Video about Botox and the pros and cons

Hello again, my name is Joanna Graff, I’m the medical aesthetic practitioner, I run my own skin clinic and I have been practicing for the last 10 years. In the previous chapter I expanded a little bit over the aesthetic treatments and I divided them into three categories so that it’s easier for us to understand the aim of aesthetic procedures. But these, as I mentioned, these categories, the line between them is very blurred. So we can use different tools or the same tool in different categories. And today I would like to expand a little bit over the most, probably common, and probably at the same time the most controversial technique, which is injection of botulinum toxin. Botulinum toxin has been introduced to the market a good 30 years ago and is registered, at least in the UK, as a prescription-only medicine. Prescription-only medicines, you must trust them because I’m the pharmacist so I know everything about medicines and what interests me the most is what is actually in the bottle. Prescription-only medicines, they are under very strict regulation. So you can use prescription-only medicine for cosmetic purposes, but you can’t use cosmetics for medical purposes because they are under two different regulations. The regulation for medical products are very strict. It means that every single side effect or every single complication has to be reported for at least 40 years of existence of this medication on the market. Why am I expanding over it so much? Because I think it’s very important for all of us to understand that if something is called a medicine and is on the market for about 40 years, if it was dangerous, we would have known already. So I’m not trying to encourage anyone to have those treatments and I’m not trying to say that it’s absolutely safe for you to have it done because you are responsible for yourself. I’m just trying to deliver objective information regarding the product itself and reported side effects. So it is medicine, it’s not a cosmetic product and that’s very important for us to understand how in terms of safety, the use of botulinum toxin is safe from a medical point of view. So far I used and I did it intentionally, I used the word botulinum toxin. So as a pharmacist I only focus mainly on the active ingredients, as I mentioned before, what is in the bottle. And I can, I’ll give you the example, I can make cheesecake, someone else, your auntie can make cheesecake and I can, a neighbour can make a cheesecake. And I can call my cheesecake Betty, you can call your cheesecake Anna and someone else can call their cheesecake Julia, but they will be all cheesecakes. So all of the brands of the botulinum toxin are still botulinum toxin and that’s very important to understand. But the most commonly botulinum toxin is known by the name Botox. That was the first brand and I’m going to distinguish in these videos, brand and active ingredient. So Botox is the brand name for the first discovered and purified and registered for medical use botulinum toxin. And then during the medical use, some patients or some practitioners discover that they actually, it has a side effect and there’s a side effect that this side effect is disappearing of wrinkles on the forehead. So they started investigating and after a few years, they registered also Botulinum toxin for cosmetic use for relaxation of four headlines. And then after a while, they registered Botulinum toxin for relaxation of wrinkles around eyes, dynamic wrinkles around eyes. And this is where the journey began. Because it became so popular, other companies, other cheesecakes, bakeries decided to make their own cheesecake because it was so profitable. And so, and that’s how we developed different brands of same Botulinum toxin. Also, there’s another, I’m not going to use those names because it doesn’t really matter and I don’t want to promote any products because always every single product should be, and that’s very important thing, should be selected for the patient. So different products may vary and some of those products may have more binding proteins. So maybe better for people that build up resistance against Botulinum toxin. So it’s sometimes it’s good to choose a brand. Everyone has their favourite brand. Every practitioner has their favourite brand and that’s absolutely fine. So we’re not going to say which one is better, which one is worse. We stick to the one that we are the most convinced. We have the highest percentage of successful cosmetic treatments. And now very important thing, not many people say about it. If you find it boring, please scroll. But I think it’s very important to describe how it actually works. Because there are again so many horror stories out there like that big lips or don’t have Botox in your lips or you’re going to have a swollen face if you use Botox. So let’s see how it all works and how Botox works and how this miracle of magic of wrinkles removal happen. The main muscle. So let’s focus. As I said before, the first use of Botulinum toxin for cosmetic purpose was for the forehead lines. We have two types of forehead lines. Vertical between eyebrows and horizontal on the forehead. And Botulinum toxin works or acts by relaxation of the muscle. But how this relaxation really takes place. We have our central nervous system and we’ve got our nerves, two types of nerves. And it’s a simplification, but we’ve got two types of nerves. One is responsible for action. The other one is responsible for feeling for sensation. So our brain sends signal. So those nerves are like a cable and there are connections between nerves and muscles, which I would describe as a socket and a plug. And normally, the plug is inserted in a socket. And if there’s electricity signal going on, it delivers signal from the brain through the cable, which is a nerve, to the muscle