June 23, 2026 • 34 mins
With so many neuromodulators on the market, it's easy to assume the product is what determines the outcome. In reality, that's only part of the story.
In this episode of Plastic Surgery Uncensored, board-certified plastic surgeon Dr. Rady Rahban is joined by aesthetic nurse Charlene for a comprehensive discussion on Botox, Dysport, Xeomin, Daxxify, and the growing world of neuromodulators. Together, they explain how these products work, what distinguishes them from one another, and why the skill and judgment of the injector often have a far greater impact than the name on the vial.
From forehead lines and crow's feet to masseters, gummy smiles, neck bands, and lip flips, this conversation explores the most common treatment areas while separating evidence-based medicine from today's aesthetic trends.
If you've ever considered Botox—or simply want to better understand what these treatments can and can't do—this episode is an honest, practical guide to achieving natural, balanced results through a conservative approach.
✨ If you enjoyed this episode of Plastic Surgery Uncensored:
✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.
✔️ Rate & Review—your feedback helps more people find us.
✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:
In this episode of Plastic Surgery Uncensored, board-certified plastic surgeon Dr. Rady Rahban is joined by aesthetic nurse Charlene for a comprehensive discussion on Botox, Dysport, Xeomin, Daxxify, and the growing world of neuromodulators. Together, they explain how these products work, what distinguishes them from one another, and why the skill and judgment of the injector often have a far greater impact than the name on the vial.
From forehead lines and crow's feet to masseters, gummy smiles, neck bands, and lip flips, this conversation explores the most common treatment areas while separating evidence-based medicine from today's aesthetic trends.
If you've ever considered Botox—or simply want to better understand what these treatments can and can't do—this episode is an honest, practical guide to achieving natural, balanced results through a conservative approach.
✨ If you enjoyed this episode of Plastic Surgery Uncensored:
✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.
✔️ Rate & Review—your feedback helps more people find us.
✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:
- Instagram: @drradyrahban
- TikTok: @radyrahbanMD
- YouTube: @Rady Rahban
- Facebook: @Rady Rahban
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:06):
All right, welcome to another episode of Plastic Surgery and Censored.
I'm your host, doctor Roddy Rabon, and we're going to
put together a little quick series for you. I think
you guys are going to like this upcoming series. I'm
here with Charlene. This episode is going to be about neurotoxins,
neurotoxins or neuro modulators, and essentially what that means is
(00:28):
drugs that we inject and as a result of injecting them,
they modulate or affect the muscles, which then affects the wrinkles.
And the most famous of such is Botox. Actually, I
am guilty of using the term botox as a ubiquitous term,
even though we're going to talk about the different brands
(00:51):
there are different brands of it. We use botox just
because it seems to be the most commonly. It's a
universal term. It's kind of like using Kleenex to describe
tissue paper, right. All right, So Charlie, right now, on
the market, there are multiple you know, Botox was the
first one to come into the market. For those of
you who don't know, botox was originally a drug that
(01:11):
was invented for medicinal reasons. It was not a cosmetic drug.
It was a drug that was used, if I'm not mistaken,
in ophthalmology for blepharospasm. People would get twitches in their
eyes and this drug was invented and it would help
address that. And then later of course they realized, wow,
it does more, and here we are now and it's
(01:33):
it's essentially the I would say the number one cosmetic
treatment globally.
Speaker 2 (01:37):
Absolutely.
Speaker 1 (01:38):
Yeah. So what aside from botox, which everyone knows, what
are the different names of neuromodulators that are out there now?
Speaker 2 (01:46):
There is a couple of different ones, and every year
I feel like there's more that are coming out. Botox
is definitely one of the most common disport. We have, zemin, Jubo, Daxify.
There's a whole bunch of different ones coming out so.
Speaker 1 (01:59):
First, and people want to know. Whenever there's things that
are multiple, it's like which one's better. Yeah, And the
reality is that I would argue in this particular arena,
they're all pretty much six and one, half a dozen
the other for several reasons. Number one, the main reason
they're all the same is because the actual active drug,
the drug is the same drug. It's bochelinim toxem a derivative,
(02:19):
and so the same would be equivalent of ibuprofen, motrin
and advil, which is better. People come to me and
they're like, oh, I only add so much better. It's
like it's the same drug.
Speaker 2 (02:30):
Yeah, that's exactly how I explain it to patients too,
And they ask me. I say, it's all about preference.
You know, sometimes you won't really know unless you try
different types. But that's exactly the same analogy. Yes, it's
like it's using a different type of ibuprofen, you.
Speaker 1 (02:44):
Know, right, and so the one that so the base
drug is the same. However, where the little bit of
nuances come is in the way that the drugs are
carried the carrier meaning inside the drug how you and
then all also how each provider reconstitutes them. In other words,
(03:04):
you know, they come in as a powdered form, you
add saline. That saline then reconstitutes it. The degree of
the dilution equals the strength. So for example, you may
go to one med spa and you're like, well, dude,
the disport didn't work. Then I would assure you if
disport didn't work, it was the way they diluted it.
