LAM FACIAL PLASTICS

Hi Dr. Lam

I was reading on a website that botox is now being used in places that were previously off limits, like neck bands, in the chin, and to raise the corners of the mouth and eyebrows. I think this was refered to as facial sculpting. I even read obout it being injected intradermally to refine the pores! Do you use botox for these areas? Do you think it is safe to use botox in these areas?

Thanks for providing this resource to all of us!

it is only safe with proper consultation and a qualified injector. let's break down the lower face treatments so you understand the basic risks and benefits:
1. jawline botox or masseter botox. this is really practically risk free. sometimes you may feel tired chewing for a couple of weeks but i only remember one patient who had this temporary issue. this is far away from the mouth so that should not be a problem.
2. neck botox: platysma. ONLY good in patients with hyperdynamic wrinkles that bound when you talk. terrible for the aging neck if the neck is drooping. it will worsen the bands.
3. neck botox: necklace lines: a waste of money. does not work consistently and too much money to spend on that area.
4. smoker's lines: i tend to only do one lip but at times with very animated upper and lower lips i do both. the real reason that i do these lines is not to get rid of them but to stop someone from creating them from bad pursing habits. it is more effective than filling in someone who has a bad habit since it knocks out the source problem. there are two major problems: a slight to noticeable blunting of the P and B sounds and it lasts a short time like 6 weeks or so (which in a way is good in case you don't like it.) it will make it harder for drinking soup and sucking on a straw (which you should avoid anyway despite what the dentist wants.)
5. gummy smile/deep nasolabial groove: i only do this for a gummy smile. it is the same technique to drop the NLG but in my opinion fillers to a better job. if you want to be technical, you are knocking out the levator alaeque nasi muscle.
6. depressor septi: if people do not like when their nose dips during smiling i can treat that. again, these little things are a waste of money but if you want it, i'll do it.
7. depressor anguli oris (frown lines): i would rather fill them but i know how to lift these corners up a bit with botox. pretty safe with an experienced injector unless your injector does not know basic anatomy.
8. mentalis/pebble chin/peau d'orange: this is rather foolish use of Botox but okay, I can do it too if you wanted it.
9. pores- i have noticed tremendous improvement in upper facial and periorbital texture from repeated botox use. however, i do not do "micro botox" in the classic asian sense. i think there is too much risk hitting the zygomaticus muscle and causing a mouth drop.

okay, now that you know what i can do, i am not a "dermatologist" who can get off on treating these little doo-dads. i'll do it for you but as you know i like people to see the big picture and not waste money on nothings of the face. i will guide you as to what lower facial botox is helpful. botox is so expensive that to just place it anywhere you want is crazy (in my opinion) but in select areas (smoker lines when they are habits and flared jawlines) that makes sense to me. just remember: just because you can do botox in those areas, should you waste your money to do so? also, these are areas of very advanced treatments. do not go to someone who does not know the anatomy and who looks scared when you mention lower face botox.
sml