In my years as a plastic surgeon in Manhattan, I have had the privilege of educating both patients and surgeons on many aspects of plastic surgery. Below, I share some of the most frequently asked questions and their answers.
Q: What is the most popular non-surgical procedure for the face?
A: Botox injections are the most popular non-surgical procedure for the face. It is primarily used to reduce frowning and crows feet. When properly administered it does an excellent job in both of those areas.
Q: How do the eyebrows become too low in patients who have had Botox?
A: There is only one muscle that raises the eyebrows. It’s called the frontalis muscle. It is the muscle that causes the creases across the forehead. If that muscle is completely paralyzed with Botox injections the eyebrows don’t have a muscle to hold them up and therefore they become too low. In my opinion, eyebrows that are too low are just as much, if not more, of a distraction from a good aesthetic appearance as creases on the forehead. The creases on the forehead can be reduced with the proper amount of Botox, but the forehead should not be completely paralyzed.
Q: Is Vanquish a safe procedure, what are its costs, and does the fat return?
A: Vanquish is a device that uses radiofrequency to target fat cells. It is especially good for the abdomen and love handles. It is a non-surgical procedure that is usually conducted in four 30-45 minute sessions 1 week apart. It is possible to do 2 sessions in 1 week. Most patients report a decrease in the thickness of their fat, which tends to be noticeable by the third treatment. The final result is seen 3 to 4 weeks following the 4th treatment. The result with Vanquish is not comparable to liposuction, but it is a non-surgical option for fat reduction.
Q: Does Botox help to eliminate the deepness of 11 lines, or is filler necessary to eliminate the grooves?
A: Most people can be significantly improved with Botox injections to treat the depressed lines that occur from frequent frowning. Most people are not even aware that they are frowning and not only when they are unhappy but in routine daily activities and normal conversation. When the corrugator muscles and the procerus muscles are blocked with Botox injections the depressed lines become less deep and over time they improve even more. When the creases have become very deep then a small amount of a filler substance, most often Juvederm or Restalyne, will help bring the depression up to a level with the skin. Occasionally it’s necessary to put a small amount of filler in the creases again many months later. The most important injection is the Botox to stop the movement of the muscles.
Q: Is an internist an appropriate person to go to for Botox?
A: There are no State or Federal regulations that limit the medical procedures that an individual with a medical degree can perform. In other words, a doctor who has been trained in any specialty is permitted by law to perform Botox and filler injections. In general, one would anticipate a better result when procedures are performed by someone who has had training and extensive experience.
Q: Do injections (Botox, Juvederm) hurt?
A: Both Botox and Juvederm are injected using a small needle. They do hurt to the extent that a small needle puncture is uncomfortable. Some patients like to have a topical anesthetic put on the skin prior to the injections. This will reduce the small amount of discomfort. The vast majority of my patients are busy and want to have their injections and go. The number of sites of injection will play a role in the amount of discomfort one will have. Botox injections for the 11 lines between the eyebrows and crows feet take approximately 4 minutes. Filler injections are slightly more uncomfortable, but only approximately 25% of patients want numbing cream.
Q: The skin under the eyes is very thin, and was injected with a hyaluronic acid. (Restylane, Juvederm, Belotero) One eye was fine; the other eye had migration and lumpiness. What can prevent this? And what can fix it?
A: Hyaluronic acid is injected into a larger volume or close to the surface under the skin. It can cause puffiness and a swollen look to the lower eyelids. Most often this goes away. It’s important that the injector knows exactly where to put the fillers. When this occurs it can be eliminated by injection of hyaluronidase, which will break down the hyaluronic acid, and almost an immediate improvement is seen.