Botox Injection Technique for Wrinkle Reduction in Virginia

[Barbiehoe]

How old is the patient in this video? Do you recommend to start getting Botox at an early age (how young?) to prevent permanent wrinkles, such as crow's feet?

[DrNaderi]

@Barbiehoe

She is in her early 20's and she is getting Botox and dysport injections to prevent getting wrinkles and lines

[spinceara]

interesting

[chelseaandhobbes]

Thank you for your reply. Do you know what causes the scrunching effect under the midlle/lateral part of the brow after treatment? If so any pointers how to avoid this problem?

Do you ever give seminars in the UK or Europe?

[DrNaderi]

@chelseaandhobbes

My pleasure. Hard to say without seeing what you are describing but often the elevation or depression of the brow will create some unusual lines under the brow or on the upper eyelids. These typically go away after a few weeks and usually you only see them in women with very thin upper eyelid skin. I teach in various places. Going to Savannah Georgia tomorrow to teach Dysport injections but not in Europe.

[chelseaandhobbes]

Wonderful demonstration. I appreciate this process may have been shortened for video, but do you generally use the same landmarks for all your clients ie inject in a general area, or do you go ask the client to frown, smile etc and tailor the injection points to the individual?

[DrNaderi]

@chelseaandhobbes

Thank you.

Each patient has a unique expression created by unique mimetic muscle action so the injections are not only tailored to their anatomy but also to their desires such as desire for an arched brow or a more straight brow, etc.

[annayoshida]

The patient sure has very good pain endurance.... I freak out when I saw the needles going into the face.

[cutiepiealiyah]

@annayoshida right... what I do to not be freaked out is shake my hands

[DrNaderi]

@cutiepiealiyah

as long as your shaking does not shake your body and make it more difficult for your plastic surgeon to inject you accurately.

[pepemaui]

Hello,

Do you use glass syringes? What brand/size syringe do you use?

[DrNaderi]

@pepemaui

I do not like Glass syringes. I prefer much more sterile one time use BD syringes with BD 30g needles.

[towisdom]

I like the technique. I use dysport. How many units are used in each injection?

[DrNaderi]

@towisdom

Thank you. The dose depends on the patient and the strength of their muscles.

[Milussi]

There are so many videos about how you inject botox, but I haven't found one that clearly instructs how to prepare the botox. I know nothing about how to blend the botox with the saline, how much botox, how much saline, what amount of the blend you should inject, if you should shake it, etc. etc.

[DrNaderi]

@Milussi

Correct! These videos are not intended for the novice to learn how to inject botox and then go inject others with botox! It takes proper training and supervision since botox is a serious medication with potential dangers. If someone does not know the most basic things such as how to mix the botox powder with saline and how to prepare it then watching videos online is not the best way to get started. If you are a nurse or a physician, please call Allergan and set up training.

[Milussi]

@DrNaderi Well, were I live, the cheapest botox you can get i 900 $ for just on area of the face. I think it is unfair that only rich people should be able to get botox.

[DrNaderi]

@Milussi

Hi. Im not sure where you live but that is a very high price for Botox. As far as "fairness" and affordability of Botox and cosmetic surgery goes, you cannot think that way because only rich people can afford luxury cars, luxury homes and expensive food as well. There are some things that are not a necessity of life and Botox is not a necessity.

[ELIZABBCHIWAS]

todo sea por la belleza..

[sslsgause]

Hi Dr. Naderi,

Your videos have been very helpful. We're actually looking at your website to discuss coming to one of your training courses. We were just wondering what syringe/needle gauge you prefer. We've encountered more resistance than we'd like using 31 g insulin syringes.

Thank you for your time,

Sara Gause, PA-C

[DrNaderi]

@sslsgause

Thank you. I prefer 30g BD needles and 1cc BD luer lock needles. These are more expensive for us but they are fantastic for injections with less pain due to remaining sharper. Most doctors use insulin or TB needles and syringes which I do not like: too cheap and flimsy.

[sslsgause]

@DrNaderi

We really appreciate you finding time in your busy schedule to reply. Thank you for the helpful info.

[Zandercott]

I think I need to just fly out there for a short internship w/you. =) You're an awesome teacher....yes, it's those lateral lines that bug me, especially when they look "rounded" at the lateral aspect of the brow. Any way to avoid this? Also,how do u avoid a spock look on a narrow forehead with many wrinkles? Back to injecting the lateral portion of the obicularis oculi....would injecting this area still allow for some brow lift or will this cause a more horizontal brow? thanks for your help!

[DrNaderi]

@Zandercott

I actually do have a course for doctors and nurses:

botoxfillerinjectiontraining (.com)

[Zandercott]

Thank you so much for your prompt response.I'm an RN,actually worked in critical care for many years(at Inova Fairfax back in 1997 in EP lab),moved to San Diego& by chance ended up in this field.I've only had botox training through Aesthetic Enhancement Institute& feel those techniques may be outdated, especially after watching your technique.I've tried to study the facial muscles& by trial& error have learned along the way.Any suggestions for lifting brows in pt. w/excess movement in forehead?

