Archive for the ‘Botox, Dysport, Botulinum’ Category

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Dr Young blogs about Botox and the things that doctors usually recommend after botox (Bellevue, WA)

Friday, July 30th, 2010

Before botox, as I mentioned in a previous blog, you should always stay away from blood thinners 2 weeks before and after the procedure if you wanted to avoid bruising as much as possible.  We have a list of things / medications to avoid before and after botox that you can check out here. But other than that a recent number of consensus panel recommendations showed the preferences of plastic surgeons, dermatologists, and facial plastic surgeons:

100% agreed that you should not massage the area after botox, which I tell my patients as well.

78% said to contract your muscles to help activate the botox more. I tell my patients to contract their muscles as much as possible to help make the botox / dysport work. Doing this for 2 hours will help the uptake of the botox.

Only 30% said to limit your activity after botox. I suggest to all my patients to limit activity for the first 24 hours to avoid diffusion.

Only 29% said to avoid bending over after botox.  I tell my patients to avoid bending to prevent diffusion.

Only 20% mention to avoid heat after botox. I dont have a solid opinion on this as there is not enough information to say one way or another.

Only 13% of physicians mention avoiding flying after botox.  I don’t tell my patients to avoid flying.

Again, the maximal effect of botox is at 2 weeks and for dysport it is a little less than a week.

I hope that you enjoyed this and thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

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Botox or a Browlift would be an excellent option to help you with your arch in your eyebrows.

Wednesday, July 14th, 2010

Botox would be an excellent option to help you with your arch in your eyebrows.  Whereever the arch is more exaggerated you can place a small amount of botox like 1-5 units to to lower the arch.  It could require more than one shot over each arch depending on how the arch is shaped.  I would start conservative and find the right amount for you.  For a more permanent solution, you can do a brow lift in a differential way to shape the eyebrows.  It could entail elevating the lower portion or lowering the arched portion.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Botox, Dysport, Botulinum, Browlift / Eyebrow Lift / Brow Lift | No Comments »

Botox or Dysport both work equally well in decreasing the muscle mass of the jaw muscle called the masseter.

Wednesday, June 30th, 2010

Botox or Dysport both work equally well in decreasing the muscle mass of the jaw muscle called the masseter.  This procedure is very safe. I have never had any serious issues with this use. The amount of botox or dysport to use is dependent on the person because everybody has different responses and different volume of muscle. I usually tell this to people and then explain that I recommend starting at a lower dose like 15-25 units of botox for each side.  Dysport requires 2.5 to 3.0 times the units of botox for equivalent dosing.  Then I tell them that they can see if this adequate muscle relaxation in 2 weeks for botox and 1 week for dysport.  If there is still significant muscle movement of the masseter you can elect to do more.  One important point is that the muscle mass reduction lags behind the muscle movement.  It takes from 3-5 months to see the maximum volume changes in the masseter muscle and then it slowly increases the mass to normal by one year.  So, in short, there are some doctors that are seeing results from botox to the jaws for one year.  In my experience, the mass usually comes back earlier than this but the results are more longer lasting than what can be expected with other facial muscles.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

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Browlifting with Brow Bone Reduction, Hairline Lowering, and Removal of Frown Muscles can Markedly Improve Your Appearance

Thursday, May 20th, 2010

There are many reasons for browlifting (Dr Young specializes in Browlifts and Facial Plastic Surgery) and working with the upper third of the face.  One of the main reasons is to lift the brows when they are drooping.   In this case, raising the eyebrows can open up the eyelids and reduce the upper lid skin laxity.  This can be done through open approaches, through the eyelid and through minimally invasive means through small incisions behind the hairline.  What can also be done is removing the muscles between the eyes that causes the frowning.  This can reduce your needs for botox markedly to not having to need botox at all.  Some people also have significant brow prominence that can be reduced by burring the bone down.  this can be done through an eyelid incision or through an open approach which requires an incision from ear to ear.  Although the incision from ear to ear sounds daunting, the incision actually heals really well when you close it accurately. Also through an open approach you are more likely to get longer lasting results.   Reducing the brow bone can reduce the stern and masculine look that some women have.  Hairline lowering is something that can also be done for people with high hairlines. This is done through an incision right at the hairline.  This combination of procedures, browlift, brow bone reduction, hairline lowering, and brow bone muscle reduction is much more commonly done for certain patients that want to have more of a feminine appearance.  This typically is more common among my transgender patient.  Below is a picture of a just such a patient.  Although we have done this for many women.  Most of the women we have are more conservative in showing their pictures on our website.  Notice in the pictures that his brow bone is less prominent and his eyebrows are elevated to his desired height that we discussed prior to the procedure.  Other procedures that he has were a chin reduction, rhinoplasty, and permalip implants.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Before

AFTER

Before

After

Posted in Botox, Dysport, Botulinum, Browlift / Eyebrow Lift / Brow Lift, Transgender or Facial Feminization / MasculinizationSurgery, Wrinkle Treatment | No Comments »

