Botox at the Naderi Center for Rhinoplasty & Cosmetic Surgery
Botox is a non-surgical injectable treatment which relieves facial wrinkles, particularly horizontal forehead wrinkles, lines located between the eyes, and the “crows’ feet” at the corners of the eyes. Botox is a neurotoxin which works by relaxing dynamic wrinkles, or those associated with repeat facial movements like frowning, smiling and squinting. Botox effectively relaxes the underlying muscles responsible for the facial expressions, thus smoothing the associated wrinkle for a rejuvenated appearance.
At The Naderi Center for Rhinoplasty & Cosmetic Surgery, Dr. Shervin Naderi, M.D., F.A.C.S., Dr. Jessica Kulak, M.D., and Dr. Erica Anderson, M.D. perform all of the Botox and Filler injections themselves personally. Each surgeon has a slightly unique technique and approach to administering Botox treatments.
Botox Consultation at the Naderi Center for Rhinoplasty & Cosmetic Surgery
The consultations at the Naderi Center for Rhinoplasty & Cosmetic Surgery are designed to create knowledgeable patients who have a complete understanding of the benefits and uses of Botox. We want our patients to be comfortable with our expertise and our choices and decisions.
We explain the benefits associated with each procedure based upon a skin analysis. A combination of treatments may be suggested. Any of our three expert surgeons will examine your skin and advise you on the best skin care regimens and procedures.
Botox Injection Procedures
Facial wrinkles are formed perpendicular to the muscle. When the muscles contract the wrinkle is formed. Botox is injected into the facial muscles, weakening them. It is not injected directly into the wrinkle.
A skilled and experienced injection is crucial. The injection must first contain the correct saline and Botox mix, the injection must be short and quick, the location of the injection is vital for good results. Botox diffuses as much as an inch from its injection site. Even the same injection method can yield slightly different results although these represent insignificant differences.
The Naderi Center’s gentle, yet fast “no downtime” injection technique minimizes swelling. Did you know that the longer the injection is prolonged, the greater the trauma resulting in additional pain and swelling? Botox works by weakening certain muscles of expression and must be injected in a correct pattern for natural expression. Botox’s bad publicity is a result of inexperienced injectors creating an unattractive look with inappropriate Botox injections.
What is Botox?
Botox is a botulinum toxin type A protein distributed by Allergan used by millions of people and by numerous different medical specialists to treat a variety of issues. Botox is used by dermatologists, plastic surgeons and facial plastic surgeons to reduce the appearance of wrinkles and to prevent wrinkle formation.
What can Botox do?
In addition to minimizing facial wrinkles and crow’s feet, Botox can be used to prevent or reduce the appearance of a “gummy smile.” It can help elevate the outer eyebrow in some women to create an arching eyebrow. Lip wrinkles in some women can be reduced or prevented. Lips may no longer “thin out” while smiling. Botox may help reduce the size of the masseter muscle on the jaw and help reduce the size of a wide jaw often seen in some Asian patients.
How long does it take Botox to work?
While you may find Botox injections produce observable results in two to three days, two weeks may be required to experience the full effects of Botox.
How often must I have Botox Injections?
Because the nerve regenerates new nerve endings every three to four months, Botox injections must be repeated on average every three to four months to maintain results. Botox leaves no significant residual effects beyond the four-month timeframe for most.
Some patients find the Botox injection effect continues for six months or more. Generally, in these cases the Botox has worn off; however, muscle memory has been interrupted, meaning the patient no longer frowns or squints as before the Botox injection.
The best timing for your injection is before your last Botox injection wears off. The goal is to keep the targeted muscles in a weakened state. Our patients are encouraged to schedule their visits before their frown muscles are able to regain bulk or strength. Weaker muscles mean fewer wrinkles. For best results, Botox should be re-injected three to four times per year; however, twice a year may have some impact, as may even once a year Botox injections.
Is Botox right for men?
Botox is effective for men by reducing forehead wrinkles, frown lines and crow’s feet. Men are excellent candidates. Botox procedures 3 to 4 times per year will help prevent wrinkles. An experienced physician’s approach is vital in retaining natural expressions and preventing an over-arched eyebrow or a fake look.
Men require more Botox because of their heavier muscles. The expert surgeons at the Naderi Center for Rhinoplasty & Cosmetic Surgery have the necessary experience and understanding of the amount of Botox required for specific male muscles. Some men choose a lower dose injection with more movement and receive injections every two months.
Is the strength of the Botox solution important?
Yes, the strength of the Botox solution is vital to a good outcome. Botox is packaged in 50- and 100-unit sterile vials in powder form. Adding saline to the vial reconstitutes or dilutes the powder.
I want to start by saying how much I appreciate you (and your staff). To a lot of people it's "just Botox and filler" not a big deal but to me finding someone who could understand and address the unique situation with my post car wreck nose reconstruction (graft) was a very big deal as that is a source of great insecurity for me and not easy to talk about, especially in a plastic surgeons office surrounded by "beautiful" people, with that being said you have always made me feel so comfortable and although you see many patients before and after me each visit you always make me feel like I am your only patient, giving me your undivided attention and honest opinion and even boosting my confidence, not once making me feel like my concerns are trivial, thank you for that!
Dr. Kulak typically choses to use 2 to 2.5 cubic centimeters of saline water to keep the Botox concentrated while creating a medium with sufficient volume to inject the entire muscle length. Facial wrinkles are formed perpendicular to the muscle. When muscles contract, wrinkles are formed. Botox is injected into the facial muscles weakening them. It is not injected directly into the wrinkle.
