Cosmetic Injections

What is Botox?

Lori Haney, RN, MEPC, LSO No Comments

Botox and Dysport (neurotoxins) are the number one cosmetic procedure in the United States today with millions of injections performed yearly. Despite this, many patients like you remain confused or misinformed about what it is and what it does. We’ve put together this at-a-glance page to help you better understand this popular and effective treatment.

Botox (Dysport) is:

  • A drug that has been used safely for several decades. It was first used to treat painful muscle spasms of the neck and back. From there, it became an effective way to treat twitching of the muscle around the eye. Botox was first approved for use in muscle spasms in 1985 and has been used for cosmetic purposes since the mid 1990’s (Dysport was approved in Europe in 1988) .
  • los angeles botox is botox safe after pictureslos angeles botox is botox safe before picturesA highly-purified protein that is reconstituted (or mixed) in saline prior to use for injection. When purchased directly from the manufacturer, Allergan, (the only legal way to do it in the U.S.) an injector can meticulously control the amount of Botox that is given to each patient.
  • An FDA-approved drug that has a better safety record than over-the-counter aspirin.
  • A treatment that can smooth and erase existing lines and wrinkles as well as work preventatively to stop their formation.

Botox is not:

  • A paralytic. Instead, it relaxes the muscle by blocking the neurochemical activity that triggers muscle contraction.
  • An injection procedure that any type of practitioner or facility can or should do. To ensure that you receive the best results that help you look more naturally relaxed, awake and youthful, see an injector who has plenty of knowledge and experience in aesthetic medicine and regularly participates in ongoing training on the latest and safest uses for Botox Cosmetic.
  • A treatment that causes you to look frozen or fake. As you can see from the photos on this page, a patient injected with Botox was able to smooth away a deep line across the forehead effectively while maintaining a natural and pleasing look to the area.

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What Is The Difference Between Botox and Restylane?

Lori Haney, RN, MEPC, LSO No Comments

What’s the difference between Botox and fillers?

Patients ask us often about the difference between Botox Cosmetic and dermal fillers. Consumers hear these names all the time but aren’t sure how the types of products are used or related. Botox Cosmetic and Restylane are brand names of injection products. Botox is in a class of products called neurotoxins and Restylane belongs to another class called dermal fillers. Neurotoxins work to smooth wrinkles by relaxing the muscles that cause them. Dermal fillers help smooth lines and folds by adding volume.

Dermal Fillers

Besides Restylane, there are many other dermal fillers such as Juvederm, Restylane Lyft (Perlane), Voluma, Belotero, Sculptra and more. Although all of these products can provide volume to replace collagen and fatty tissue, they are made of different materials. Hyaluronic acid, which occurs naturally in the body, is the main ingredient in most fillers, while calcium microspheres are the primary ingredient in Radiesse. Dermal fillers made of hyaluronic acid work by attracting water to the injected area. Hyaluronic acid has the ability to absorb 1,000 times it’s weight in water. This water attracting action plumps the skin adding volume where fat and collagen have been lost to the aging process. Dermal fillers add volume and definition to the mouth, cheeks, tear trough area (under the eyes), the laugh lines around the mouth (nasolabial folds), and even to the area around the chin and corners of the mouth.

Botox, Dysport & Xeomin

Botox Cosmetic is a product designed to temporarily relax specific muscles of the face to prevent and resolve lines and wrinkles. Dysport and Xeomin are similar to Botox in that they are also made of Botulinum Toxin Type A. Both are competitors to Botox. All of these products work well to relax the muscle that causes frown lines between the eyebrows (glabella area), the crow’s feet lines at the sides of the eyes and the horizontal wrinkles present above the eyebrows.

Combining Botox and Dermal Fillers

By combining both types of products (Botox or Dysport and Restylane, Juvederm, Perlane, etc.) patients are able to achieve a very natural, appealing outcome. Although Botox, Dysport and Xeomin help to resolve and prevent fine lines and wrinkles, they do not add volume like dermal fillers. Thus the products are complimentary and used in different areas of the face.

Restylane injections for dark circles under the eyes.


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Lip and Mouth Enhancement with Botox, Restylane and Juvederm

Lori Haney, RN, MEPC, LSO No Comments

We spend a lot of time talking every day, but have you ever wondered what your mouth says about you? We’re not taking about actual words of course, but rather the appearance of your mouth and lips. The lower third of the face often gets overlooked in terms of age-related changes. The truth is though that it says a whole lot more than you might like about your age!

