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Q & A with Dr. Litner on Botox and Its Uses

By Jenna

I recently took a trip to Beverly Hills to visit one of our beloved and respected doctors, Dr. Jason Litner. Before I start about my Botox excursion, I want to tell you a few things. I am in my early 20’s and DO NOT NEED Botox injections and I know this. In fact, as an esthetician, I’ve spent a lot of time and energy convincing people that there are alternatives. I went to Dr. Litner on a mission to clear up my questions and misconceptions that I’ve always heard about Botox. I feel that the only way to be an expert at what you do is to consistently educate yourself on the why and the how, as well as educate others around you. In order to keep myself on the same level as a lot of my clients, I also got Botox injections to experience what it feels like. Honestly, and as a bona fide natural skin care freak, I completely fell in love with Botox.

Q. What is Botox?

It’s a neurotoxin, derived from botulism which is a bacteria. The way it works is it actually works on the nerve endings at the muscle to prevent the muscle from contracting.

Q. Is hexapeptide 8 the same thing?

It’s not really the same thing, Botox blocks the release of the neurotransmitter from the nerve ending where it meets the muscle and it breaks down that area at nerve ending. What happens over 3 months is you grow new nerve endings and attach to the muscle and allow it to work again. So it’s a permanent effect while it’s there on the receptor, but you’re constantly creating new receptors, so the effect is temporary. The topical stuff like hexapeptide 8 works a little differently, they work on the muscle itself to temporarily reduce the activity of the muscle and it’s a very short term effect. They are great but it’s essentially freezing the skin for a very short period of time so it’s great if you’re going to wedding or something if you put it on right before but it’s not something that will have a long lasting effect. It doesn’t necessarily do anything healthy to change skin aging so you’re better off with something that will actually reverse some of the signs of aging.

Q. What are its uses?

The main cosmetic use of Botox is for wrinkles. The cosmetic use was discovered actually by accident about 20 years ago while being used for its effect of paralyzing muscles. It was used for kids and people who had overactive eyelid muscles so Ophthalmologists were doing it and they found that some of the patients came back and said my lines are gone! So it got the FDA approval not too long after that. The thing about cosmetic stuff like Botox, fillers etc, they have FDA approval for certain areas. So you can use it for anything related to muscle spasms, TMJ, it’s very useful for migraines, spastic muscles of any variety. People with twitches, cerebral palsy, or someone where their muscles are very tense and can’t relax, so it can be used in very high doses, but it gets dangerous. For cosmetic use, it’s used in very small doses you’re probably safer using Botox than Aspirin or Tylenol. One bottle of Tylenol can do more damage than a vial of Botox, but there’s the fear of Botox.

Q. Where do you inject Botox?

Mainly in the face, sometimes the neck but it’s rare. I find that Botox is not cost effective for that kind of thing so for us we focus on the forehead, brow elevation, crow’s feet, a little around the nose.

Q. Is there anything to avoid before or after getting Botox?

When getting Botox injections there really isn’t a whole lot. We used to say no alcohol or working out for the evening after the procedure, but we found over time that it’s not all that important. Alcohol is something that we frown upon. Main reason is it affects your ability to make decisions. Doctors from an ethical standpoint tend to not really look well upon doing these Botox parties and mixing alcohol. At the end of the day it really doesn’t matter but for us it’s treating it with the respect it deserves. I think other people kinda swing the other way and look at it as an accessory and it’s like putting on nail polish. If it’s in the wrong hands then it can lead to side effects and other injuries. So you just have to treat it appropriately.

Q. So what about the drooping eye?

The report is about 1 in a 1000 patients that will get it. The thing is when Botox is injected close to the eye to raise the eyebrow or to affect the muscle in between the eyebrows it can happen. Botox disperses so a little bit is injected into the belly of the muscle itself and depending on the concentration and how you mix it is how it will disperse. If too much is injected or it’s injected in the wrong location it can disperse and affect the eyelid causing the droopy eyelid. I’ve never had it happen so I’ve never seen it, but it does happen. It’s about taking care of the patient and understanding the anatomy, we do brow lifts, so we are under there and know where the muscles are and where we can be and where we shouldn’t be. It’s about treating the procedure with respect and taking your time to get it done right but it can happen. If it does happen then it is treatable. When you get the droopy eyelid, the injections weren’t at that spot so normally it does go away within a few weeks and it also depends on how much was injected. There are also eye drops that can be used that will temporarily open the eyelid during that time so you aren’t walking around with it.

Q. Are there any long term side effects for people that have been getting Botox for years?

There have been a lot of studies to show that there’s really nothing to worry about when it comes to Botox side effects over a long period of time. It’s absorbed to a minimal degree in the bloodstream. We don’t use it during pregnancy or breast feeding because like every other medication we don’t test it during pregnancy. Even though the risk is minimal, we don’t recommend it. What we do have happen is patients will keep getting Botox every 3-6 months for a while then after they stop they will age regularly again.

Q. Can you build immunity to it?

There are reports that Botox can start to have less of an effect over a period of time. I haven’t seen anything to really support that so I’m not sure the validity of that but there are people that claim that Botox has less of an effect on them.