(03:26):
Because Disport's going to work, saxtifies they're all going to work,
they'll work differently, But I think a bigger issue is
who's injecting you and how they dilute it. In other words,
the concentration of the drug. The reasons why I've used
Disport for shoot as as soon as it came out,
and the reason I like it a little more, again
(03:47):
we're all the same a little more than the other
ones is I feel that it kicks in a little quicker.
Maybe what do you think about three three days to
five days? We would say. I felt like Botox took
like five to seven days. Second, I feel like the Disport,
pound for pound, is a little stronger. So if I
(04:09):
put in five units of Disport, I'm sorry, five units
of botox. Technically, the way the numbers work, it's fifteen
units of Disport, but let's just say for all intensive
purposes the equivalency. I feel like the Disport sort of
lasted a little longer. Did you get that experience? Yeah?
Speaker 2 (04:29):
For me personally, that's how I felt about it.
Speaker 1 (04:32):
Yeah. And then the other thing I like about the
Disport was that and this actually turned out to be
something that people hated about the disport Originally it spreads
a little more, and so if you do reconstitute it
with too much saline. In other words, I want to
put a dot of disport here above my brow if
(04:54):
there's if it's too dilute, I have to put a
lot of fluid, and it spreads. And actually, when it
first came out, myself included, I was diluting it the
way I was diluting botox, and I had some non
desirable outcomes. People immediately blame the disport. Again, yeah, you
should blame the provider. And now that now that I
(05:16):
use a very much more concentrated form, I feel like
the reason why I like it is when you put botox,
the drug goes and it works in a very finite space.
So the space right next to it, I feel, is
a bit more abrupt, like it's on off, on off,
whereas the disport kind of like spread.
Speaker 2 (05:35):
It has like a really nice diffusion.
Speaker 1 (05:37):
A diffusion to it exactly.
Speaker 2 (05:38):
So that's how I even felt when I had it
done on me. Personally, I've had botox done the very
first time and I felt like it was very harsh. Yeah,
but with the disport, it really was a soft effect,
but it gave me the exact type of results.
Speaker 1 (05:50):
Again, doesn't matter if you're going to respond they're injecting
you with daxify. As long as you like the outcomes
and the price point is about the same, that's really good.
The next thing about these is people want to know,
let's talk about where we can use them. So we're
the areas that what I would consider the core areas
that we would use the neuromodulators.
Speaker 2 (06:11):
Yeah, core areas would be the upper third of the face.
That'll help with the foreheadlines, the frown lines, and then
the crow's feet.
Speaker 1 (06:18):
Yeah, so we call them the number eleven people who
do a lot of frowning. Right right in the middle
of your eyebrows. Those are the muscles, are the corrugators,
and if you see they kind of move inwards. Some
people have an additional muscle called the preserus and it
comes it pulls down so it has a line across
the nose. There is the forehead, the frontalis, and then
(06:39):
of course the crow's feet, which are on the side.
And I think those are tried and true, and those
are areas that when people ask me, like, oh, I've
never done botox, before what areas you suggest. I always
suggest those three, even if one of your three areas
is worse than the others. So I don't generally tell
people to just do theirhead or just do their corrugators.
(07:02):
The reason being is that I feel, and I don't
know if you've experienced it, that when I inject one area,
I find like the other area gets a little worse
because people are trying to still animate without knowing it,
and it's just isolated and it just overcompensates.
Speaker 2 (07:18):
When you relax when area, the other area is going
to overcompensate and have a strong repult.
Speaker 1 (07:23):
Yeah. So those are the three tried and true areas.
But there's a boat load, I mean a boatload of
areas that people inject. Now, I myself, I just I've
always been more conservative and I like things that I
think are consistently awesome, not usually awesome. So the other
areas that people do I think that are effective. One.
(07:46):
I think massiters are effective, definitely. I think the problem
with massaters is overinjection. Yeah, it's a muscle you need,
right you don't need you.
Speaker 2 (07:59):
From talent common right now to do a lot of
botox and the massters because people want that cosmetic effect
of that facial swimming. But even for me in my practice,
I don't like to do that. I always I always
question the patient. I'm like, is this going to be
for cosmetic reasons or therapeutic?
Speaker 1 (08:14):
Right? So why would you do? Why does one do
the master? Right? Yeah?
Speaker 2 (08:19):
So for me, I like to treat the massters therapeutically.
If someone has strong massters, if they clench a lot,
if they have TMJ, if they just want a little
bit of relief from that area, doing the massaters with
botox could really relieve some of the pressure in that area.
Speaker 1 (08:34):
So we found that it affects migraines mm hmm. We
found that it affects grinding and teeth decay right some people.