and then muscle responds by contraction. So let’s say I want to maybe maybe not this one, but I want to bend my arm. This is my conscious action. So I focus. I want to send that information to my muscle and the muscle responds. But do you can you frown consciously? You can. But can you do it subconsciously? Yes, sure. And then after a while, you may develop these lines and they might but not have to, start bothering you. What will happen next if we use botulinum toxin, it literally breaks connection within a socket. So it breaks the socket. So you have it still the plug plugged in, but the signal cannot go from nerve through the cable to the muscle. So you may want to bend your arm, but you won’t be able to. You can try really hard, but the impulse from the brain will be broken. And this is how we relax those muscles. So it’s a funny sensation when you have your botulinum toxin done between your eyebrows for the first time, because you’ll be really trying hard to frown and just won’t be able to. It’s so funny sensation that I call it metal plate syndrome. So it’s almost like a sensation of having metal plate inserted between your eyebrows or on the forehead. And you’re trying really hard to force the body can’t. What happens? So the after about two weeks, muscles don’t respond at all to your. impulses from the brain and it relaxes everywhere. So if you don’t imagine a piece of paper and it that you bend it and bend it and fold it and then after a while, just for two weeks, you don’t fold it at all. The line disappears and the same happens to our lines on the forehead. So let’s start to describe the treatments. Botulinum toxin on the forehead. If you experience those lines, horizontal lines on the forehead, and you feel like you’re really not happy to have them and you are over 18, you can consider the use of botulinum toxin to remove them. And technique, there are several techniques. Anyway, every single product has description on how to use it for medical purposes. And if you look at the Botox SPC or other otulinum toxin SPC, you will see the pictures of drawings on how to inject those and how many active units should be injected in every area. But forehead is not that easy and straightforward. Because every single person is different and also the relaxation of this muscle can result in very common and unwanted side effect, which is hooded eyes or eyebrow ptosis. So normally we used about 20 to 40 units So normally we used about 20 to 40 units of botulinum toxin in different dimension all over the frontalis muscle. Frontalis muscle is the muscle that covers our head and finishes on our eyebrows orbital rims, on the upper edges orbital rims. And this is the muscle responsible for lifting your eyebrows. When you lift your eyebrows, you develop lines. So if you relax the muscle responsible for lifting your eyebrows, you won’t be able to lift your eyebrows. But you will get rid of wrinkles. And the whole art of aesthetics is actually to find the right balance, right distance between injection points and right and the proper… pattern of injection points. What would you expect? Next day, when you get during the treatment, you may experience a little bit of stinging, but it’s not really very bad. Next day, probably you won’t notice anything and that’s good and bad because it’s good because you don’t have any visible marks. So you can go directly to work, but at the same time, you wake up and you think like, “Oh my God, what have I spent my money for?” Because next day, you won’t see even a mark. You won’t see anything. But really, botulinum toxin takes time to completely relax the muscle responsible for lifting your eyebrows. So usually, after about a week, you see first signs of its activity. Also, what is very important, and again, I always tell my clients, I do not accept any complaints for two weeks Nothing. And usually, still, if someone complains, not complains, but is a bit concerned and messages me, like, “Oh my God, Joanna, can you reverse it?” After two weeks, when they have their follow-up appointment scheduled, everything is perfect, everything is fine. So it is very important to be very patient and just trust the process for the first two weeks. What we want to achieve, what is my goal? I want to have nice and smooth forehead with a little bit of ability to raise your eyebrows and with a little bit of expression, but still nice and smooth. That is my aim. Also, we have another group of muscles on the forehead. I forgot to mention one more thing. The common side effect, and again, it is very important to distinguish between complication and the side effect. The side effect will wear off very quickly. Usually, when you haven’t had your Botox to have done for the, never ever in your life, or you haven’t done for the first time, you may experience, and it’s very often subjective. So it’s only something that you can feel. If you look at yourself or someone else looks at you, you can’t really tell the difference. It might be the feeling of heaviness. And that feeling of heaviness is because you can’t actively, or you don’t, subconsciously actively raise your eyebrows. So obviously, you experience heaviness. Please, because many people and many of my patients, Google and find those drooping eyelids. Drooping eyelid is a complication. And this is the only known complication, which also, again, you have to go over. Botulinum toxin, I’ll explain it in a minute, wears off after about three months, and this complication will resolve spontaneously in about three months. Nothing, we can’t reverse Botox or botulinum toxin, unfortunately, but what is the difference between hooded eyebrows or heaviness or drooping eyelid? Drooping eyelid is when the botulinum toxin spread a little bit too low and gets to the muscle responsible for lifting, active lifting your upper eyelid. It means that in general, you