Xeomin

Now what we are going to do is inject her frown lines here, and what we are going to do is use a little bit of a botulinum toxin just to relax this. Basically in the face there is one muscle here that pulls everything up, and everything else pulls it down. So by relaxing this set of muscles here and here – we will be able to relax the muscles that pull down as she should get a little bit of an eyebrow lift and that will look really nice. Sometimes we go ahead and combine that with a little bit of injection out here, and again that allows us to relax the muscle that pulls it down here giving you a lift, so botulinum toxins are all opposite when you relax the muscle that goes down you get an elevation and when you relax the muscles here that hold the eyebrow and eye lid up you get a droop. So a lot of times I will see people that come from other places, and what they have done is had injections through here to try and get rid of these lines, and unfortunately what that will do is drop you so what we will do is go ahead and start. Go ahead and frown, give it a little pinch. What we like to use here are these very, very small microscopic needles to place the protein perfectly where it belongs. Pinch – it also decrease the discomfort and we have a few other things that we do here that make it much more comfortable for the patient. In general, no matter which product we are using we try and do about 5 or 6 injection sites and that gives us a very nice pattern. How are you doing? Good! So you can see it is a fairly simply injection and what we are doing is using these imported needles from Japan and they are so small you can barely see them. We go through a lot of these, the other thing is that sometimes we will use our insulin syringes again because they are very small very comfortable. Minimal, minimal bruising. You will see a little bit of fluid there and you will see just 5 little fluid bumps and what that is, is this saline or salt water that we use to reconstitute or mix up the toxins, and most of the ones that are available today are similar in that respect. Some of the newer ones will come pre- mixed. Raise your eye brows for me? So again this is one muscle here called the frontalis that is pulling everything up. In her it is giving these lines, but they are not that deep and we don’t really want to every go below the bottom third. If we go below here and she will get an eyelid heaviness. So go ahead reach up, lift up for me, little pinch sorry – and so in contrast with some of the other injections we do. What I am doing here is spreading the protein out evenly with tiny, tiny, tiny injections. So we are not going to get every single line but we are going to clean up the neighborhood, and make her look a little bit more relaxed and less stressed. How are we doing? Good. So I am taking my time here and going along and trying to make sure that the body of the muscles relaxed and that she still has something that works to hold her eyebrow up. Trying to make it as symmetric as possible, and again that is a pretty easy injection. Are you okay? Mhmm. So that is how we treat the frontalis or forehead muscles and that is how we do the frown lines or glabella but very, very easy to do the only thing is you have to know where you are going and use the right amount of product. There are many different products available today from Botox to Dysport to Jeuveau to Xeomin and they are pretty interchangeable to some degree. You just have to understand the difference between them and correct for some dosage. There are some subtle differences that we will also talk about in the next part. So you should be perfect for that!

Okay, so let’s see. So what we will do now is we will talk about the different types of Botulinum toxins, of course there is one called Botox that has been around for more than 20 years and been approved for cosmetic use, and it has been one of the ones that everybody starts with and now there is all kinds of other products available and it is really a lot like Coke and Pepsi so there is all kinds of things that we can do with each of the different ones and sometimes we add them together to get different effects sometimes we us different products in different regions in the same person, but there is a lot going on and as you can see behind me, I have written a book about the use of Botulinum toxins and that book has been used for several years and has now been translated into a few different languages so the first one that we saw approval for in the US is called Botox and it is a type A Botulinum Toxin, it has been around for a while we use it to treat all kinds of things, I like to use it for what is called the masseter muscles or the chew muscles in here, in people that have grinding teeth or have a little bit of thickness in the lower half of their face, we use it here in the front lines or glabella, here and here. I like to put a little bit in the chin and in some people that have deep wrinkles around their mouth, we will put a little bit of Botulinum toxin in there too. The next product that was approved is called Dysport and that is also a really outstanding product, it is a type A toxin that we use. A lot of people think that it is a little bit more of a diffused or gentle spread so we use it in muscles that are a little bit larger and more diffused, and again it is really Coke and Pepsi. Some people just absolutely love one product and don’t want to go back, some people rotate, some people just want to try the next thing, but we have everything in this office, the next product that was available is called Xeomin. Xeomin is an interesting product. It is also a type A toxin but unlike the other toxins that are available, it has no carrier protein so it is referred to as a clean product. We use that in a variety of patients and again it is a Type A toxin that works pretty well and again feel free to ask questions we are here to answer whatever you guys have and talk about all the different toxins in addition we are right now running our beauty week and this is the last day of beauty week, and to participate in beauty week all you have to do is, call the office at 561 655 9055 and speak to one of the receptionists and they will walk you through what beauty week has, offering some promotions on different injections and lasers and skin care products so that everyone who is in quarantine can feel and look better! Let’s see the last product that we will talk about is Jeuveau and Jeuveau is the most recently released product it is really a wonderful product like the others, and it is used in frown lines we think that in the near future they will get approval for some other areas and then will be using it all over the face again your doctor or injector has discretion. Once the product gets approved we can use it in any part of the body that we and the patient think is appropriate so a lot of times when we see patients with different needs we use the same product even though sometimes it may not be approved for that area, that is considered an off label use. I see a lot of my patients and friends are watching, Kristen thanks for tuning in, if anybody has any question please let us know – be happy to help you answer them! So lots of the questions that we see are about how long proteins last and again it depends on the person. If somebody is a marathon runner they are going to metabolize the protein and build muscle – so they probably won’t get more than 3 months and if they are doing triathlons they probably won’t even get that. If it is a male that is very muscular we tend to dose them a little bit higher but in general if people are getting injected on a sort of routine basis and getting the correct amount of protein we think that they tend to last about 3 and a half months. I have patients that have been doing it for 20 years and they you know, there are few of them that can come twice a year and be perfect! So the more frequently you will do it the better you will do, and a lot of times what we see is people that stick with a regiment and come in, start to get duration that is really much longer. The other thing we see sometimes is after a while patients will sort of form a bond with one product or another, and I will find that one product lasts for 4 months and another for 3. Very, very patient specific.

So we see a lot of that. The next question new get a lot of is, injections are 200 dollars in this place, and 400 dollars in your place – what is the difference? And the difference typically is 2 fold. Number 1- the integrity of the product, and also the experience of the injector, so some places dilute out their products to try and get them to last longer and we don’t, we try to make sure that the products are used as directed. Let’s see there is a question – do you have to be in a certain age group to get these injections? The answer is no you can be in any age group and get injections with Botulinum toxins. In general they don’t really need to be done before 25 years old, and I do a have a few patients that require them earlier. Thanks. So we see that pretty much anytime is a good time to start if you are genetically programmed to have wrinkles then you might as well start treating them before they are etched in. Once they are etched in we use a little bit of filler to try and get them unetched and more flat, and then we will use the botulinum toxin type A to keep them from etching in further. Let’s see next question can you exercise afterwards? We like to have people not exercise for the rest of the afternoon. Certainly the next day is fine. Let’s see – the last question is what are other places we inject? I like to inject in a variety of places. A lot of times we do the chin and the neck, and sometimes we will do the under arms to treat sweat and we have people who do that frequently and what it does is it allows them to not have as much sweat and look great in their dresses. So I think that was a really nice session and I want to thank you guys for watching! Again any questions feel free to call us. Thank you.