I've had patients who have broken through mouth guards. We
found that it affects TMJ, which is directly, and we
found that affects just regular garden variety headaches. So in
that regard, I think it's really effective. The problem is
(08:58):
that as you inject the massa, it's a muscle and
a will start to soften and it becomes slimmer, and actually,
in my opinion, esthetically it looks worse. The reason I
don't like it is that we do everything we can
aesthetically to create a strong job and the muscle in
(09:19):
some people is a critical part of that angle of
the jaw, and I think when you over inject and
really melt that muscle down a I think that it
affects chewing, which is what the massacre was designed for. Two.
I think it softens the angle so much that you
lose that transition and your mandible kind of just blends
(09:40):
into your neck. The reason it became very popular esthetically
is actually in the Asian community, right because they're one
of the only, really the only community who has a
lot of jaw angle and maybe could benefit from a
little bit of so called slimmy But that's more of
(10:01):
a Korean like. They like heart shape, not square shape.
But I would tell you ninety nine point nine percent
of times I'm aesthetically striving for an angle, So I
would caution you. I think I never inject more than
fifteen units, So it's usually ten to fifteen units. You
see most people they're dropping twenty five units per side
or more. I think you're going to get into trouble.
(10:24):
Another area that I find really effective is injecting the
chin pad, right, and why would we inject the chin pad?
Speaker 2 (10:31):
Are this little temple?
Speaker 1 (10:33):
Yeah, I call it cobblestoning or pew the orange pew.
The orange is orange peeling, and it usually occurs for
people who are straining this muscle. The mentalis muscle helps
keep the mouth shut, and some people just animate forcing
their lips together.
Speaker 2 (10:51):
It's a little overreactive, and some people don't realize that
they even tend to do.
Speaker 1 (10:55):
Ninety nine percent of times where I do chin I
mentioned yeah, because it's one of those things that you
only do when you speak, and when you're looking in
the mirror, you're not speaking, so you don't see it.
So then it's one of those things that I generally suggest.
The beauty of that area is it's like five units.
It's like it takes nothing. An area that's Another area
(11:17):
that is effective but needs to be thought through a
little bit is neck bands. So neck bands is a
little you gotta be careful number one. It's a large muscle,
so you can drop a ton of money and a
ton of neuromodular for little gain. So, for example, I
(11:40):
do it a lot of actors and actresses people that
are on camera because of the band when they speak
and they animate, it sort of bounces and they see.
I stood in people who really don't want to have surgery,
but this is the caution. It must be exclusively muscle
(12:03):
and unless you're super young. Yeah, I'm talking early forties
or younger. I find that as you get into your
late forties and fifties, now you're having some skin accumulation,
so its skin and muscle, and then you'll inject these
bands and maybe it's a little better. Maybe it's a
(12:24):
little worse because now the muscle relaxes and your skin,
which needs a neck lift, becomes more prominent. So this
is neck bands. I don't think are a treatment for
people who are older and their necks starting to sag
and they need a facelift or a necklift. It's a
good thing in young people that have hyperactive or overactive necks. Yeah,
(12:47):
I agree. We have some areas that I don't love.
We have the DAOs. I'm not a fan. Some people
are what is the doos and what are they for?
Speaker 2 (13:03):
The dios pulled down the pretty much the lateral sides
of your mouth, So it's the ones that make you
frown like that, right, They're.
Speaker 1 (13:10):
The muscles adjacent to your mentalis, and when activated, they're
attached to the corner of the mouth and they pull
the corner of the mouth down. The idea or the
objective is that when you inject it and it relaxes
the muscle, the corners of the mouth wise up. My
(13:32):
experience has been that because that area has a cluster
of different muscles, there's actually not just one muscle there
that if it's not exactly done correctly, it causes actually
animation deformity, like you're talking and your mouth is just
off and like one side's higher than the other. And
(13:53):
for many years I found it to be very difficult
to get a super smooth outcome. So I personally have
stopped doing it. I just it's just too much of
a headache for me. Do you play with it sometimes?
Speaker 2 (14:08):
It really kind of just depends per patient, piece by case.
Speaker 1 (14:11):
Yeah, we have actually not very effective, but people who
have what do you call it smoker's lines upper lips.
Smoker lines when you pucker your lip like for a straw.
So that's a big complaint for a lot of people.
There is no perfect solution. It's a combination of things.
(14:32):
But putting in the tiniest amount of botox weakens your
obicularis and then it softens those wrinkles. But remember it
also affects your ability to speak, and it affects your
ability to pucker and more importantly, whistle or drink from
a straw. So when I say tiny, I mean tiny.
(14:56):
What other areas are there that are sort of more
random that people do?
Speaker 2 (15:02):
The Barbie botox.
Speaker 1 (15:03):
Traps definitely, in my opinion, a disaster. Yeah, no, no, no,
no no. Once you start getting to huge muscles, a
trap muscle first of all, Like the whole point of botox,
in my opinion, is because it's temporary, it has to
be cost effective. Yeah, So let's say I had a
(15:24):
procedure for you. It was three thousand dollars in every
three months you had to redo it. Like, what kind
of stupid procedure is that? So the beauty of these
other eras is they're like ten units, fifteen units, et cetera.
