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Is there a way to make Botox last longer?

 

Injecting Botox or Dysport every three months can be a bit of an inconvenience for some of my patients. So what kind of options do we have and what impacts the length of duration of Botox and Dysport? I inject my own patients in my Fort Worth and Southlake, Texas offices and get asked a number of these questions daily.

  1. Increase the dose – There is evidence that higher dosages of Botox and Dysport can result in longer duration of action. There are trials using twice the dosage which can show duration of action closer to 4-5 months in about 60 percent of patients. This may or may not be worth the added cost.
  2. Metabolism plays a role in duration of Botox/Dysport. For patients that exercise daily and participate in high intensity exercises, neurotoxins may last a shorter period of time. Extreme examples may be 2-3 weeks, but on average in my practice these patients can have a length of duration of around 6 weeks. Decreasing frequency or intensity may not be worth the trade-off, but is considered an option.
  3. Product resistence. This is a real phenomenon that we see in our practice. Patients may become resistant to one product or the other, but the alternative therapy may last longer or be more effective. The reasoning behind this may have to do with the proteins that allow delivery of the botulinum toxin. Trying Dysport if you are showing decreased response to Botox, or vice versa is an option.
  4. Next Generation Botox? There are new products on the horizon, although a year or two out. One promising agent is Daxibotulinumtoxin which may last up to 6 months from preliminary data. Check out our Daxibotulinumtoxin page for more details/updates.
  5. Nerve Destruction. There are methods of permanently cutting or damaging the nerves that travel to the forehead or glabella (corrugators or frown lines). These methods are performed using a radiofrequency probe which can locate and weaken the nerve.

If you have any questions please let me know by emailing me at jordan@rihanimd.com 

-JR

The Botox Browlift

How do you lift the brow with Botox?

This is a common request I receive from patients and is something not all injectors know how to assess properly. I want to outline proper assessment of brow position and how to avoid the much feared brow drop.

Step 1 – Assessment

Whoever is performing your injections should be assessing your brow position with your eyes closed! This is the most important part of the initial Botox/Dysport consultation. If they are not doing this, your chances of having a dropped brow are significantly higher. People naturally lift their brows when their eyes are open. Only when we close our eyes and really relax our forehead can the true brow position be assessed.

If your brow position sits below the rim of the eye socket with your eyes closed, Botox/Dysport should be used very conservatively in the frontalis muscle to prevent brow drop.

 

Brow Position with Eyes Open

 

Eyes Closed, Forehead Relaxed

 

Actual Brow Position (Where brows will fall if frontalis movement is eliminated)

Step 2 – Anatomy

Botox works by weakening muscles. If you weaken the upper forehead (frontalis) muscles, you will not get a brow lift, your brow will drop. The injector actually must weaken the muscles that pull down the brow. These muscles are the muscles BETWEEN the eyebrows (the 11’s, corrugator and procerus muscles) and along the OUTSIDE OF THE EYES (crows feet, orbicularis oculi). This allows decreased pulling of the eyebrows downwards and allows the frontalis muscle to lift the brow.

Step 3 – The Final Result

When the frontalis muscle is able to lift the brow, there is still upper forehead movement and wrinkles present, but the brow is now in a higher position. Again, this is the common misconception and something I educate my patients about. If you eliminate all horizontal forehead wrinkles then you will be dropping your brow down to the natural position of your brow (where it is with your eyes closed and your forehead relaxed).

Step 4 – Less is sometimes more

If you can understand these concepts, then you are steps ahead of many people that receive Botox/Dysport as well as many injectors! As my patients get older, I actually use less Botox in order to preserve a higher brow position.

Step 5 – Find someone you trust

If all this sounds rather confusing, then don’t worry! Find someone experienced that you trust to perform your injections. Preferably someone with a strong background and understanding of the facial anatomy and how it functions.

Lastly, are there surgical options to correct a low brow?

For patients with a low brow, the best correction that can both raise the brow and eliminate forehead wrinkles is a Browlift. This can be done through an endoscopic approach in most cases. Endoscopic browlifts are done through small incisions in the hairline and have minimal downtime. Most swelling and bruising is gone within 1-2 weeks.

Any questions? Don’t hesitate to email me: jordan@rihanimd.com

 

Post Rhinoplasty Expectations

Answering commonly asked questions about rhinoplasty surgery. Do I use nasal packing during surgery? What is the post operative visit like and is it painful?

How to Apply Retinol and Retin A

One of the most common issues patients have after starting retinol is peeling and skin sensitivity. Most often, the issue is actually improper application of the product. Start slow, apply as tolerated at night, and start in the oily parts of your face to prevent unwanted side effects. Check out our newest video with House of Preservation which sums everything up. And don’t forget to check out their blog at houseofpreservation.com!

 

What is the recovery for a facelift?

This is one of the most common questions I get, so wanted to answer this here.

What is the recovery for a facelift?

In general I say 2-3 weeks, although this varies for everyone. This is the amount of time that I generally recommend avoiding social gatherings or special events.

I do not use any drains after the surgery, so my patients are actually able to wash their hair the next day.

Is there a lot of bruising after a facelift?

Bruising and swelling vary from person to person. Some people have very little to no bruising, believe it or not. The majority of people fall somewhere in the middle with some light red bruising around the lower cheeks and neck. If eyelid surgery is performed at the same time, there is usually bruising around the eyes as well. Covering bruises with makeup is possible when the incisions have began to heal.

Some patients take Arnica Montana or Bromelain after surgery to expedite resolution of bruises.

Is a facelift painful?

Facial surgery tends to be well tolerated and patients rate pain levels as significantly lower than body surgery. I have some patients that take only tylenol after facelifts! I prescribe pain medications to all my patients and recommend they take them for the first few days.

What are the activity restrictions after a facelift?

Driving – If a necklift is performed at the time of your facelift, I require 2 weeks of no driving. If you look at the strength of a wound that is healing, 80% of the strength returns at 8 weeks. Any limiting of stretching and pulling (especially head turning during driving) will help prevent scar widening and compromise of your best result.

Exercise – return to light workout (walking) early after surgery is encouraged. I tell patients to avoid heavy lifting or neck straining for 8 weeks. If it feels tight, listen to your body!

 

Hope that answers a few of your questions. Feel free to email me with any others. Don’t forget to check out my facelift page.

 

JR

Lunch and Learn August 1st

Join us on Tuesday August 1st for our lunch and learn featuring Galderma.

Galderma is one of the global leaders in injectable aesthetic products and their US Headquarters is actual here, locally, in Fort Worth TX (which we love!). Their product line includes Dysport, Restylane, Restylane Silk, Restylane Lyft, Restylane Refyne, Restylane Defyne, and Sculptra.

The lunch and learn will be in our Southlake Office – 521 W Southlake Blvd, Ste 175 Southlake TX 76092 – from 11am to 1pm. Lunch and light refreshments will be provided. Product demonstrations will include a cheek augmentation featuring Restylane Lyft on a real patient. Raffles and give-aways at the door and discounts on all Galderma products, including injectables if appointments are made during the event!

RSVP is required so please email us at hello@facialplasticsurgeryinstitute.com

See you soon!

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