can’t open your eye, and it’s usually one side only. So you have closed eyes or closed, you can’t lift the eyelid higher than half of the size of the height of the eyeball. As I said, we can’t reverse it, but please don’t confuse hooded eyebrows or heavy eyebrows with droopy eyelid, because there are two different problems. Hooded eyebrows or droopy eyebrows is quite common side effect, and again, it will wear off or resolve spontaneously in about two to three weeks. It’s just a subjective, temporary sensation, because you didn’t get used to inability or being unable to actively lift your eyebrows, and that’s the main difference. There’s also another group of muscles on the forehead, which is also very often treated separately or along with the horizontal lines, which are lines between your eyebrows. There are three muscles responsible for frowning, and frowning is related to developing these lines. There are two muscles on the sides and one muscle in the middle of the forehead. What is the main goal? The main goal is to stop you from developing those lines, but stop you from active developing of these lines. And now we have this so-called med scale. It should be in every aesthetic practice. It tells us very clearly the stages of the lines. So horizontal lines, we’ve got stage zero, non-lines, stage four, very severe lines. And by the use of botulinum toxin, we can skip the scale by two. That is very important. So I don’t wanna promise miracles, and I never promise miracles, but if your lines are at the stage two, which are moderate lines, you can expect to completely get rid of them. If your lines are very severe, you can probably expect to get to the stage, the middle stage, which are moderate lines, if it makes sense. Same with… Promo lines. If you are at stage two or three, you can skip by two. So you can expect to completely get rid of them. But if your lines are very severe, you will probably be left with some lines after the treatment. What is the goal, the main goal? The main goal is to stop you from active development of lines. So we need to stop the activity. So sometimes when the muscles exercised for a good 70 years, we will have to do it in stages, because muscle, first of all, the pattern in your brain of subconscious development of these lines is very often used. But at the same time, you throw subconsciously, and that muscle, the more you exercise your muscle, it’s like your facial muscles, frown lines, they’re almost like on the gym all the time. So you just exercise, it’s an exercise. So the muscles are bigger and stronger. So to completely relax it, we will probably need two or three stages, two or three treatments. And those treatments are done in stages. So it means that we do the first initial treatment, and then after two weeks, we do review. And after two weeks, another two weeks, we do review. Usually from my experience, those three treatments are enough to stop people from any frowning. And then we can think what to do with remaining lines. But if we treat frown lines, we start from b otulinum toxin. What is also important? Your practitioner should be able to explain you these treatments are related to some costs. Your practitioners should be able to tell you the average or precise cost at the beginning of the treatment so that you know how much you’re gonna spend on it. Because I don’t find it a good practice to tell people the price of one treatment and then charge them for another treatment in two weeks time and then charge them again. This price should be assessed at the beginning. So make sure that person who does it is experienced enough to be able to assess the price fee. And what is also very important? Usually this area, again, what are the side effects? Usually there are no cosmetic side effects. So everything usually looks very well. Why? Because in general, in majority of aesthetic treatments, we want to, the bigger eyes, the more youthful face. So these muscles, it was possible for frowning. If you frown now, if you feel it, they are actually pulling the eyebrows down. So they close eyes. So if we relax it, the result should be opposite. So it should result with kind of a little bit of, eye opening result. And that’s why that’s what we want. And that’s why that’s what we want. another use, cosmetic use of botulinum toxin, traditionally is for crow’s feet, which are lines which you develop when you smile now. Have you got plenty lines? Yes. Now relax and look in the mirror and think, try to observe, do you have lines now when you relax? Exactly. Because if you don’t, you shouldn’t consider, or you should be told that it’s not time for you to have botulinum toxin around your eyes. I know it’s not really common practice, but when I was very young and I had my botulinum toxin for the first time, the doctor who did it, she encouraged me to have my crow’s feet done, even though I didn’t see any when I woke up in the morning. And she said, it’s kind of preventative. You don’t use botulinum toxin for prevention. You use botulinum toxin only for existing lines. And that is something everyone, including young people should be aware of. Many places are focused on profit, and profit is very important, but also, not also, but most of all, your health is important. So I am trying to, I always tell everyone, and I also do it myself, plan your aging. Okay, have a plan for it. You know what will happen in your 30s. You know what will happen in 40s, 50s, 60s. We already know that. So there’s absolutely no point for use of botulinum toxin as a prevention of aging. Why? Because it doesn’t come in the long term. It doesn’t come without side effects. What are the side effects though? What are the side effects on the forehead? The side effects on the forehead, again, it’s also, everything is very logical. If you think that you relax the muscle, think about your