So the trap is huge. The idea is that it
relaxes the muscles, it causes soft kind of swimming down,
(15:46):
and then it's been associated with all kinds of other conditions,
breathing issues and things of that nature because you're now
injecting a lot of botox in critical areas and it's spreading.
So it wasn't there a lady who was on a ventilator. Yeah,
on Instagram she was literally on a ventilator because they
did I think trapped too much, trapping jobs. So I
think that's just again like everything, people are going to
(16:09):
be in a spa, they're going to sell you the product.
You know, they want to make more money, and I
just think it's overcare.
Speaker 2 (16:14):
And then with that too, a lot of people don't
realize that doing that much botox in that area, your
body is going to overcompensate for the lack of use
of these muscles, so then people start to get sore
backs and.
Speaker 1 (16:24):
Sore stupid idea, in my opinion. Another area that's kind
of interesting that I found in some people really love
it and it's a tiny amount is a lar flaring.
So some people when they speak or they talk, their nostril,
the roundness of their nostrils flares. It's it's a muscle
we use for deep breathing, Like if I ran a marathon,
(16:44):
at the end, I bet and my nostrils. But some
people just do that in conversation and it takes like
it's painful as hell.
Speaker 2 (16:51):
It's painful. I've tried it. It's very painful.
Speaker 1 (16:55):
It takes a dog, but it is.
Speaker 2 (16:57):
It's just a tiny drop, and it does make a
nice difference ending on the person that's you know.
Speaker 1 (17:01):
It makes a difference. There's the flip lip, yet another
one of those that I don't love, but I know
that you had dabbled in, and you do it here
and there, the idea being.
Speaker 2 (17:10):
Yeah, And even with that, I'm very selective on the
patients I like to do it on. I really like
to do it on patients who when they smile their
lip upper lip really curves in or have a gummy smile,
because it does relax the upper lip enough where you know,
it doesn't show.
Speaker 1 (17:24):
So gummy smile is a different story.
Speaker 2 (17:26):
Yeah, they're just doing a tiny little.
Speaker 1 (17:28):
I think gummy smile is a phenomenal use for it.
So what is so there are people when they smile
just regular, their upper lip gets pulled up so high
that in addition to their teeth, they see a lot
of gum and it's generally not a very attractive look.
And by dropping a tiny amount of botox in the
upper portions right at the pure forms where the nasalabia
(17:51):
folds are. It softens up muscles so that you don't
retract it up as high, and I have actually found
that in some people it's very very effective. The next
thing is philosophically, I have for twenty years been injecting
half the dose that is normally injected everywhere else. I
(18:13):
want you to just want you to listen to me here. Recently,
I just love all these stupid marketing names. They call
it baby botox, and it's like baby botox, What the
fuck is baby dough botox? We're not injecting babies. So
what it is is they realize For me, when I
came out of training, there's the sort of guidelines, right,
and when I interviewed a bunch of nurses, it was
(18:34):
obvious to me that they're all trained with these stupid guidelines.
Who makes the guidelines, the companies that sell the product.
And the idea is that like a forehead is twenty units,
let's just use that as an idea. Between the eyes
is twenty units. Each eye for the crows feed is
ten and ten, which is twenty units. So the average
(18:55):
patient who goes and gets these products gets fifty to sixty.
I inject for twenty years, twenty to twenty five units,
the occasional thirty unit. And when I interviewed a bunch
of people, I had them come in, and I had
the one easy way to just check check their preferences
(19:17):
was to ask them. They'd walk in, I'd be like,
all right, here's Gail. Gale's my patient. How much do
you inject? And they're like, oh, fifty five units? And
like I'd open up Gale's chart and I'd be like, look,
Gale's been coming to me for fifteen years. Every single
one of these is twenty twenty two, twenty five, twenty two,
twenty two, twenty five. And the reason is that people
(19:37):
in general want to look natural. What makes you look
not natural is it's just too strong, and you get
frozen forehead, your brows drop, you animate weirdly when you smile,
like nothing moves, but some like muscle way back. Where
So this idea of baby botox is ridiculous. It just
means injecting the correct amount. And ironically, in men, I
(20:04):
inject less botox than I do in women, yet they
have stronger muscles. Do you know why?
Speaker 2 (20:11):
So that it doesn't freeze the area, and it looks
a lot more natural.
Speaker 1 (20:14):
Guys look ridiculous, ridiculous when frozen women, we have a
different esthetic for a woman. It's more glossy, it's more polished,
it's more smooth. Men. The reason we do botox is
to just slow down the wrinkle formation. So number one
reason why I inject less in men than women is
they just look odd, sort of, that whole masculine element
(20:37):
of them goes away. The second reason is because in
general men's brows, a man's browseits lower than a woman's brow.