The reverse of this is also true; many woman simply plump their lips with fillers such as Restylane or Juvederm, creating an uneven, disproportional and unnatural looking mouth. The real truth is that balance and symmetry are essential when treating this area with Botox and fillers. It can be a very fine line to walk, and the insight and skill necessary can take years for an injector to hone in on and develop. This is why who treats you can be just as important if not more than what they treat you with.

los angeles restylane for lips before photolos angeles restylane for lips after photoLet’s use the woman in the photos on this page to demonstrate some of the very common age-related changes that can occur around the mouth and the effective, yet subtle impact that cosmetic injections can have in this area of the face.

Notice in her pretreatment picture that the area between her nose and upper lip appears flat and elongated. This happens because the muscle that encircles the mouth (like a purse-string) repeatedly contracts, pulling the upper lip down and curling it inward, toward the teeth. You don’t see them as much on this patient, but tiny, vertical lines (smoker’s lines) that appear above the upper lip also form in response to this muscle’s repeated contractions as we age. Notice how her mouth is almost turned down at the corners and how her upper lip appears much thinner, smaller and out of proportion with her lower lip.

Now, take a look at her photo after injections of Botox and dermal fillers. Wow! Big difference, huh? A very small amount of Botox was injected into the muscle around the mouth, softening its downward and inward pull on her upper lip. Hyaluronic acid based dermal fillers such as Restylane and Juvederm were also used to reshape her mouth by careful injections into the border of the lips (vermillion border). Combined with the Botox, this has the effect of rolling the upper lip out and upward (lip eversion), effectively shortening the distance between the nose and upper lip.

She also had a bit of filler placed in the red part (mucosa) of the lip, restoring the balance between her upper and lower lip as well as the proper proportion. Last but not least, a small amount of filler was added under the corners of her mouth. By replacing this small amount of natural volume that she’d lost with age, the corners turned up slightly. The overall appearance of her lips and mouth area is much more pleasing to the eye and looks totally natural, youthful and beautiful!


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What Is The Difference Between Botox and Dysport?

Lori Haney, RN, MEPC, LSO No Comments

Botox Cosmetic and Dysport are both classified as botulinum type A products that are used for not only cosmetic purposes but medicinal as well. Botox is manufactured by Allergan, and Dysport is produced by Medicis. Both are well-known companies with an excellent reputation for products. Both products have FDA approval for the treatment of glabella (frown) lines for cosmetic indications.

For treatment purposes, the products are quite similar with the only difference being dosing requirements as well as the manufacturing process. Onset, effects, and duration for both are quite similar.

los angeles dysport before and after pictures los angeles dysport before and after pictures

Regardless of which product the patient and practitioner decide upon, healthy competition in this arena is a win-win situation for consumers. This is clearly demonstrated by first-time consumer rebates being offered by Allergan with promotional incentives as well by both companies.

Be sure to discuss your treatment goals and the available options with your practitioner.


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Sculptra for the Buttocks? What you don’t know matters.

Lori Haney, RN, MEPC, LSO No Comments

The latest and a concerning trend in the use of Sculptra is the Sculptra butt lift. For those of you that don’t know what this is let’s start with Sculptra. It’s an injectable filler product that stimulates the body to make its own collagen. It is an excellent product for volume loss in the face and FDA approved for this treatment.

While Sculptra is most commonly used in the face, often medical practices use products “off label”, which means in a way that is not FDA approved. The Sculptra Butt Lift is an example of off label usage. The question about off label usage of this kind is when it becomes too far afield from what most practitioners are willing to offer? At Celibre, we pride ourselves in taking a practical approach to cosmetic medicine and in the case of the Sculptra Butt Lift, we don’t think the procedure is a good option for consumers.

The average consumer would need a minimum of 10 vials per buttock to make even any appreciable difference in the curvature. On average, Sculptra is sold for $700 vial, making this procedure a $14,000 investment. At that cost, a surgical procedure, the Brazilian butt lift, makes much more sense. It will be the same or could be even cheaper in price and the results will be better and more consistent.  Finally, the duration of Sculptra tops out at approximately 2 years, whereas surgery results will last many years beyond this.

So, we must ask…why would the Sculptra butt lift be a good option for consumers? In our minds, it’s not. And that’s why we don’t offer it.


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Cheap Botox – Is It Worth It?

Lori Haney, RN, MEPC, LSO No Comments

Botox $8.00 per unit? Dysport $3.00 per unit? Restylane for $350.00 per syringe?

