

So you can see how it's straighter. That indentation is gone. These brow tip aesthetic lines are following smoother and straighter, and that the tip now no longer looks bulbous here. Because that area is straighter. If you lift your chin up a little bit, you can actually see that better.

Cool.

You want to take a look at your—

That's amazing. Looks so cute. So pretty. Wow.

The tip looks— I mean, I didn't fully correct. I corrected like 80% of it because I didn't— When you said, is it going to look thicker? Now I'm like, oh no, sorry. So I went like 80% correction. Yeah. 100%, I would have got a little bit more, but it would have been a little bit wider.

Yeah.