Why Does Botox Depend on Your Anatomy?

Needle Ninja time. I'm going to talk about anatomy, right? Most of my patients that come here always say, I don't know what I want, you tell me what you want to do to me. And that's because I've set up this expectation over 20 years of seeing patients. They come in and they go, what do I need? I like that, because I can analyze their face and tell them exactly what they need.

Now, some patients, like our master esthetician, know exactly what they need. She's in this industry. She knows her face, she knows what she needs, and we've already had a discussion. So this morning she comes to me and says, I want a brow lift. I'm like, all right. So we talked about her brow lift, and let's look at anatomy. Raise your eyebrows for me. So when you raise your eyebrows, her frontalis is working. That way I can relax the muscles. Frown for me. I can relax the muscles that frown, leave these ones alone, and she can get a brow lift.

Now, if she came to me and she was somewhere else three weeks ago, she had Botox through her entire forehead and the forehead was paralyzed, and she said I want a brow lift, it ain't going to happen. It's not going to happen. The muscle that's going to lift is asleep. So you have to make sure you come in here with ideal anatomy. In this situation, anatomy means the frontalis muscle has to be working. The other part is you have to have enough strength to get the brow lift. Some people, as they lift their brows, the middle part of the brow goes up. Some people, the outer part of the brow goes up. So whether you get a Spock eye or you don't get a Spock eye, it all comes down to anatomy. So what we're going to do for her today is give her a little bit of a lift, but not go for a Spock eye. That's number one.

Number two, she's a grinder. So the masseter muscles, we've talked about this before, they're right here. The masseter muscle helps with contouring of the jaw by flattening it and creating more of a heart-shaped, triangular face. She likes the heart-shaped, triangular face: high cheekbones, fullness up top, slim down as you go to the bottom. Now, some people like more of a square jaw face. In those, you don't want to really be melting the masseter, and if you do have to do it for functional reasons, then you want to fill it with fillers. But in this situation, we want to go for the heart-shaped face.

So we're going to do Dysport for the glabella, and if you zoom in you'll see it better. So I'm going to go for the procerus right here. We're going for the depressor supercilii. Again, these are all muscles. Then I'm going to get her corrugators, the medial corrugators. These are small little tiny drops. Now, if I stopped here, she would shoot up way too much. We don't want that. So we're going to soften that up a little bit by going slightly more lateral. That prevents a super sharp Spock eye, but she'll still get a little bit of lift this way. I'm going to relax her medial frontalis, but I'm leaving the outer frontalis alone so it can lift.

Then we're going to come underneath the lateral brow. Hold the brow up out of the orbit and put a drop there. Come on this side, do the same. Lift the eyebrow all the way out, put a drop there. Now, by the way, incidentally, you'll see all these spots and stuff. She's been lasering herself, so those are just going to flake off. Bye-bye, freckles. And if you want to say bye-bye to your freckles, come see [our aesthetician]. Now I'm going to put one little drop way up high, close to the hair. People are like, why are you treating my hair? I'm not. But by doing that, you're going to get softness to the frontalis, but the whole muscle will still elevate as a unit. And lastly, we'll go back and finish up over here. And no bruises. So that is the Dysport.

Bite, relax. Bite, relax. You can see my finger just jumping up and down right there. That's where the masseter is, the bulk of it, right there. So I'm going to do it in three or four or five divided doses. These are deep injections. The angle of the mandible, that's your anatomic landmark. Don't veer off too much from there, because then you'll get muscles that have to do with the corner of the mouth, and we don't want that to happen. So that's one side. Same thing here. Relax, relax, and you can see where the belly of the muscle is for her, right here. So we're going to go in the belly. She's been doing this for a while, so the rest of the muscle is atrophying and getting smaller, but the belly is right there. The masseter comes around and wraps around the jaw. It's a landmark in deep plane facelift.

All right. Now again, a lot of places you go, they're going to inject every single person the same way. When they do Botox, it's going to be the same pattern on every single person. But every single person has a different anatomy, every single person has a different musculature. We all have the same muscles, but the shape, the strength, the innervation, where they work is different. So you have to analyze every face and do this properly. That way you get natural results for every single person, and you don't hit some and miss some and get good results and bad results. You're going to get perfect results on everybody. Never frozen. I don't like a frozen look, but a really natural, soft look. That's the goal of Botox. Thanks.