So often if you meet a guy and you're like, hey,
have you tried botox? Oh no, no, no, I'm never
doing that again. Well what happened? Oh my brows were
so heavy and I well, that's because you went to
someone they injected you with botox. They relaxed the muscle
(20:59):
and it dropped your brain and as a result, you
hated your experience and now you stay clear of botox,
when in reality you should be staying clear of that injecty. Okay,
So that's that another thing that I'm we need to
clarify about, which I hear almost every day. The idea
is like, hey, doctor Rebond, can you put some botox
(21:19):
right here on the outer brow? Why would you want
me to inject you there? I want my eyebrows to
go up. So wait, you want me to put botox
in the corner of your eyebrow, so your eyebrow goes up.
You do know that if I put botox in the
corner of your eyebrow, your eyebrow will go down. Right, Wait,
what do you mean? So let's talk about this idea
(21:42):
of browlifts. So when you put botox, and again we're
using botox as a global term, anywhere it paralyzes that muscle,
then that muscle doesn't work. Then what that muscle was doing,
it doesn't do anymore. So your forehead muscle lifts up
(22:02):
your brow. So anywhere you inject it drops the brow. Yeah,
so how do we get a browlift? Then it's certainly
not from putting the botox where you want it lifted, right,
So tell me how we get a browlift.
Speaker 2 (22:16):
Then I do a little bit on the ubiculous oris,
because that is a muscle that does do a little
bit of a depression. So remember botoxas the opposite of
what it is supposed to do. So oftentimes if you
do a tiny drop there, it'll just give a little
eye opening effect.
Speaker 1 (22:30):
Right. So the two ways that you can raise the
brows that can be done individually or together is one
knock out the obicularis which is the crow's feet, which
then relaxes right, relaxes, and that lets the brow free
and goes up and or inject the middle of the
(22:51):
forehead and not the outer part. And that allows the
middle not to move and the outer to move, which
will then lead it to lift high. So it's a dial.
In some people, that's exactly what they don't want, and
that's exactly what they tell me they want to avoid,
is that spark. Look, I don't want my eyebrows in
(23:11):
the eye up in the air. And in some people
their brows are super flat and that's what they're begging for.
So that's why you are provider needs to say, Hey,
you're a bad candidate for raising brows, and you're a
great candidate for raising brows.
Speaker 2 (23:25):
I've had I've had inchecktors want to raise my brows
every time, and I'm like, do you see these browsies
are natural? Like I do not need a brows whatsoever.
Please do not touch that.
Speaker 1 (23:33):
It's gonna look. I'm gonna definitely look in surprise. Yeah,
all right, son, So let's go over what is the
when when a patient comes in they're having botox done
for the first time. What is the recovery so to speak,
because like, oh, there's been so many things about what
I can do and I can't do whatever, So what
do you what do you tell them is they're recovery.
Speaker 2 (23:53):
Recovery is very mild with botox. You know, you could
come in and do it. It takes about five ten minutes
to do and afterwards, you know, you might have a
little bit of some tiny, little pinpoint bleeding in the
areas that were injected, very tiny, maybe a little swelling
from the bowtox itself, but those bubbles will go down
in about twenty minutes. Other than that, the rest of
the day you're pretty free. I just recommend patients don't
(24:15):
go to the gym right afterwards. No hot tubs on
the steam rooms lay up right for about three to
four hours, but pretty wild. Can you turn to your normal
activities the next day?
Speaker 1 (24:25):
Yeah, So here are the things that Number one, it's
if done correctly, you should come in, inject, go back
to work within thirty minutes. Number Two, usually I would say,
in all the botox I've done in twenty years, maybe
one percent of people get bruising. Yeah, very little, it's
very unlikely. Number Three, you can resume everything you were doing.
(24:50):
Oh I heard, I can't do this. No, I can't.
You can do everything. The only thing we suggest, and
this is really more of a suggestion, is we just
injected you with this that is sort of going to
attach to something. It's going to attach the muscle. So
we highly suggest you don't do things that make you
sweat a boatload early on right away. So exactly I
(25:11):
wouldn't go and do like a major cardio class. I
wouldn't go in a sauna, steam shower, jacuzi whatever, because
you're heating up. What can I do tomorrow? Everything? The
only other thing I also to tell you is don't
do the injection and then go lay on a massage
table with your face in a table, point down, pressure
on your face for three hours that same night. So
other than that, go to a dinner, go to a movie,
(25:32):
put on makeup, whatever. So it's really actually a very
simple and easy recovery. How often do I need to
get the boat.
Speaker 2 (25:42):
Talks usually three to four months on outage.
Speaker 1 (25:44):
So I want you guys to listen to this concept
because it's very important for you to understand that I
can inject you with a boatload of boatox and it
will last six months. So you come in twice a
year and you'll be frozen like for the first two
and a half months, you'll be frozen. Or I can
inject you with less botox more often, in which case
you'll look natural. At the end of the year, you
(26:06):
will have spent the same amount of money. So it
is the idea is less more often than more less often,
and the less I inject more often, the more natural
you will look. So we have found that that happy
place where I'm not in here every three weeks and
I'm not coming in every six months is three to
(26:28):
four months. Right around three months, it'll start giving way,
so that when you get to four months, you're due
and there's probably ten to fifteen percent of it's still left,
and you kind of just pit it again and let
it go, and hit it again and let it go.
