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Category: Botox and Dysport

Botox Makes You Look Better…

…But can it make you feel better?

With annual sales north of a billion dollars, the makers of Botox must be doing something right. I personally inject Botox to the 11 lines, forehead, and crows feet about 5 to 10 times weekly, and it is highly effective in reducing dynamic wrinkles in these areas.

There is now significant research to indicate that botulinum toxins (Botox and Dysport) may also be effective in treating over half of patients with moderate to severe depression. As reported by Scientific American, The New York Times, and Clinical Psychiatry News, many patients receiving Botox report improvement in their mood. Why? People convey depression, anger, and fear by facial expression. When Botox impairs their ability to look angry or sad, they look better—not only in the mirror but also to those around them—making them feel more confident, youthful, and attractive.

Though it has not yet been studied, many physicians also believe that injection of facial fillers, such as Restylane and Juvederm, has similar positive effects on emotional well-being.

To the adage “you only look as good as you feel,” we must now add the converse: “you only feel as good as you look.”

 

Botox injection to the 11’s
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Before After

 

Botox injection to the forehead
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Before After

 

Botox injection to the crow’s feet
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Before After

 

Ronald M. Friedman, M.D.

Director, West Plano Plastic Surgery Center

Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas

www.plasticsurgerydallas.com

Performing Facial Injections

I am fully aware that Botox and facial fillers are available on practically every street corner. Doctors’ and dentists’ offices, medical spas, and even beauty parlors offer injectables. Patients are routinely injected by gynecologists, dentists, nurses, aestheticians, medical assistants, and occasionally personnel with no formal medical education.  The results of the injections are variable: some are pretty good, and some are awful.

In contrast to the other injectors, plastic surgeons make their living by operating on people, not by injecting them.  I am no exception.  So why do I personally perform every injection?

Botox to glabella

botox injection plano tx

Before

botox injection plano tx

After

Restylane to the nasiolabial folds

restylane injection plano tx

Before

After

Because I’m good at it.  With an artistic background as a wood and marble sculptor and a medical background as a plastic surgeon, I feel better qualified to perform Botox and Restylane injections than the nurses and medical assistants in my office.  I understand the anatomy of the facial muscles better than your dermatologist—because I perform surgery on those very same muscles.  I can mark the muscles for injection based on your unique anatomy, rather than using a standardized diagram provided by the medical manufacturers.  I know that Restylane and Juvederm are not interchangeable products, and I understand when to use each.  I did not develop my knowledge through a weekend course at a hotel; instead, I developed it over 17 years as a board-certified plastic surgeon.

If I am the most qualified person in my office to perform injectables, I cannot delegate this duty to anyone else.  I really do care about doing my best for my patients, and I am compulsive about providing consistent, quality results.  Although I could hire an aesthetician or train a nurse injector, I still believe that if you want something done right, you have to do it yourself.

Ronald M. Friedman

Director, West Plano Plastic Surgery Center

Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas

www.plasticsurgerydallas.com

Dr. Friedman prides himself on personally performing every Botox, Dysport, Restylane, and Juvederm injection.  Although ice is suitable for many patients, he believes that it is unfair to charge extra for patient comfort.  So he provides effective topical anesthetics and/or 70% nitrous oxide (laughing gas) at no additional charge.  Our practice serves the Plano, Frisco, Allen, and McKinney communities.

Please visit our website for more before and after Botox and Dysport photos and before and after Restylane and Juvederm photos of patients who have been injected by Dr. Friedman.

Sculpture and Surgery: a brief autobiography

Plastic surgeons and cosmetic surgeons routinely advertise that they can “sculpt” your features: your nose, your tummy, even your breasts.  Patients routinely request a “chiseled” jawline. Who would want to have liposuction when you can have liposculpture?

 

The sad truth, however, is that most surgeons are not actually sculptors.  There are no art classes offered in medical school.  And if your surgeon, by chance, has a background in drawing or painting, these are 2-D activities which poorly translate into the 3-D world of surgery.

 

Before                                              After

 

By contrast, I am fortunate to have extensive experience in wood and marble sculpture.  I took shop class in 7th grade when I couldn’t figure out what else to take for an elective—and I fell in love.  Soon I was spending 60-hour weeks in my workshop during high school summers.  It got really exciting when people started buying my sculptures: first neighbors and eventually strangers.  Then I started displaying in shows and galleries.

 

At some point toward the end of high school, I had to make a decision: pursue art and music (my other major endeavor) or pursue academics.  I decided to pursue medicine, in general, and plastic surgery, in particular.  Plastic surgery was and continues to be the closest that I can come to doing sculpture for a living—and still be able to make a living.  (You’ve heard of starving artists, but you probably haven’t heard of starving plastic surgeons.)

 

Does this mean that I can sculpt your body?  Not really.  Surgery is not sculpture because the human form is far less predictable than a block of wood or marble.  Unlike any other medium, human tissues are fragile; can become scarred, infected, or bleed; and change contour as they heal.