We all recognize that price is important. However, most will agree that cheaper doesn’t necessarily equate to better. In fact, we would even argue that cheaper, in most cases, doesn’t even equal adequate.

We often hear stories of Groupon deals wherein the Botox “did not last.” In one serious case, a patient was injected with a dermal filler obtained overseas that resulted in a serious tissue infection.

No business or practice will operate in a manner to lose money. To support pricing that is significantly below the standard in our profession, many corners may be cut. Short- cuts and compromising standards in a medical profession does not bode well for patients and also calls into question the ethics of the medical professional.

What consumers may not realize is that it is illegal for a medical practice to purchase, obtain, use, or distribute Botox, Dysport, or any injectable dermal filler from anyone other than the manufacturer in the United States. Because of this widespread problem, regulations and enforcement are finally equipped to catch up with those placing patients at risk and degrading the aesthetic medical profession. See the below link for a widespread operation that targeted numerous local and non-local medical professionals illegally purchasing their products.

You may be wondering right about now if it’s worth risks vs. the potential benefit of saving money. If the only negative outcome is a short or substandard duration with your Botox, then you are still not saving money. However, please consider that illegally obtained products cannot offer a guarantee of sterility, proper handling, or that you are even receiving a safe product. If something goes wrong, the insurance carrier for the injector will not cover the adverse event. Finally, if we cannot trust our physician and nurse to obey the law in one area, it calls into question everything as it pertains to ethics and integrity.

We recognize that we are not the cheapest, nor do we strive to be. Our goal is to offer competitive pricing with a safe, appreciable outcome, and most of all…remain a trusted name in aesthetic medicine.

 

https://www.fda.gov/Drugs/DrugSafety/ucm349503.htm

https://www.fda.gov/ICECI/CriminalInvestigations/ucm545872.htm


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Techniques For Treating Vertical Mouth Lines

Lori Haney, RN, MEPC, LSO No Comments

In previous blog articles, we’ve addressed how small amounts of Botox Cosmetic can dramatically improve if not completely resolve the fine lines that develop above the upper lip area – the smoker’s lines.

In addition to Botox injections, use of cosmetic dermal fillers such as Juvederm or Restylane can augment the outer border of the upper lip to minimize the appearance of the lines by adding volume and stretching the skin that has the wrinkles. For deeper wrinkles, injecting a small amount of dermal filler (Restylane or Juvederm) into the actual wrinkles will help fill these areas.

los angeles botox for smoker's lineslos angeles botox for smoker's linesAnother newer technique is to place the Restylane or Juvederm dermal filler product in a horizontal fashion and stretch the skin at the same time.

This does not require much product, produces moderate to dramatic results immediately, and is ideal for those wrinkles that extend farther above the lip.

In many situations, it is a combination of Botox injections with Restylane or Juvederm that create the best solution for resolving smoker’s lines. In some cases it is only by using both Botox and the dermal fillers that we can meet the patient’s goals by re-shaping the mouth through relaxation of the muscles above the lips as well as adding volume and support to the upper lip.

At Celibre Medical, we practice injection techniques that result in a natural and appealing look. Make certain that your practitioner understands and practices the newer Botox and dermal filler techniques and concepts presented here to get the best resolution of your smoker’s lines.


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When Botox and Restylane Goes Wrong…

Lori Haney, RN, MEPC, LSO No Comments

We all know and love the famous actress pictured below. Although many stars deny using any type of cosmetic injection treatments to keep them looking young and beautiful, at the end of the day, it is their job to look good. It’s a good bet that almost all of them do! So, back to our friend below. Yes, she is beautiful, but when you look at this picture, you probably think something is a bit off…and you’re right! Let us tell you more about what’s gone wrong with this actress’s look.

Botox: Yep, she’s done more than just “try” Botox. She’s a regular. How do we know? Because she’s developed a tell-tale sign of long-term Botox use known as “bunny lines”. Do you see those little lines on the side of her nose? Notice that the rest of her forehead, between her eyes and even her crow’s feet area looks almost perfectly smooth when she smiles. So, what’s happening exactly?

Remember first how Botox works: it blocks the muscle receptor that is stimulated by the nerve that tells it to contract. Treated muscles stay in a constant state of relaxation, which makes the skin look perfectly smooth instead of wrinkling with contraction (facial expression). Your brain is still telling your muscles to move and they can’t. If certain muscles can’t or won’t move to create facial expressions, others start to take over to get the job done! Bunny lines result from over-activity of the nasalis muscle on both sides of the nose. They usually only appear with a smile, so you won’t see them at rest. They happen when too much Botox has been used or when other facial muscles normally used in facial expression are constantly relaxed.

