Dr. Sam Lam Plastic Surgery Forum

Hello, Doctor. Thanks for creating this board!

1) I would like to know why you think mesobotox / intradermal botox is not safe. I understand the zygomaticus muscle, if affected by botox, could create major problems . But doesn't intradermal botox imply very superficial injections? would the botox still reach, in that way, the zygomaticus muscle or any other that could create some problems?

2) When intradermal botox is used to refine the skin / close pores, does that mean the person has to have injections in each single "open" pore? Or can one inject a bit in one area and have the pores of that area react by "closing"?

3) How long does typically intradermal botox for large pores last?

4) I read the archives and saw that you consider the use of botox for a gummy smile not as useful as the use of fillers. Do you mean that filling the area below the nose and above the mouth one can achieve the same result?

And finally, this one not related to botox... for acne scars that are rather shallow and not large, of the pitted type, but not really deep, does dermabrasion (not "micro", actual dermabrasion) work? It would be for a small area in the nose, in someone with light skin (Fitz II) and never had pigmentation problems with scars or any peeling or dermatologic procedure.

Sorry for so many questions.

And can one arrange an appointment with you while living in another country, so that one already has an appointment when visiting your country?

THE RESPONSES ARE BELOW IN ALL CAPS:
1) I would like to know why you think mesobotox / intradermal botox is not safe. I understand the zygomaticus muscle, if affected by botox, could create major problems . But doesn't intradermal botox imply very superficial injections? would the botox still reach, in that way, the zygomaticus muscle or any other that could create some problems?
FIRST OF ALL MESOBOTOX REFERS MORE SPECIFICALLY TO THE USE OF NON-BOTOX TREATMENTS OF MESOTHERAPY THAT SIMULATE BOTOX SO IT IS A BAD TERM. MICROBOTOX IS WHAT YOU ARE REFERRING TO IF YOU WANT TO BE ANALLY CORRECT. HERE IS THE PROBLEM: BOTOX INTO THE DERMIS CAN SPREAD DOWN. IN FACT, THE ORBICULARIS MUSCLE IS ATTACHED TO THE DERMIS AROUND THE EYES SO TO AVOID AND BRUISING AROUND THE EYES, MY INJECTION IS ENTIRELY INTRADERMAL BUT IT GETS TO THE MUSCLE ENTIRELY. SO BE CAREFUL WITH WHAT YOU ASSUME WHEN IT COMES TO BOTOX DIFFUSION. IT IS VERY REAL.
2) When intradermal botox is used to refine the skin / close pores, does that mean the person has to have injections in each single "open" pore? Or can one inject a bit in one area and have the pores of that area react by "closing"?
NO, BECAUSE THE PORES ARE NOT THE TARGET, IT IS THE SMOOTH MUSCLE THAT CONTROLS THE PORES SO YOU DON'T HAVE TO DIRECTLY INJECT A POOR. REMEMBER AS MENTIONED BOTOX TENDS TO SPREAD A BIT SO THAT LEVEL OF PRECISION IS UNNECESSARY. ALSO REMEMBER I DO NOT DO MICROBOTOX CLASSICALLY SPEAKING I JUST SEE THE EFFECTS OF DOING IT IN THE UPPER FACE SINCE I DO SIMILAR MICRO DROPLETS BUT REALLY TO TREAT WRINKLES AND MUSCLE ISSUES WITH A DERIVATIVE BENEFIT ON THE PORES AND TEXTURE.

3) How long does typically intradermal botox for large pores last?
I HAVE NO IDEA. I REALLY DON'T DO THAT EXCEPT AS STATED ABOVE. PLUS MY PATIENTS STAY WITH ME DOING BOTOX.

4) I read the archives and saw that you consider the use of botox for a gummy smile not as useful as the use of fillers. Do you mean that filling the area below the nose and above the mouth one can achieve the same result?
NO, NO, YOU MISUNDERSTOOD. READ THAT ANSWER AGAIN. I MEAN TREATING THE SMILE LINE IS NOT THAT EFFECTIVE WITH BOTOX AS COMPARED WITH FILLER. I THINK IT WORKS WELL FOR GUMMY SMILES. THERE IS LITTLE THAT IS BETTER. HOWEVER, YOU ARE EFFECTIVELY TARGETING BOTH ISSUES SINCE IT IS THE SAME EXACT INJECTION THAT MANAGES BOTH.