So that's usually the timeframe that we would suggest, which
is the best. Three times a year is really what
it takes. Let's talk quickly about complications. So complications, you know,
(26:56):
what could go terribly wrong.
Speaker 2 (26:58):
Honestly, really cruising if you can bruise for a couple
of days. But again, like you said, that's going to
be very minimal. Other than that, I mean unless you
have a severe allergy. I haven't really seen any complications
unless it's overly injected.
Speaker 1 (27:12):
Yeah, so that Yeah, the things that can go wrong
are very very minimal. You have to remember something about
this drug. This drug has been around for now thirty
forty I don't know many many years, and it's been
injected in over billions of people. So let's take any
(27:32):
drug and let's say the complication rate of a drug
is I don't know one percent. I make it up.
That is a lot of complications. Yeah, right, you would.
It would be on the internet, it'd be everywhere. So
the reality is like point zero something. The things that
are very the things that are inject or driven are
(27:54):
someone can over inject your brows and then your brows
drop and now you're like, god, damn it, my brow
is so heavy. Hey doctor Bond, I need you to
fix this. There ain't no fixing it. Yeah, there is
a drug that was recently discussed where it can reverse botox,
but I don't. I don't think it's made to the
(28:18):
market so for now and has been forever, you own
it for three to four months. The second thing that
can happen, which is ten times worse than dropping your brow,
is you can drop your eyelid. Then you're really pissed,
which means the muscle that keeps your eyelid open, the levador,
is right underneath your eyebrow. So if someone injects you
(28:42):
right over your eyelid and it's too much or it spreads,
it'll drop into your eyelid and then it'll knock your
eyelid out, and then your eyelid will be droopy and
you'll be really annoyed for a couple of months. Yeah,
that's the next thing it happened. It's pretty bulletproof. Pretty bulletproof. Yes.
(29:03):
Bruising is usually if you're a bruised and you're like,
every time I go, I'm hella bruise. Something's not right.
Either you have a bleeding disorder or your injector's a hack.
But it should be boom boom boom boom in out
and you go about your business. But yeah.
Speaker 2 (29:16):
Other than that, I say, majority of the times, even
if you absolutely hate the botox, it'll wear off in
three to four months, everything goes back to normal.
Speaker 1 (29:24):
So yeah, yeah, I mean doesn't happen. The one beauty
of botox is that it's one hundred percent reversible. And
so if you have a bad experience, and my suggestion
to you is if you had both, if you did
botox and you had a bad experience, you should just
go to another provider, not eliminate botox. It's just too
valuablellet tool to help you maintain a overall beautiful esthetic.
(29:51):
So here is my philosophy about boatox, and I think
this is really important for you to understand. Who should
do botox? Everyone? Wait, come on, doctor Von everyone everyone
at what age? Mid twenties? Yeah? What? So here's the
basic principle. Botox is misnamed as preventative. Preventative means I
(30:14):
do something and it prevents something from happening. It is
not preventative. It is delayative. It delays something from happening
that will happen. So we know for a fact that
every human being after one million, two hundred forty seven thousand,
two hundred and four animations meaning moving my eyebrow. Smiling
(30:36):
then makes a wrinkle that is temporary, Like my son
makes wrinkles when he smiles, and then when he's not smiling,
he's porcelain smooth. At the age of thirty seven or whatever,
that wrinkle he has will become permanent. He'll not smile.
You're just standing here and there it is. Look at
that wrinkle in your forehead, and then after a certain
period of time it's etched in. It's actually a scar.
(30:59):
It is a embedded in your dermiss. So if there's
a treatment that's relatively affordable, relatively low risk, easy to
do that eliminates or slows down the progression of these wrinkles,
why on earth wouldn't you do it? And so the
(31:21):
reality is the sooner you start, the longer it takes
for those wrinkles to become permanent and irreversible. If you
show up in my office at sixty and you've never
done it before, I cannot get you to a place
where you're going to be like, oh my god, that's beautiful.
(31:41):
The botox will help a little bit. Then I got
to resurface your skin. Then I got to inject the
wrinkles with thiller. However, if you come here and you're young,
and I don't need it, exactly precisely, you don't need it,
you're not doing it because you need it. You're doing
it because you will need it. So the difference is
when my niece or my young patients come in, I
(32:03):
put an eight tiny amount, tiny tiny like fifteen units,
and when someone comes in and they need it, I
put in still very little, but more. The idea being
I put less in people who don't need as much
of it because I'm trying to just slow down the progression.
So I'm a big, big, big, big fan of neuromodulators.
(32:26):
The number one key to neuromodulators is less is more.