Q. Have you had any 15 year olds come to you asking for Botox?

I mean we get some young people, you do see more people late teens, early 20s but we don’t tend to get a lot. We have a particular demographic and we’re kind of known for a very natural result, so when you’re building a practice you get a lot of like minded people. There are others that do a lot of procedures on really young people and we aren’t big fans of that. When you’re in your 20s you can talk about it, but if you’re not seeing any signs of aging you’re really getting ahead of yourself. Your best bet in that age is good skin care, sun protection and don’t smoke. If you have specific areas, everyone is different, because of over-active muscles, and then it has really good results.

Source: Flickr user Thomas Weidenhaupt

Q. What is the difference between Botox and a filler?

A filler works in an entirely different way. The most common filler that we use is hyaluronic acid, Restalyne, Juvaderm. Those are one of the main building blocks in your skin. There are two main building blocks that create volume in your skin; one is hyaluronic acid and the other is collagen which you’ve probably heard of. Collagen injections have fallen out of favor because they don’t really last too long and they potentially cause allergies so you have to get tested before using it. So since Restalyne came on the scene, collagen really isn’t requested anymore. How it works is hyaluronic acid is normally produced in your skin and it binds water. It can hold 1000 times its weight in water. What that does is it voluminizes or plumps up the skin and gives it fullness. As we get older, the ability to produce hyaluronic acid in our skin goes down and you see that it loses a little bit of its volume and you see superficial wrinkling. Hyaluronic acid is replacing that and is synthetically made but it’s the exact same molecules that your skin normally makes. You’re injecting it and relying on it to bind that water and voluminize areas that need it. We use fillers most commonly in nasal labial folds in older women and the corners of the lips. In recent years it started to be used more as volume replacement. Now people are using it under the hollowing of the eyes or in their cheeks to build that up. There are potential issues with under the eyes something called the ‘tindel effect’. For people with thinner skin, the bone is relatively close to the skin. When you put filler in there, the filler is a clear gel and when light reflects it can show a blue hue or discoloration. We don’t use a lot of filler there for that reason but there are some patients that it works great for. For most people a fat transfer would be a better choice.

Q. Are there any people that are not good candidates for Botox Injections?

People who tend to have problems with their nerves or muscles that causes weakness, probably shouldn’t have Botox. People with MS or other things that have to do with the nerves probably aren’t a good fit for Botox.

Q. How do you gauge how much you are going to spend?

For the cost of Botox, the best thing to do is to ask about what’s involved and find out what you’re getting. In case you move, it’s good to know how much you’re getting because everyone has a certain amount that works well for them. There’s typical learning curve at the beginning. That’s why we start off a little lower on your first time because it’s always easy to come back and get more when you can’t go back the other way. In that case it’s a waiting game. A lot of doctors don’t price it in a way where it’s transparent; a lot of them will do it by area so you’ll pay however much per area. That’s great, but how much Botox are you using?  You might be 20 units there, 35 units here but most of the time you have no idea and don’t know. So it’s not the most transparent way to know what you’re getting. A lot of us will price it by the unit and the unit is a standardized measure. Wherever you go, 1 unit of Botox is 1 unit of Botox. In Beverly Hills it’s a little higher about $15 a unit and other cities it may be a little less but more importantly it’s about who’s doing it. Starting dose for in between your eyebrows with us are about 15-20 units depending on how deep it is. It depends on each person, no one should ever tell you that they use the same amount on each person, it’s like surgery not one should be the same it should be catered to the treatment.

Q. What’s the max amount?

In between the eyebrows the maximum that we do is about 12 to 30 units, some dermatologists do even more. We don’t favor the wax figure look like the Nicole Kidman. That’s not what we are gunning for. The idea is to enhance you, make you look like you but just look better, younger, fresher, more vibrant. We don’t want you walking down the street getting asked who did your Botox. There are those especially in LA, that want that frozen look though but we aren’t huge fans of that.

Q. Is Botox responsible the culprit in making you look plastic?

There is a way you can look scary with Botox, it’s a tool and like surgery, you can use it as a feather or as a hammer. If you’re using it thoughtfully and judiciously, it’s really a wonder drug it really has done amazing things for anti-aging. On the other hand if you’re over the top with it, it can look overdone and too much can give you a really frozen, unnatural, surprised look just when used by itself.  A lot of times when you see that, it’s usually a combination of other things. There are people with expectations and desires that should be turned away.

Q. What is your philosophy?

It’s simply about treating people well and taking care of them. At the end of the day nobody wants surgery, but they want their external appearance to feel a little more in balance with the way they feel about life and that’s what we’re trying to accomplish. We want people to feel like themselves only better. Whatever they are perceiving when the look in a picture or the mirror and they aren’t liking what is happening over time, you want to be able to tackle that goal and create that sense of balance. It should look and feel right for them. We don’t look at people and say you have to look a certain way, we aren’t trying to pigeonhole anyone but it’s all about enhancing that person.

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One Comment

  1. Roy Kim
    Posted April 18, 2011 at 9:12 am | Permalink

    Wow! This is a great article about the Q&A’s of Botox. This would be very helpful for patients considering getting Botox treatments. I have similar articles on my blog http://www.drkim.com/blog

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