And finally, this one not related to botox... for acne scars that are rather shallow and not large, of the pitted type, but not really deep, does dermabrasion (not "micro", actual dermabrasion) work? It would be for a small area in the nose, in someone with light skin (Fitz II) and never had pigmentation problems with scars or any peeling or dermatologic procedure.
I WOULD HAVE TO SEE IT. EACH PERSON IS DIFFERENT. IT IS SO HARD TO ANSWER THIS QUESTION.
Sorry for so many questions.

And can one arrange an appointment with you while living in another country, so that one already has an appointment when visiting your country?
SURE. JUST SCHEDULE THAT WITH CONSTANZE.

You are the dearest! you answered so soon and so thoroughly!

Very clear!

One only doubt, though. It became now clear to me that botox can diffuse enough for microbotox to imply some "danger".

My remaining questions on that regard would be:

a) is there any part of the cheeks and nose where the diffusion of botox would not represent a risk because there aren't important muscles nearby? (say, are there areas so that the orbicularis orbis nor the zygomaticus nor some other important muscle that could cause unwanted side-effects could NOT be reached and so microbotox IN THOSE AREAS be rather safe)? Or is it only in the forehead/upper face that one sees that? (I was unlucky, though, previous botox sessions worked fine for wrinkles but did not leave me with a smoother skin - did the doc inject too deep??)

b) when filling the area below the nose with fillers to avoid a gummy smile, doesn't that change (pull up or change the shape, that is) of the mouth?

c) a filler under the nose for the same gummy smile issue could in turn have an uplifting effect on the tip of the nose (for a person with the famous problem of some dropping of the nose when smiling).

I was impressed with your webpage and lectures. Congrats!!! so, so good to listen to, thanks.
I will highly recommend your website to educate people around here.

Looking forward to meeting you in person!!

a) is there any part of the cheeks and nose where the diffusion of botox would not represent a risk because there aren't important muscles nearby? (say, are there areas so that the orbicularis orbis nor the zygomaticus nor some other important muscle that could cause unwanted side-effects could NOT be reached and so microbotox IN THOSE AREAS be rather safe)? Or is it only in the forehead/upper face that one sees that? (I was unlucky, though, previous botox sessions worked fine for wrinkles but did not leave me with a smoother skin - did the doc inject too deep??)

BASICALLY, THE GREATEST RISK FOR BOTOX IS PLACING IT IN THE MIDCHEEK OR IN THE AREA OUTSIDE OF THE ORBITAL BONY RIM. BEYOND THAT, EVERYWHERE CAN BE A RISK BUT IS GREATLY MINIMIZED BY AN EXPERIENCED INJECTOR. IT IS NOT JUST THE UPPER FACE THAT IS SAFE: THE LOWER FACE AND NECK ARE SAFE TOO SO LONG AS YOU HAVE AN EXPERIENCED INJECTOR. I HAVE NO IDEA IF YOUR INJECTOR WENT TOO DEEP OR WHAT. INJECTING THE BOTOX DEEP IN THE AREA BETWEEN YOUR EYES IS CRITICAL BECAUSE THAT IS WHERE YOUR MUSCLE RESIDES SO SOME AREAS I GO DEEP, SOME AREAS I GO SUPERFICIAL. IT DEPENDS ON THE LOCATION DEPTH OF THE MUSCLE.
b) when filling the area below the nose with fillers to avoid a gummy smile, doesn't that change (pull up or change the shape, that is) of the mouth?
IT IS NOT "FILLING" ANYTHING. IT IS RELAXING A MUSCLE. OBVIOUSLY, YOUR LIP MAY DROP A LITTLE EVEN WHEN YOU DON'T SMILE BUT THE BIG CHANGE SHOULD BE PRINCIPALLY WHEN YOU SMILE.
c) a filler under the nose for the same gummy smile issue could in turn have an uplifting effect on the tip of the nose (for a person with the famous problem of some dropping of the nose when smiling).
PLUS OR MINUS. THE DEPRESSOR SEPTI AND THE LEVATOR ALAEQUE NASI MUSCLES ARE COMPLETELY DIFFERENT MUSCLES WITH COMPLETELY DIFFERENT ACTIONS SO WHEN YOU HIT THE D.S., YOU ARE PRINCIPALLY GETTING LESS TIP DIP OF THE NOSE. IF YOU HIT THE LAN, YOU GET A SOFTER NLF AND A LESS GUMMY SMILE.