Botox treatment (or Dysport) for Facial Palsy and Bell’s Palsy for hyperkinesis and synkinesis

Saturday, May 8th, 2010

There are many people out there that have suffered from Bell’s Palsy.  This is a condition that causes the facial nerve to become weak so that you have a problem moving one side of the face.  In fact, it can be so bad that for a time, initially, the whole face will not move for several months and it can take months for it to come back.  After regeneration, you can have weakness on that side and also something called synkinesis where the muscles don’t act individually.  When you damage your facial nerve, when the nerve starts to grow back, it doesn’t always go to the correct muscles.  What happens is that the brain and the area of the brain that controls a certain area (say the left eyebrow and eye muscles of movement) will tell those muscles to contract and the nerve will travel from the brain to the muscles.  The problem occurs when the regenerating nerve travels to the wrong muscle when it grows back.  So some of the nerve fibers will travel to the mouth instead of the eye and eyebrow.  So when you want to move the eye and eyebrow, you also get some movement of the mouth.  This is called synkinesis.  Also when the weak side has a heard time moving as strong as the unaffected side, it will look different when a person smiles.  Botox can improve these situations to a degree.  Below I show where I inject botox and how many units in each area to decrease movement on the stronger side to get more symmetry.  You can change the amounts based on individual situations.  For the twitching you can place it on the weaker synkinetic side just enough to decrease that movement as well.  But this is much harder.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

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Can you inject botox and filler at the same time in the same area?

Thursday, May 6th, 2010

Injecting botox first and then to follow it immediately with a filler (Dr Young in Bellevue Washington) can risk problems with moving the botox around.  There is not sufficient scientific evidence documenting the safety of both at the same time.  It is not widely accepted.  If the botox and restylane are used in different places then it is more okay and accepted in my opinion.  I like assessing the results of the botox first and determining if the results of the botox is achieving the results that you or the client likes.  If more results are desired then you can consider the filler 2 weeks later.  This also allows the filler to stay longer because the muscles are not causing the dispersement of the filler and also the metabolism of the filler to be increased.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

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What is the muscle that causes crows feet?

Sunday, March 7th, 2010

The muscles that cause crows feet are the orbicularis oculi and the smiling muscles: levator labii superioris, zygomaticus major and minor.  Here is a picture of these facial muscles.  When we try to improve crows feet with botox, these are some of the muscles that we try to weaken to decrease the formation of wrinkles.  Botox is injected in the sides of your eyes in the skin to weaken these muscles.  By doing this, we make the muscles weaker so they are less likely to form these dynamic wrinkles.  Dynamic wrinkles are the wrinkles that show up when you move the muscles of your face.  They are more pronounced when you move your facial muscles.  Static wrinkles are the wrinkles that are so etched in that they are present when you are not moving your facial muscles of expression.  Dynamic wrinkles are mostly effected by the actions of botox.  Over time, with continued use of botox, the static wrinkles can become more improved.  This is done because with botox, eventually allows the skin to remodel and reduce the static wrinkles.  This action of improving the static wrinkles however takes a long time and requires regular and consistent use of botox.

I hope that was interesting for you!

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Botox, Dysport, Botulinum, Dermatology, Fat Transfer / Fat Injections, Fillers / Facial Fillers, Wrinkle Treatment, YoungVolumizer | No Comments »

What are the options for Crows feet?

Saturday, March 6th, 2010

Crows feet are due to the eye muscles that surround the eye. These muscles are meant to close the eye, to blink, to protect the eye, etc.  When doing these movements, they can affect the skin around the sides of the eyes.  What results with this movement are the wrinkles that are commonly called the crowsfeet.  Botox is usually the way that people get some relief for them.  It usually takes about 8 – 12 units of botox on each side and the costs are around 10-16 dollars per unit of botox.  Other options include laser resurfacing, fillers, or fat injections for these wrinkles.

Fat injections and fillers function to do the same thing. When we age we lose volume in the skin and in the whole face in general.  What this does is bring the skin closer to the muscles of our face.  When we were young, there was a greater distance from the muscles of facial expression and the skin.  This distance was occupied by our skins fat and connective tissue.  When you smiled when you were young, the muscles tended to glide under your skin.  The fat in the skin above the muscles of facial expression allowed the skin to slide.  This exact phenomenon occurs in multiple areas of your body.  It is essential for muscle movement in fact.   As we age, the muscles of facial expression become closer to the skin, when we progressively lose the fat and connective tissue within and under the skin.  Hence, progressively when we smile are muscles of facial expression begin to exert more effects on the skin and these are manifested through wrinkling when we smile.  Through fat injections, fillers, or the YoungVolumizer, this layer of fat between the skin and muscles is increased and the muscles of facial expression have less of a wrinkling effect on the skin.