Filler: It’s no secret that we all lose facial volume as we age. One of the places where these changes can make us look dramatically older is around the mouth. There are many areas that can be injected with dermal fillers here. They include the “white” lip (area between the lip and nose), the vermillion border (the edge of the lip itself) and the lips (or “red” lip). Think of each of these as specific, different pieces of a puzzle that all need to be balanced with each other for it to look complete or right. If one area is out of proportion, the whole thing looks off. That is what’s happened here.

At rest, her lips may look great, but when she smiles, you can see that only the body of the red lip has been treated with filler. Her vermillion border is totally flat. Smiling causes the lip to “stretch” and essentially makes the upper lip look like it’s swollen and “rolled” upward over the teeth. This is not a very natural look.

This picture demonstrates the fact that cosmetic injections can be tricky. There is no one, cookie-cutter approach to any of them, Botox or filler. Your injector needs a trained, skilled and artistic eye that not only sees your natural shape and areas that need improvement, but one that can also judge and mitigate unintended consequences of treatment like the ones discussed here. Your evaluation should include an appraisal of your appearance both at rest and with expression and movement. This is the best way to judge appropriate treatments for you and tweak things that may not look quite right. This takes time, attention to detail and a personalized approach to cosmetic injections. Here at Celibre Medical, we pride ourselves on these things and believe our approach is what gives us an edge over the competition.


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The Aging Face Temporal Hollows

Lori Haney, RN, MEPC, LSO No Comments

los angeles perlane injections for temples before and after pictureslos angeles perlane injections for temples before and after picturesAs we’ve discussed in many previous articles, the aging face begins to lose volume beginning in the upper third of the face. As muscles and facial tissue descend as we age, the upper part of the face begins to appear more hollow and angular. This hollowness is often seen in the temple areas and the condition is often referred to as temporal hollows. The loss of volume in the temple area then affects the frame of the face – the eyes. By using dermal fillers such as Juvederm or Restylane, we are able to restore volume to the temple area. Filling the temporal hollows allows for a more balanced facial appearance and brings interest back to the frame of the face, the eyes.


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Some Little-Known Uses of Botox

Lori Haney, RN, MEPC, LSO No Comments

When you think about Botox, chances are you think about getting rid of the dreaded “11” frown lines between your brows or smoothing out your forehead wrinkles. While it’s true that Botox is the best fix for these concerns, it also has many other lesser known uses. We’ll discuss three other common facial concerns that Botox can address in a snap!

The Lateral Brow Lift

Your lateral brow is the outer edge of your eyebrow. As we get older, repeated squinting, squeezing and blinking of the purse-string-like muscle encircling the eye can pull the outer eyebrow down and guess what? That makes you look older and your upper eyelid look heavy. Botox can be injected into part of the muscle that lies just beneath this part of your eyebrow to relax it. This allows the muscles that lift the brow to take over, resulting in a more youthful, awake and refreshed appearance for your eyes.

botox brow lift los angeles before botox brow lift los angeles after

Upper Lip Wrinkles

These wrinkles are often referred to as “smoker’s lines”, but smoking isn’t the only thing that causes them. If you’ve spent time in the sun or are losing facial volume you may be developing these pesky little lines. Many of us just develop them naturally as we get older due to everyday movements we use in speaking and facial expression. They can cause that annoying little problem where your lipstick bleeds beyond the lip.  Luckily, Botox can help! The muscle around your mouth is a lot like the one around your eyes. It’s a strong, circular muscle that when contracted, causes your lips to pucker and makes those lines worse.

By injecting a few units of Botox into the muscle of the upper lip, we can soften these lines and dramatically reduce them. The trick here is finding the right dose: too little and you won’t see a change and too much and you may not be able to pucker or pronounce words that require you to contract your upper lip. However, getting it right can really soften those lines and even help your upper lip look smoother and help that lipstick glide on.

smokers lines botox restylane before smokers lines botox restylane after

Pebble Chin

We usually think of dimples as being “cute”. But when they’re on your chin, they’re anything but! Some people just develop an over-active chin muscle (or mentalis muscle) that causes a condition known as pebble chin. By relaxing this chin muscle with Botox, we can restore softness and smoothness to your chin. It usually only takes a few units to see improvement, but the results are impressive!

botox for pebble chin before botox for pebble chin after

More Botox Before and After Pictures


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