That's all you need to do. Literally, Oh my god,
doctor ban I'll go nowhere else. You're incredible. And I
keep telling them it's just I'm really conservative, and so
when you're conservative, it looks great. Why aren't other people
doing it that way? They make money? Listen, it's very simple.
(32:52):
They're bias. If I inject you with fifteen twenty units
for a unit of time I'm here, you're standing in
front of me, I'm injecting you with fifteen to twenty
units or forty to sixty units, which is better for me.
That is the answer of why people are frozen across
this country, because people are just getting over injected with botox.
(33:15):
And we'll be talking about filler in our next episode.
And this is the same shit there too. The whole
duck effect occurred because I make money injecting you. Holy shit,
all of a sudden, now you need two syringes instead
of one. I think that's really about it. I'm I
think we hit all the key points. I don't think
there's anything else. Is there anything else on the neuromodulators?
(33:35):
All right, guys, I hope you like that tutorial, that
basic intro, that basic if you will overview on neuromodulators,
come and check us out. Come to our new restore
by Ramon MD. I refer to it as a wellness
center because in addition to all the esthetic treatments that
we offer, which is botox, fillers, micro needling, lasers, PRP skincare,
(34:01):
in addition to all those things, we're gonna hopefully be
adding wellness and ad drapes, vitamins, things of that nature.
So all right, that's a rap. As always, if you
like our show. Do me two favors. One go write
up great reviews and number two, share this information with
people you love. At the end of the day, the
purpose of this podcast is educational and you just simply
(34:24):
don't know who knows what and who doesn't, So share
this with your friends, download and subscribe. All right, guys,
that's a rap. We will see you next week on
Plastic Surgery Uncensored. As always, your host, doctor Rodney rab
All right, welcome to another episode of Plastic Surgery and Censored.
I'm your host, doctor Roddy Rabon, and we're going to
put together a little quick series for you. I think
you guys are going to like this upcoming series. I'm
here with Charlene. This episode is going to be about neurotoxins,
neurotoxins or neuro modulators, and essentially what that means is
(00:28):
drugs that we inject and as a result of injecting them,
they modulate or affect the muscles, which then affects the wrinkles.
And the most famous of such is Botox. Actually, I
am guilty of using the term botox as a ubiquitous term,
even though we're going to talk about the different brands
(00:51):
there are different brands of it. We use botox just
because it seems to be the most commonly. It's a
universal term. It's kind of like using Kleenex to describe
tissue paper, right. All right, So Charlie, right now, on
the market, there are multiple you know, Botox was the
first one to come into the market. For those of
you who don't know, botox was originally a drug that
(01:11):
was invented for medicinal reasons. It was not a cosmetic drug.
It was a drug that was used, if I'm not mistaken,
in ophthalmology for blepharospasm. People would get twitches in their
eyes and this drug was invented and it would help
address that. And then later of course they realized, wow,
it does more, and here we are now and it's
(01:33):
it's essentially the I would say the number one cosmetic
treatment globally.
Speaker 2 (01:37):
Absolutely.
Speaker 1 (01:38):
Yeah. So what aside from botox, which everyone knows, what
are the different names of neuromodulators that are out there now?
Speaker 2 (01:46):
There is a couple of different ones, and every year
I feel like there's more that are coming out. Botox
is definitely one of the most common disport. We have, zemin, Jubo, Daxify.
There's a whole bunch of different ones coming out so.
Speaker 1 (01:59):
First, and people want to know. Whenever there's things that
are multiple, it's like which one's better. Yeah, And the
reality is that I would argue in this particular arena,
they're all pretty much six and one, half a dozen
the other for several reasons. Number one, the main reason
they're all the same is because the actual active drug,
the drug is the same drug. It's bochelinim toxem a derivative,
(02:19):
and so the same would be equivalent of ibuprofen, motrin
and advil, which is better. People come to me and
they're like, oh, I only add so much better. It's
like it's the same drug.
Speaker 2 (02:30):
Yeah, that's exactly how I explain it to patients too,
And they ask me. I say, it's all about preference.
You know, sometimes you won't really know unless you try
different types. But that's exactly the same analogy. Yes, it's
like it's using a different type of ibuprofen, you.
Speaker 1 (02:44):
Know, right, and so the one that so the base
drug is the same. However, where the little bit of
nuances come is in the way that the drugs are
carried the carrier meaning inside the drug how you and
then all also how each provider reconstitutes them. In other words,
(03:04):
you know, they come in as a powdered form, you
add saline. That saline then reconstitutes it. The degree of
the dilution equals the strength. So for example, you may
go to one med spa and you're like, well, dude,
the disport didn't work. Then I would assure you if
disport didn't work, it was the way they diluted it.
(03:26):
Because Disport's going to work, saxtifies they're all going to work,
they'll work differently, But I think a bigger issue is
who's injecting you and how they dilute it. In other words,
the concentration of the drug. The reasons why I've used
Disport for shoot as as soon as it came out,
and the reason I like it a little more, again
(03:47):
we're all the same a little more than the other
ones is I feel that it kicks in a little quicker.
