LAM FACIAL PLASTICS

Hi :)
(So good to be back!!!)

Dr Lam, regular botox is something that's clearly great to have both for its immediate effects and its long term effects. Ok.
Sadly, it is costly enough as for not being something one can do for all the muscles that should be paralyzed or for a few too regularly.
At least it is my case. I can afford having botox once in a while, but not each time it starts wearing off, or for each muscle that could benefit from it (while still keeping a natural non frozen look, of course! ).

If one has to "pick" in what areas to have botox because not all can be done (=paid), how much of a negative effect it will have to NOT have it in a msucle we rarely "use", anyway?
When we naturally tend to not frown or give ourselves expression lines in some particular spots, do we still need botox in those areas and/or does the area age fast and get wrinkled more or faster than if we had botox?

Knowing this might sound confusing, an explanation. For a reason I can not explain, I almsot never make a gesture that gets me horizontal lines in my forehead. I can make that movement, it's just not something I normally do. That's why I still don't have horizontal lines in my forehead, but I assume at some point I will get them, even if I wrinkle "there" very few times in my daily life, while expressing myself naturally expression-wise.
Does that mean I can skip botox in that area? Or should I still get botox there?
How much faster does an area age and develop lines when not botoxed... even / if those muscles are not an are where the gestures make us wrinkle often?
Does gravity and collagen loss or whatever still work against a smooth forehead as time goes by even if we do not gesture in a way that we get horizontal lines?

Should I still try to save and get botox in that area to *prevent* ageing? or can I postpone it and not make the ageing too much faster if I keep on not wrinkling "there" in my daily life, living normally, gesturing normally?

Hope my question makes some sense!!!

great questions. if you are not making a fold in that area, you don't need botox in that area right away. i always tell my patients how to prioritize areas based on wrinkle patterns. let's say that i see a deep furrow between the eyes, then i know that they are a frowner. then they need consistent botox there every few months like a religion for the first year to break the habit. let's say i see they have horizontal lines on their forehead, then they need at least one year of consistent botox to break a habit and to speed one toward healing then we can negotiate. if you don't have many wrinkles anywhere, then you can certainly wait.

one area that tends to still worsen is the crow's feet because we all have to smile. also, that area should be captured earlier than later because once the crow's feet start to pass beyond the bony rim of the eye, it becomes harder and harder to recapture. once they are like halfway down the face, forget it. botox will never bring the lines back in. so if you notice early crow's feet when you are smiling and you don't have lines elsewhere, focus in that area. as i say, botox is like exercise. any little bit will help. even if you can only afford to do one area twice a year, it can serve as a wonderful preventative measure especially in the crow's feet. that area, almost none of us can truly escape aging unless we simply never smile, which may not be good. hope that is clear.
sml

Yes, it was hyper clear and relieving to hear!! (read)

I mean, thank God I took the right approach so far, without even being sure of what I did.

I normally do not wrinkle my forehead. It is not a frozen look. I guess I gesture in a way that I naturally don't raise the eyebrows in a way that moves that area. Of course the area is not all perfect smooth: little by little the skin texture is starting to change as I age , but still no lines. I will keep on keeping it for whenever I can have botox but not have it as my first target, as I did until now.
Only once I had botox for the forehead and it was actually because the doc had some "remaining" botox that he was kind enough to use on that part when treating me for the botox above the nose (vertical lines).

So far I have concentrated on the vertical lines I still did not have but I could tell were slowly forming in between my eyes but always focused first and above all in the lines in the undereye area. When I get treated the latter, the doc normally includes injecting a couple of points on the sides of the eye and above (I guess for preventing crow's feet and for "opening" the eye), but I'd say 90% of what I get are 2 units of botox in the undereye area and not too close to the inner area. As you said it should be done (that is why I chose that derm , because he says the same you say about most things, I decided to trust him in particular ).
I think I have a proof of your theory of the preventive power of botox as I did not have crow's feet but little by little I was seeing very light lines to start to show (although, really, looking too carefully!) but they are now totally gone thank to how botox for the eye area in general indirectly prevented them from developing, In other words, the area there is really smooth because I caught the lines even before they were really formed. The undereye area is tricky for me. I guess I will have to be constant and perseverant with it!

So I have basically treated with botox my undereye lines while preventing the crow's feet and also weakened regularly the vertical lines above the nose. I will keep on "holding on" the forehead lines, as my budget does not allow me to face the cost of treating "everything"
But it is comforting to know that so far I and the derm that injects the botox have approached first the spots that, indeed, must be approached first in me.