[DrNaderi]

@Zandercott

My pleasure. The way to do it is to relax all of the "depressors" of the brows while leaving the lateral elevators un touched. They will see some lines laterally over the brow but most patients who desire higher arched brows will choose the higher brow over the completely smooth forehead. There are ways of doing it very naturally and without a tell tale sign of "having botox."

[Zandercott]

Hi Dr. Naderi: I absolutely LOVE your video, very clear & concise.  I'm always so worried about injecting in the midpupilary region, close to the brow. Is there any risk in injecting the lateral portion of the orbicularis oculi? I assume a 4cc dilution would be too much volume in this area? My boss likes using the 4cc mix & I'm trying to convince her to use 2cc.

Thanks

[DrNaderi]

@Zandercott

Thank you. I actually do inject the lateral portion of the Orbicularis Oculi muscle in patients that do not want a higher arched brow and in ones who notice glabellar movement despite relaxed Corrugators. These patients recruit muscle fibers from over active lateral O.O. muscle. You have to be VERY conservative and careful and simply sub cutaneous and not very deep and only 2 units of Botox. I am not a fan of 4cc dilution because of the risk of excess travel.

[lovethenewyou]

Good educational video

[DrNaderi]

@lovethenewyou

Thank you

[bonmom]

Nice job, Dr. N. How many units per cc is your dilution? Do you put 1.5 NaCl in the powder?

[DrNaderi]

@bonmom

Thank you. I like to use 2cc per 100 Unit vial. I have some use as much as 4cc. That is too much extra saline just swooshing around and can increase risk of Botox migration and adverse brow or eyelid ptosis. In the last 10 years, I have not had even a single brow or eyelid drop (knock on wood). I have seen some use 1 or 1.5cc. Thats fine but it does not give you enough volume for contouring and you will waste lots of botox in the needle hub or at the bottom of the bottle that way

[isisbenny404]

i had this done today it hurt like hell

[DrNaderi]

@isisbenny404

Pain is very subjective. The exact same procedure causing a certain pain level may have one person calling it "hurt like hell" while another person calls it "didn't hurt much at all."

With that said, injection technique is also very important. Two doctors don't inject the same way and one may hurt more than another. Having a "gentle smooth touch" is important in making it not "hurt like hell."

[mssuperblondie]

nice vid ! but doctor im afraid they say botox can be sometimes dangerous for some reasons ! can you explain it please ? thank you xx

[DrNaderi]

@mssuperblondie

Botox is a medication so it should be handled and injected by trained medical professionals. Too many hair salons and spas and non trained people are injecting it these days. However, if used properly, it is relatively very safe. It has been FDA approved in the U.S.A. since 1989 for eyelid spasm and it is used for various medical problems. in cosmetic use bruising and temporary eyelid drooping are the main risks. Eyelid droop should not occur in trained hands though.

[batwings24]

Dr Naderi; once Botox is reconstituted, can it be stored and used for a later time or does it have to be used within a certain amount of time or days before the efficacy wears off??

[DrNaderi]

@batwings24

Good question!  Once reconstituted you may keep it in the fridge for 3-5 days or in the freezer for 2-3 weeks. It should not be kept at room temperature. You should use sterile technique by wiping the top with alcohol and using sterile one time use needles. For Therapeutic Botox (which is exactly the same as Botox Cosmetic but with a different label for medical use) the company recommends using one vial per patient and a one time use. There are no clear guidelines.

[batwings24]

Ur videos r awesome!! Very well explained, very informative...many thanks...

[DrNaderi]

@batwings24

Thank you! 

[bigal01771]

Dr Naderi,

Thanks for the quick response. I appreciate it....... 5-10 units into each corrugator, does that depend on size of the muscle and previous result from prior injections? How many units for the three injection in the orbicularis oculi and frontalis. I hope you don't mind my questions as I adopted you as my new mentor.

Sincerely, Dr. Al, DDS

[DrNaderi]

@bigal01771

My pleasure Doc. Depends on size, strength, sex and the desired results. I place very little in the Orbicularis - about 2 units or so. For the Frontalis, I do less than 10 to keep the brows nicely arched and mobile. I don't like a heavy, frozen look and feel.

[bigal01771]

Doc,

excellent technique! Are your dilutions 1:1 or 2:1 ?

how many units did you place in the corrugators?

GREAT VIDEO send me more!

[DrNaderi]

@bigal01771

Thanks! I use a 2cc reconstitution. Typically I use 20 units to the glabella which I divide between the Procerus, Depressor supercili, corrugators and lateral portion of Orbicularid Oculi. I place 2 injection sites into the corrugators for a total of about 5-10 units.

[owataqtpie]

I am soooooo calling you on Monday!!!

Thinking of taking the dive and getting botox so I can share with on my site what I think about it

Looks like you know your stuff

[lalastinker]

Wow you did a fabulous job. I told my Dr. about this video when i went in recently to have my forehead lines touched up. I was considering getting my crows feet done and I told my surgeon to watch this. We are close friends so he took my advice and tried your technique, and Im happy to say that it worked wonderfully!

[DrNaderi]

Thank you very much for the kind comment. Glad it worked out well for you.

[DrNaderi]

Thanks for the comment.

[MarionDBrown1]

very interesting about the injection points for the crows. Years ago we were taught to inject deeper, but the muscles around the eyes will respond very well as the doctor explains, by doing little blips.