 

Does this make my background in sculpture useless?  Of course not. Every day I have to make decisions during surgery.  While some of these simply require a good tape measure or caliper, others require something more elusive: an artistic eye.

 

I sincerely believe that my background as a wood and marble sculpture has helped me become a better plastic surgeon.

 

For more information about breast augmentation–including more photos, please visit www.plasticsurgerydallas.com

Ronald M. Friedman, M.D.

Director, West Plano Plastic Surgery Center

Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas

www.plasticsurgerydallas.com

 

Botox and Dysport: Understanding facial muscle anatomy (Plano, Frisco, Allen, Lewisville, Flower Mound)

In order to understand what to expect from Botox or Dyport treatment, a basic knowledge of muscle anatomy really helps.  Look at the diagram below:

Anatomy diagram:

http://antiagingwithsasha.com/botox/facial-muscles.php

A. Frontalis muscle: contraction raises the eyebrows and causes horizontal brow wrinkles.  Injection of Botox or Dysport will reduce the wrinkles but—depending on the dose and exact locations of the injections—may weaken the brow enough to cause annoyance when putting on eye makeup.

B. Corrugator muscle: contraction moves the inner eyebrows down and in, causing vertical lines between the eyes (the so-called 11’s).  Injection will reduce the wrinkles and may raise the inner aspect of the brows.
C. Orbicularlis oculi muscle: contraction causes squinting, which moves the outer eyebrows down, creating crows’ feet wrinkles.  Injection with Botox or Dysport will reduce the wrinkles and may raise the outer aspect of the brows.

The point is that these muscles create balanced forces, which determine the shape or your eyebrows.  Botox and Dysport injections can selectively alter these forces and consequently the shape and position of the brow—for better or for worse.

For example, injection of the orbicularis and corrugator may cause a mild chemical browlift by leaving the elevating force of the frontalis unopposed.  Conversely, a large dose of Botox or Dysport to the frontalis may cause sagging of the brow, as the downward forces of the corrugator and orbicularis are unopposed.

It is important that your injector be experienced and have a good working knowledge of the anatomy.  This is why I personally perform all Botox and Dysport injections in my Plano/Frisco office.

For more information, including before / after Botox and Dysport photos, please click here.

To schedule an appointment, please call us at 469-467-0100 or email us at drfriedman@plasticsurgerydallas.com

Ronald M. Friedman, M.D.

Certified, American Board of Plastic Surgery

Director, West Plano Plastic Surgery Center

Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas, Texas

www.plasticsurgerydallas.com

Botox vs. Dysport: Which should I use? (Allen, Frisco, McKinney, Plano, Flower Mound, Lewisville)

Botox (manufactured by Allergan) has been FDA-approved for wrinkle-reduction since 2002.  It is a highly effective product that reduces wrinkles between the eyes (glabella), in the forehead, and in the crows’ feet (smile lines adjacent to the eyes).

Dysport (manufactured by Medicis) was approved by the FDA for wrinkle reduction in April 2009.  It is essentially a variation on Botox with a very similar set of properties.  I use both in our Plano/Frisco office.

Main differences between Botox and Dysport:

  1. Weight: Botox is a heavier-weight molecule than Dysport.  Heavier molecules (Botox) tend to “stay put” while lighter molecules (Dysport) diffuse further from the site of injection.  Why is this important?  It is my impression that Botox is better than Dysport for the corrugator muscles (between the eyebrows), since these are small, strong muscles that need a concentrated dose.  I believe that Dysport is superior to Botox for the orbicularis oculi muscles (that cause crows’ feet wrinkles), since these are large, thin muscles that need a more “spread out” injection.  Either product works well for the frontalis muscle (forehead).
  2. Speed: Dysport is faster.  Effects of Dysport are apparent within 24-48 hours of injection.  Botox usually takes 3-5 days.  So if you have to look good for a reunion in a couple days, you may want to consider Dysport.
  3. Dosing:  25 units of Botox are essentially equivalent to 60 units of Dysport.  When you see physicians price these products by the unit, make sure you understand what they’re talking about.  25 units of Botox for $375 is a good deal.  25 units of Dysport for $325 is a terrible deal.  For more information about our prices on Botox and Dysport, seeBotox and Dysport Costs in Plano
  4. Coupons: Botox has a customer loyalty program called Brilliant Distinctions where you can earn points and redeem them for a coupon on your next visit, filler products such as Restylane and Juvederm.

Bottom line:  I like both products.  I usually inject Botox in the glabella (between the eyes) and Dysport in the crows’ feet.  I use them interchangeably in the forehead.  Why? Each product has its proper place (literally), and you get rebates from both manufacturers.

For more information, including before / after Botox photos, please click here.

To schedule an appointment, please call us at 469-467-0100 or email us at drfriedman@plasticsurgerydallas.com

Ronald M. Friedman, M.D.

Certified, American Board of Plastic Surgery

Director, West Plano Plastic Surgery Center

Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas, Texas

www.plasticsurgerydallas.com

© 2018 Ronald M. Friedman, M.D., P.A.

Contact Us At 469-467-0100

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