On a sidenote, I will always wonder why some people might make the same gestures and not get lines somewhere while others do, and get lines where others don't! I get a lot of undereye lines (always did) when smiling (and I don't plan to stop smiling, so I'd better keep on saving for botox religiously) but not in the crow's feet area while most of my friends get lines in the crow's feet area and not as many or almost none in the undereye area! and I get a few faint "bunny lines" but not forehead lines. Odd how we all have the same muscles and yet we do not all move and show in our face our gestures the same way. Incredible, non? we really are all unique. In every way!

1. if your forehead texture is changing, you might consider to do botox in that area once or twice a year to reverse that but it is not critical. like exercise, anything you can afford to do with botox will help in the long run. however, without lines visible at rest, you should be fine for quite some time.
2. when you said, the kind doctor had a little botox left, that makes no sense to me. perhaps he is still adhering to Allergan's ridiculous policy of dumping botox after 4 hours following reconstitution. they have done studies to show that the botox actually has the same potency 3 weeks later. i do about 400 bottles a year so i run through a couple of bottles a day so i don't keep it for more than a few hours. however, that is really outdated information, just FYI. obviously, you probably would be at a disadvantage if you told your doctor that information. lol.
best,
sml

>if your forehead texture is changing, you might consider to do botox in that area once or twice a year to reverse that but it is not critical. like exercise, anything you can afford to do with botox will help in the long run. however, without lines visible at rest, you should be fine for quite some time.

Thanks for the tip!

> when you said, the kind doctor had a little botox left, that makes no sense to me. perhaps he is still adhering to Allergan's ridiculous policy of dumping botox after 4 hours following reconstitution.

I don't think he agrees with Allergan on that, although he prefers to use it as soon as possible once opened. But I think it's more about not breaking the "cold chain" or avoiding contamination of the product by too much handling or opening of the refrigerator where it is kept, etc. (I hope I am not distorting what he said, he mentioned the subject but it was long ago).
In this case, it was simply that the vial of botox had very very little powder left to dissolve, something that once "prepared" would be a too weak dose for what his next patients usually need but that was an enough dose for me. It was a nice gesture of his, he could actually have used that little remaining for some other patient, but he thought that for such a small dose, he'd rather leave me looking better (get an overall better effect) and "lose" those few units, and open a brand new vial for the upcoming clients that normally require a lot more units of botox per spot.

Here we get European brands of botulinum toxin, so Allergan here has not had too much luck with its claims of this or that. We always had the version/s and indications of brands such as Dysport, Dyslor and I don't remember know others (there is a German one, for example... all European Community-Health Department approved, of course). Actually, Botox arrived here after other brands of botulinum toxin type A. We got first it through laboratories of European origin.
Actually, Botox tried to enter our market with outrageous prices, and as they realized they were not selling the vials because most docs preferred the other brands that were also good and a lot cheaper, and so Allergan has lately changed (lowered) big time the price of the actual Botox here. But ,say, we never got those warnings concerning "one vial per person" or "only effective for injeccting it in a matter of few hours" claims. The basics of hygiene and safety when handling botox are respectede, of course. But Allergan's representatives here didn't even try to make a fuss over the "one bottle per person" thing. I learned about it online, from US sites only!

> obviously, you probably would be at a disadvantage if you told your doctor that information. lol.

LOL!

interesting. we just have botox brand here. but we will soon have reloxin (aka dysport). because of that, this is the first year, botox did not raise their prices so i didn't either.

I thought of sharing this...

What is interesting too is that while all the toxins are the same in their final results and equally safe (I am speaking of bot toxin a made by serious laboratories) the way of dissolving the power to get the same "strenght" varies, so with some you need x units to achieve what is y units with botox-- but a very interesting thing a doc shared with me (that in turn had been discussed with colleagues who use it for different purposes) is that some brands of the toxin (all safe, well made) are better for some type of treatments than others.
Say, dermatologists usually prefer the brands that provide faster results (apparently different brands show their effect with slight differences in the amount of days needed for full effect) and/or when they have to inject areas of the face that are tricky in the sense that they must target a very specific spot (=if the toxin got difussed in the area it could lead to some complications), while neurologists treating problems such as hyper spasticity of muscles or other neurological problems involving the need to paralyze muscles prefer other brands whichs effects are maybe not as strong or need more units, yet they need less vials and obtain sometimes better results because with that specific brand they notice the toxin is more likely to diffuse to nearby areas. In cases that need the treatment of large muscles, it can give good results in larger areas with the same amount of toxin, or even less.

yes, dysport/reloxin is known to diffuse more than botox and should be used with greater caution around the mouth area or between the eyes because of that reason. for me right now even when reloxin hits the market, i see no reason to switch from a proven success with botox.

I like very much your common sense when considering whether or not to try something new when something "old" works. As people say, common sense is the less common of senses sometimes! but glad you have it and share it with us!