Dr. Sam Lam Plastic Surgery Forum

1. Is it true that the lower down in the face it is used, the longer and stronger the effect? If so, why?
ACTUALLY, QUITE THE OPPOSITE, THE AREA AROUND THE MOUTH TENDS TO LAST HALF AS LONG AS THE UPPER FACE. THE JAWLINE CONTOURING (MASSETER ) DOES LAST TWICE AS LONG AS THE UPPER FACE BUT ONLY BECAUSE OF THE BULK OF BOTOX I GIVE. THE PLATYSMA I HAVE FOUND LASTS IN MANY CASES A LITTLE LONGER THAN THE UPPER FACE BUT NOTHING TO WRITE HOME ABOUT AND ALSO CAN BE QUITE VARIABLE. IF YOU WANT SPECIFIC TIMES THAT I HAVE OBSERVED: UPPER FACE: 3 TO 4 MONTHS, MOUTH: 6 WEEKS TO 2 MONTHS, MASSETER: 6 MONTHS TO A YEAR, PLATYSMA: 3 TO 5 MONTHS.

2. Is it also true that after several uses the muscle eventually stops contracting (and can you then avoid neck surgery)?
NO, THIS IS ALL BASED ON HABIT AND THE AIM OF BREAKING THE BAD HABIT OF CLENCHING YOUR PLATYSMA. I HAVE SEVERAL PATIENTS I HAVE BEEN INJECTING FOR MANY YEARS NOW WITH THE SAME PROLEM. IF YOU CAN BREAK THE HABIT OF CONTRACTING THE NECK, THEN IT WILL HELP GIVE YOU LONGEVITY. ALSO, AS YOU PROBABLY KNOW THIS IS NOT A TREATMENT FOR AGING NECK. IT CAN ACTUALLY TAKE A FLACCID AND HANGING PLATYSMA AND MAKE IT MUCH OLDER LOOKING BY SAGGING FURTHER. THIS IS USUALLY FOR HYPERKINETIC (OVERLY MOVING) PLATYSMAS IN YOUNG, ATHLETIC INDIVIDUALS. HOWEVER, I DO HAVE A FIFTY SOMETHING WHITE WOMAN WHOM I HAVE BEEN DOING FOR THE PAST FEW YEARS ONLY BECAUSE HER NECK IS AN EXCEPTION. THE PROBLEM IS TOO MUCH MOBILITY AND NOT SAGGING. JUDGEMENT IS EVERYTHING. TECHNIQUE IS EASY.

3. Is it necessary for this injecting to be done by a surgeon as I have read somewhere due to proximity to the vocal chords etc?
NO, THE CORDS ARE MILES AWAY. THIS IS DONE JUST UNDER THE SKIN. JUST GO TO SOMEONE WHO KNOWS HOW TO DO THIS. SINCE DERMATOLOGISTS PROBABLY DO A LOT OF THESE ESOTERIC BOTOX AREAS, YOU MIGHT WANT TO CONSIDER ACTUALLY A DERM. DERMS TEND TO USE BOTOX AS THEIR ONLY HAMMER SINCE THEY DON'T DO SURGERY IN MOST CASES SO THEY BOTOX EVERYTHING. EVEN THOUGH I AM NOT A DERM, I KNOW THE MUSCLES QUITE WELL IN HOW TO INJECT BOTOX IN THESE "ADVANCED" AREAS.

1.I'm not sure I'd call myself athletic! But I'm 40 and slender and apart from a little gather at the 'crook' of my throat my neck is fine. Does it sound like I qualify?
SOUNDS OKAY TO ME! WOULD NEED TO SEE YOU TO MAKE ABSOLUTELY CERTAIN THOUGH. MALE, YOUNGER: BOTH SIGNS YOU ARE MORE LIKELY A GOOD CANDIDATE.

2. I thought the muscle here contracted automatically more over time and there wasn't much you could do about it...? Is it then still possible for the botox to 'train you out of' using the muscle?
THE MUSCLE DOESN'T REALLY DO MUCH. IT IS THE MUSCLE THAT IS ACTIVE IN HORSES. THEY USE IT TO SWAT FLIES. (IT IS ALSO THE BACON FROM PIGS.) THE ONLY WAY YOU WOULD BE CONTRACTING THE MUSCLE IS DUE TO BAD HABIT DURING EXERCISE (WEIGHT LIFTING), JUST BAD HABITS OR YOU CAN'T AFFORD A FLY SWATTER AND LIVE NEAR A SWAMP. YES, BOTOX CAN TRAIN ONE OUT OF A HABIT IN MANY CASES.

3. Is a contraction in this area a clenching (how?) or stretching of the neck? I'm guessing the first, if so, is stretching the neck good to reduce the tension which causes the pulling, or doesn't it work that way?
CLENCHING IS CORRECT.NO, STRETCHING WILL DO NOTHING FOR YOU.

sorry, don't know why i thought a guy. just that there is more of a developed musculature and they lift a lot of heavy weights but i have done many women as well.
best,
sml