LAM FACIAL PLASTICS

Hello Doctor

a) Why do your injections of botox make pores smaller? By what mechanism does the botox get that result?

b) Does it depend n the depth where the botox is injected by you in particular? (dermis? muscle?= how deep) Do other docs get the same results or normally not?

c) Where is botox injected in general for wrinkles, in what layer of the skin OR in the muscles below the wrinkles??

d) When you say that the pore tightening indirectly obtained by repeated botox injections only achieved in the areas treated for wrinkles with it (logically), does it mean that only the pores of the forehead or in the outer corner of the eyes can be treated indirectly with botox injections for wrinkles?

e) Are there any other facial areas where botox can achieve the same without implying risks of muscle "paralysis" and negative side effects?? can botox be used below the tear through / in the undereye area as to close some pores close to the nose?

f) Is botox "useable" on the nose in any way? if applied there, can it have some negative side effect? (thinking of the botox there for bunny lines wrinkles but also indirectly getting to make pores smaller if possible...???)

All these doubts stem from the fact that I have had botox (and it worked for wrinkles) many time but I did not notice a change in the pore appearance, ever, in my case. 3 differend good derms injected me over time, but none made me obtain that effect. (Wish you lived closer!!! will have to save to travel up there!)

a) Why do your injections of botox make pores smaller? By what mechanism does the botox get that result?
I INJECT 30 TO 50 INJECTIONS IN THE UPPER FACE. LITTLE DOSES OVER A WIDE AREA CAN HELP WITH THAT. ALL THESE INJECTIONS ARE PREMARKED OUT SO THAT THEY ARE UNIFORMLY PLACED. MOST INJECTORS JUST HAPHAZARDLY INJECT THE STUFF.

b) Does it depend n the depth where the botox is injected by you in particular? (dermis? muscle?= how deep) Do other docs get the same results or normally not?
MAYBE, THE DEPTH REALLY IS IMPORTANT TO AFFECT THE MUSCLE. HOWEVER, I AM GUESSING THAT WHEN I WORK ON THE FOREHEAD, I DO GO CLOSE TO THE SKIN SAME AS AROUND THE EYES SO PERHAPS IT IS DOING SOMETHING. THAT IS ONLY CONJECTURE. HOWEVER, THAT IS HOW MICROBOTOX IS DONE: RIGHT IN THE DERMIS.

c) Where is botox injected in general for wrinkles, in what layer of the skin OR in the muscles below the wrinkles??
IT DEPENDS. THE FOREHEAD MUSCLE AND SMILING MUSCLE ARE NEAR THE SKIN SO I INJECT SUPERFICIALLY. THE FROWNING MUSCLES ARE ALL VERY DEEP ON THE BONE SO I INJECT VERY DEEP THERE.

d) When you say that the pore tightening indirectly obtained by repeated botox injections only achieved in the areas treated for wrinkles with it (logically), does it mean that only the pores of the forehead or in the outer corner of the eyes can be treated indirectly with botox injections for wrinkles?
NO, BUT THAT IS ALL I DO. YOU CAN LOOK AT MY VIDEO LOG ON MICROBOTOX TO UNDERSTAND WHAT SOME PEOPLE DO ALL OVER THE FACE IN THE PHILIPPINES. GIVEN HOW EXPENSIVE BOTOX IS IN THE U.S. IT IS PROBABLY COST PROHIBITIVE. BUT MORE IMPORTANTLY, I DON'T HAVE THE TIME OR ENERGY TO INJECT YOUR WHOLE FACE NOR DO I WANT TO ACCEPT THE RISKS (AGAIN, WATCH THE VIDEO).

e) Are there any other facial areas where botox can achieve the same without implying risks of muscle "paralysis" and negative side effects?? can botox be used below the tear through / in the undereye area as to close some pores close to the nose?
THAT AREA DOES HAVE RISKS. I DO INJECT IT ON OCCASION IN PEOPLE WHO BUNCH UP WHEN THEY SMILE ESPECIALLY AFTER BOTOX. HOWEVER, WITH POOR LID TONE, YOU CAN HAVE ROUNDING OF THE LID. THE AREA NEAR THE NOSE (BUNNY LINES) CAN BE EFFECTIVELY TREATED. HOWEVER, PEOPLE WITH DRY EYE CAN HAVE WORSENING BECAUSE IT IS RIGHT NEAR THE LACRIMAL TEAR DUCT WHERE 70 PLUS PERCENT OF YOUR TEARS DRAIN. THAT IS WHY THE ART AND SCIENCE OF BOTOX MANDATE AN INTIMATE UNDERSTANDING OF BOTH THE SURFACE ANATOMY AND ALL DEEP STRUCTURES.