Resurfacing through chemical peels, lasers, or dermasanding / dermabrasion essentially takes away the top layers of the skin to allow skin cells deep within our hair follicles, glands etc to “resurface” the skin.  In the process of the procedure, we remove wrinkles, create a new layer of collagen underneath the skin, remove unwanted pigmenation and DNA damage, remove precancerous or cancerous cells, etc.  The skin then becomes renewed with healthier cells, you have less sun spots, wrinkles and the tone and texture of your skin is rejuvenated.

I hope that was interesting for you!

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Botox, Dysport, Botulinum, Fat Transfer / Fat Injections, Fillers / Facial Fillers, Skin Care, Wrinkle Treatment, YoungVolumizer | No Comments »

What is the best treatment for laugh lines? Fillers or Botox?

Monday, February 22nd, 2010

Juvederm is commonly used for laughl lines as well as botox.  It is important to know what you mean by laugh lines.  Many refer to these as the lines around the eyes, or crows feet.  Others mean when the say “laugh lines”, the lines around their mouths or nasolabial folds.  I have a blog that defines those areas if you are interested to know the terms.  But the nasolabial folds are the folds that run from the nose along the sides of the mouth. Whereas the lines below the mouth on the sides are commonly refered to as the marionette lines or puppet lines.  The crows feet can be improved by botox and they can also improve the nasolabial folds to some extent.    Fillers like juvederm can also fill in the nasolabial folds, marionette lines and also help with the crows feet.  In order to really understand how they work a visit to a facial plastic surgeon would be helpful.  Now the difference between fillers and botox is that fillers replace volume that is lossed during aging.  When you lose volume there is an excess amount of skin compared to the underlying tissues.  More skin for a set amount of volume leads to more folding of the skin and hence more wrinkles.  Fillers replace that volume and hence fill in the skin and thereby decrease the ability for the face to make wrinkles.  Botox, which is a neuromuscular agent can make the muscles less likely to contract.  Hence they are most beneficial for dynamic wrinkles, or the wrinkles that are caused by muscular activity.

I hope that helps.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Botox, Dysport, Botulinum, Fillers / Facial Fillers, Juvederm, Perlane, Radiesse, Restylane, Wrinkle Treatment | No Comments »

Glabellar frown lines – The lines between the eyebrows can be improved

Thursday, February 11th, 2010

What are the options to improve those angry lines in between the eyebrows. Well I will talk about the lease invasive type to the most invasive types.  To begin with skin care is a good place to start.  I would always start with a good skin care line. I would suggest a alpha hydroxy toner, gentle cleanser, alpha and beta hydroxy acid lotion, a retinoid and regular superficial peels.  The goal is to decrease the number of days the skin takes to turnover from the usual 28 days to 10-12 days.  This will help to freshen the skin, lighten brown spots, and decrease fine wrinkles.

The next progression is botox. This neuromuscular agent will keep the muscles from working in between the eyebrows and decrease the dynamic wrinkles.  Over time as your skin remodels, your static wrinkles can improve with continual use of botox on a regular basis. The drawback is the repeated treatments that are neccessary. The positives is the low invasive nature.

The next level is fillers. Restylane, Juvederm, Perlane, Radiesse, can decrease the wrinkles by volumizing the glabella and the area in between the eyebrows.  Volume loss plays a large part in this area.  As this area deflates, more skin in relation to the area leads to more wrinkling.  Also, the decrease in volume places the skin closer to the muscles in this area and allows the muscle to place more influence on the skin and hence more dynamic wrinkling.

Fat injections (Dr Young has developed the YoungVolumizer- a new approach to volumizing) is the next level in volumizing this area.  This increases the invasiveness but fat injections can be a more permanent option to filling this area and rejuvenating the glabellar area.

A browlift can also help  by elevating the eyebrows and increasing the distance between the eyebrows.  Also during a browlift the muscles that make the wrinkles in this area can also be resected and taken away from the area.  This debulking of the glabellar muscles can also be done from the eyelid incisions.  Another way of decreasing the action from these muscles is to cut the nerve to them through an eyelid incision.

One issue when taking the muscles from the glabellar area is that it can increase the volume loss to this area and lead to more relative extra skin.  This can lead to more static wrinkling to this area and when the muscles come back more dynamic wrinkling that can occur.

In my opinion fat injections to the whole forehead, and in between the eyebrows is the most natural way of rejuvenating this whole region. Also the fat injections with their stem cells can lead to skin rejuvenation.  The other effect of the fat is to increase the distance of the muscles from the skin which can decrease the influence of the muscles on the skin which can allow the skin to remodel on its own and improve static wrinkles.  This occurs because the skin has little cells in the skin layers that always remodel skin on a minute by minute, daily basis.

To change the surface of the skin, a chemical peel, dermabrasion, dermasanding, and laser resurfacing can decrease the wrinkles in the glabellar area.  I always suggest volumizing before resurfacing and reshaping through reductive type of procedures like browlifts, eyelifts, and facelifts.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Botox, Dysport, Botulinum, Wrinkle Treatment | No Comments »

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