biceps. You relax it and you don’t use it. What will happen after a year? What will happen after two years? What will happen after 15 years? If you don’t use it at all, you use it every day for lifting, for anything. And now what will happen if you stop using it? It won’t become thin and thinner and thinner and thinner. And the same will happen on your face, same will happen on the frontalis muscle. And again, we mentioned before, this muscle is responsible for lifting your eyebrows and opening your eyes. So what will happen if the muscle responsible for lifting your eyebrows will become thinner and will become weaker? Opposite. So at the age of 50, 60, you’re gonna struggle with dropping eyebrows and you won’t be able to do anything about it because all of the structure that is responsible for tightening up the forehead will be destroyed. Same will happen around your eyes. If you overuse botulinum toxin around your eyes, you will end up with the temporal hollowing or hollowing in the lateral corners of your eyes or eye socket. And it will just look bad and you won’t need to fill that. So if you don’t have static lines, don’t use Botox if anyone advises you otherwise, run away. So these three uses of botulinum toxin are described in the SPC of the medical product. It means that product and now we have to think about it from the pharmaceutical point of view and also from manufacturer point of view. Botulinum toxin is licensed for these three treatments. It means that clinical trials has been done and also that manufacturers can safely confirm that these use of the product for these treatments in these three areas is safe and it’s been checked. But now you can see on Instagram, many users want a different indication for botulinum toxin for cosmetic purposes, like for nasal slimming or for jawline or for tightening up the lower face or for smoothing their neck. And these indications, they’re not all the way round. Botulinum toxin, there’s no botulinum toxin on the market that would be today, because I don’t know what’s gonna, what are you gonna watch this video? But today there’s no botulinum toxin license for the cosmetic injection for different muscles. But also you have to remember that botulinum toxin is also licensed for medical use, not for cosmetic use for different indication. So it is used for migraines and licensed for migraines, which means again that manufacturer says, yes, I checked it for migraines, for over-sweating and for masseter hyperactivity, So, and again, the cosmetic use of botulinum toxin for forehead and for crow’s feet, botulinum toxin is licensed for it. For other use, for other treatments, it is not licensed, but it doesn’t mean that it’s not safe. It doesn’t mean it’s not safe. So you can have these treatments done, but if something goes wrong, manufacturer will say, I’m sorry, I didn’t say you can use it for it. but it doesn’t mean that the practitioner cannot make their own decision, not their own decision, that they cannot make a decision of using it for those treatments, if there’s indication. – So our main goal, our main aim in aesthetic treatment is to make patients happy about their appearance. And because we know which muscles we are targeting and what side effects we can have. And we know it’s safe for different groups of muscles. We can make a professional judgment that it will be more, there will be more benefits than potential loss or potential complications. And it is recommended to use it on those groups of muscles. So when you hear about roteus on the nose or lip flip or at the moment is very popular on Instagram, lower face or neck, again, it’s not licensed, but it’s effective. And we can assume or we assume that it is safe because every single muscle will recover from botulinum toxin in about three months. And now the recovery process, I was once, I think I was asked if I can reverse botulinum toxin, I can’t. We can’t, what was broken remains broken. But our body is very smart. And very quickly we built new sockets and we built new plugs and new connections between nerves and the brain and muscle occur. And the muscle very quickly gets back its activity. Very quickly, what do I mean by very quickly? For about three months, more or less, there are no connections. The muscle is completely paralyzed or completely relaxed. After about four months, the body builds new connections, but still there’s no activity of the muscle. So there’s not enough connection to properly contract the muscle. And usually up to five, six months, it takes about five to six months for the muscle to get full activity back. And my recommendation for botulinum toxin treatment, if you struggle with severe lines, is to have it done after those three, four months pass, somewhere between three and six months. There are exemptions. I’ve got plenty of patients who have to have it more frequently for Medical or lifestyle reasons, or just because they are big or have high level of testosterone. And it’s very individual, but in general between three and six months. And again, you will ask me when, because I very often get requests, please let’s book an appointment for the future. I don’t find it very good practice because I don’t know when you wake up and you will see static lines on the rested face. And this is the moment when you can think about having another appointment. So when it completely wears off and your muscle didn’t express anything, so it wasn’t used for eight hours when you wake up, you see those lines back. Yes, we can have it redone, but not earlier than that. So even if you have your activity back, so you can still express yourself, if you don’t have static lines, don’t do it. There’s no point. But if you have any questions regarding any part of your face of the use of Botulinum Toxin, please feel free to comment, ask questions, message me. I’m very happy to answer them all.