REMEMBER ALSO, MOST WOMEN ARE REALLY OBSESSED WITH THE FACE FROM A MICROSCOPIC PERSPECTIVE. PLEASE BACK UP A BIT. A LOT OF THINGS THAT BOTHER YOU, NO ONE ELSE CAN SEE. I HATE CHASING LITTLE THINGS TO THE POINT THAT YOU SPEND A LOT OF MONEY TO MAKE LITTLE CHANGE IN SOMETHING THAT ONLY YOU CAN SEE CLOSE UP. IF YOU WANT TO SEE A FUN AND CRAZY BLOG, LOOK AT THE EINSTEIN MONROE BLOG I JUST POSTED FRIDAY NIGHT.

f) Is botox "useable" on the nose in any way? if applied there, can it have some negative side effect? (thinking of the botox there for bunny lines wrinkles but also indirectly getting to make pores smaller if possible...???)
SIMPLY PUT, I DON'T DO BOTOX ON THE NOSE OR THE REST OF THE FACE FOR SKIN EFFECTS. I DO IT FOR WRINKLES. IN THE AREAS TREATED, I GET A BONUS FROM THE SKIN EFFECTS. THE ONLY AREA OF THE NOSE I DO IS THE DEPRESSOR SEPTI MUSCLE TO DECREASE THE TIP DROP DURING SMILING, AND I ONLY DO THAT ONCE OR TWICE A YEAR. AGAIN, MY OPINION IT IS A WASTE OF MONEY UNLESS YOU REALLY WANT TO BLOW CASH FOR NO REASON THEN I GIVE YOU MY ADVICE BUT SINCE IT WON'T HURT YOU, I'LL DO IT. MY GOAL IS TO EDUCATE YOU SO THAT YOU DON'T WASTE YOUR MONEY WITH ME. THERE ARE A LOT OF THINGS THAT I CAN DO BUT WHY IF IT IS JUST TO BURN MONEY? IF YOU HAVE A LOT OF DISPOSABLE INCOME, THEN THAT IS FINE.

All these doubts stem from the fact that I have had botox (and it worked for wrinkles) many time but I did not notice a change in the pore appearance, ever, in my case. 3 differend good derms injected me over time, but none made me obtain that effect. (Wish you lived closer!!! will have to save to travel up there!)
FIRST, I CERTAINLY CANNOT MAKE PROMISES THAT MY TECHNIQUE IS SOME KIND OF FANTASY MIRACLE TREATMENT. IT IS MUCH LESS UNCOMFORTABLE AND MUCH SMOOTHER. HOWEVER, I WOULD HATE EVEN FOR YOU TO FLY TO SEE ME JUST FOR MY "MIRACLE" BOTOX AND NOT GET THE RESULTS. BELIEVE IT OR NOT 10% OF MY BOTOX IS FLY IN. MY PATIENTS WHO WANT THE BEST HAVE GONE TO 10 PLUS INJECTORS AND I AM THE ONLY ONE THAT CAN GET THE SMOOTH RESULTS WITH LONG TERM EFFECTS (PAINLESSLY) THAT THEY ARE LOOKING FOR. HOWEVER, LESS THAN 1% ARE DISSATISFIED (I CAN'T REMEMBER THE LAST ONE). BUT YOU CAN'T PLEASE EVERYONE.

Wow, doctor, you are the best. Such clear, super explanatory answers. Wow, THANK YOU!
I forgot one question and I promise is the last. An article on botox mentioned that it was used for the "flare" of the nostrils. What does that mean??? That you can narrow nostrils with botox?????
Hugs and I wish the very best. You have wonderful wonderful wonderful work ethics

hmm, i don't know to tell you the truth. i know that the levator alaeque nasi muscle can flare the nose a bit but it is used mainly for snarling. that is what is injected to reduce the gummy smile and NLF. however, i have never heard of anyone treating the dilator naris. to me it seems risky in terms of nasal breathing. well, i am always open to learn something new. remember, i really hate getting lost in these little novelties. i like the money a patient spends with me to be worth it.

thanks for the kind comments.
sml