The Naderi Center for Rhinoplasty & Cosmetic Surgery believes four cubic centimeters in a 100-unit vial creates a wider Botox diffusion, producing unwanted effects. Too little saline in the mixture may limit the Botox’s ability to impact the entire muscle length.
Does Botox prevent wrinkles?
Botox works best when started at a younger age specifically in your late 20’s and early 30’s. Botox is an effective prevention treatment.
It is also effective for older patients once “static” wrinkles have formed.
Skin that begins forming fine lines as a result of over expression such as smiling, eyebrow expression, squinting from the sun or computer work may benefit from Botox as a wrinkle preventative as early as age 25. Some women who do not “talk with their eyes” and don’t form too many expressions may not need Botox even as they get older. Each person’s muscle movement and expressions are unique.
Think about the actor Jim Carrey and what he can do with the same muscles the rest of us have!
What are the Effects of Botox in Older Patients?
You cannot ignore your skin for 50 years and expect Botox to work magic. However, Botox may be a start on your path to a more rejuvenated appearance. Botox has a more limited benefit in older patients when used alone. Patients in their 40s, 50s, 60s, 70s, and beyond can benefit from Botox, although other procedures may be necessary for the optimum results.
In your 40’s, a good skin care regimen combined with chemical peels such as VI Peel as well as Fractionated CO2 laser provide best results. This treatment combination prevents further wrinkles, reducing those already formed. Patients in their 50’s, 60’s and 70’s or beyond often require additional surgery such as lower facelift, brow lift or eyelid lift in addition to Botox and lasers to obtain the best results.
How does Botox work?
Botox works at the nicotinic nerve ending, preventing the release of the acetylcholine neurotransmitter vesicles. This inhibits communication between the nerve and target muscle.
Botox relaxes voluntary muscle movement in certain facial areas. It reduces or eliminates “dynamic wrinkles” or those wrinkles which become more pronounced with expression and movement. Wrinkles present at rest are known as “static wrinkles.” Botox alone will not address “static wrinkles.” Additional procedures such as CO2 laser or fillers may enhance your appearance when used with Botox.
Figure 1: The nerve ending is shown above, with a small space known as the synapse or cleft. The muscle is shown below. Nerves release their transmitters into this space not directly touching the muscle.
Figure 2: Botox molecules are shown above binding to the nerve ending, preventing release of neurotransmitters into this space and not allowing nerve to muscle communication, resulting in relaxation of the muscle.
What about commercials that sell products to make wrinkles disappear?
Devices sold on TV, late at night, claiming to exercise and strengthen facial muscles actually create deeper wrinkles with those exercises!
Is Botox safe?
Botox initially gained the United States government’s FDA approval in 1989 for the treatment of eyelid spasm. It was used “off label” by many Plastic Surgeons for the reduction of wrinkles known as “frown lines” as well as “crow’s feet” and in the forehead. In 2002, Botox gained its official FDA approval for the treatment of glabellar wrinkles also known as “frown lines” or the now infamous “11 lines.”
Botox has historically been used in non-cosmetic cases in many areas including children with cerebral palsy to reduce the amount of salivation and preventing aspiration pneumonia. It is used by ENT surgeons to treat vocal cord spasms known as spasmodic dysphonia. It is used by urologists to treat hyperactive bladders and by neurologists to treat migraine headaches. It is also used by dermatologists to reduce excess sweating.
What are Botox risks?
Dr. Naderi, Dr. Kulak, and Dr. Anderson are well-experienced in Botox injections. Usual Botox risks include minor bruising from the needle. Muscle stiffness or weakness can theoretically occur, especially in people with Myasthenia Gravis. Allergic reaction and infection is also theoretically possible. Flu-like symptoms or minor headaches can occur. There can be eyebrow or eyelid droop with possible double or blurry vision. Most of the risks are temporary, subsiding as the Botox wears off.
Droopy eyelids occur in about 3% of Botox injection cases. However, at the Naderi Center for Rhinoplasty & Cosmetic Surgery, this has never occurred. Dr. Naderi is a Botox injection instructor with experience and in-depth knowledge of the proper muscles to injection points.
What are Botox alternatives?
Botox and Dysport are the two most popular cosmetic wrinkle reduction substances in the United States. Dysport and Xeomin are similar to Botox. Botox was the original FDA approved neurotoxin for reducing wrinkles and lines.
Why The Naderi Center for Botox?
Dr. Naderi is a Board Certified Facial Plastic Surgeon who participates in national clinical training for Allergen, instructing physicians in the proper Botox injection technique.
Dr. Kulak is a Facial Plastic Surgeon with a gentle, artistic touch and her patients love her nearly pain-free techniques. Doctors worldwide refer to Dr. Naderi’s instructional videos on YouTube to fine tune and improve their own Botox injection techniques. We have a “no rush, no sales pitch, no pressure” approach at the Naderi Center for Rhinoplasty and Cosmetic Surgery.
Dr. Anderson is a top board-certified plastic surgeon. She is a member of the American Society of Plastic Surgeons. She has been a long-time professor in the Division of Plastic Surgery at Emory University.
The Naderi Center for Rhinoplasty & Cosmetic Surgery offices are located in Chevy Chase, Maryland, (301) 222-2020; and Herndon, Virginia, (703) 481-0002.
Hospitals: Procedures performed at the INOVA system hospitals include Fair Oaks Hospital, Loudoun Hospital, Fairfax Hospital, or at Suburban Hospital in Bethesda Maryland.