Maybe what do you think about three three days to
five days? We would say. I felt like Botox took
like five to seven days. Second, I feel like the Disport,
pound for pound, is a little stronger. So if I
(04:09):
put in five units of Disport, I'm sorry, five units
of botox. Technically, the way the numbers work, it's fifteen
units of Disport, but let's just say for all intensive
purposes the equivalency. I feel like the Disport sort of
lasted a little longer. Did you get that experience? Yeah?
Speaker 2 (04:29):
For me personally, that's how I felt about it.
Speaker 1 (04:32):
Yeah. And then the other thing I like about the
Disport was that and this actually turned out to be
something that people hated about the disport Originally it spreads
a little more, and so if you do reconstitute it
with too much saline. In other words, I want to
put a dot of disport here above my brow if
(04:54):
there's if it's too dilute, I have to put a
lot of fluid, and it spreads. And actually, when it
first came out, myself included, I was diluting it the
way I was diluting botox, and I had some non
desirable outcomes. People immediately blame the disport. Again, yeah, you
should blame the provider. And now that now that I
(05:16):
use a very much more concentrated form, I feel like
the reason why I like it is when you put botox,
the drug goes and it works in a very finite space.
So the space right next to it, I feel, is
a bit more abrupt, like it's on off, on off,
whereas the disport kind of like spread.
Speaker 2 (05:35):
It has like a really nice diffusion.
Speaker 1 (05:37):
A diffusion to it exactly.
Speaker 2 (05:38):
So that's how I even felt when I had it
done on me. Personally, I've had botox done the very
first time and I felt like it was very harsh. Yeah,
but with the disport, it really was a soft effect,
but it gave me the exact type of results.
Speaker 1 (05:50):
Again, doesn't matter if you're going to respond they're injecting
you with daxify. As long as you like the outcomes
and the price point is about the same, that's really good.
The next thing about these is people want to know,
let's talk about where we can use them. So we're
the areas that what I would consider the core areas
that we would use the neuromodulators.
Speaker 2 (06:11):
Yeah, core areas would be the upper third of the face.
That'll help with the foreheadlines, the frown lines, and then
the crow's feet.
Speaker 1 (06:18):
Yeah, so we call them the number eleven people who
do a lot of frowning. Right right in the middle
of your eyebrows. Those are the muscles, are the corrugators,
and if you see they kind of move inwards. Some
people have an additional muscle called the preserus and it
comes it pulls down so it has a line across
the nose. There is the forehead, the frontalis, and then
(06:39):
of course the crow's feet, which are on the side.
And I think those are tried and true, and those
are areas that when people ask me, like, oh, I've
never done botox, before what areas you suggest. I always
suggest those three, even if one of your three areas
is worse than the others. So I don't generally tell
people to just do theirhead or just do their corrugators.
(07:02):
The reason being is that I feel, and I don't
know if you've experienced it, that when I inject one area,
I find like the other area gets a little worse
because people are trying to still animate without knowing it,
and it's just isolated and it just overcompensates.
Speaker 2 (07:18):
When you relax when area, the other area is going
to overcompensate and have a strong repult.
Speaker 1 (07:23):
Yeah. So those are the three tried and true areas.
But there's a boat load, I mean a boatload of
areas that people inject. Now, I myself, I just I've
always been more conservative and I like things that I
think are consistently awesome, not usually awesome. So the other
areas that people do I think that are effective. One.
(07:46):
I think massiters are effective, definitely. I think the problem
with massaters is overinjection. Yeah, it's a muscle you need,
right you don't need you.
Speaker 2 (07:59):
From talent common right now to do a lot of
botox and the massters because people want that cosmetic effect
of that facial swimming. But even for me in my practice,
I don't like to do that. I always I always
question the patient. I'm like, is this going to be
for cosmetic reasons or therapeutic?
Speaker 1 (08:14):
Right? So why would you do? Why does one do
the master? Right? Yeah?
Speaker 2 (08:19):
So for me, I like to treat the massters therapeutically.
If someone has strong massters, if they clench a lot,
if they have TMJ, if they just want a little
bit of relief from that area, doing the massaters with
botox could really relieve some of the pressure in that area.
Speaker 1 (08:34):
So we found that it affects migraines mm hmm. We
found that it affects grinding and teeth decay right some people.
I've had patients who have broken through mouth guards. We
found that it affects TMJ, which is directly, and we
found that affects just regular garden variety headaches. So in
that regard, I think it's really effective. The problem is
(08:58):
that as you inject the massa, it's a muscle and
a will start to soften and it becomes slimmer, and actually,
in my opinion, esthetically it looks worse. The reason I
don't like it is that we do everything we can
aesthetically to create a strong job and the muscle in
(09:19):
some people is a critical part of that angle of
the jaw, and I think when you over inject and
really melt that muscle down a I think that it
affects chewing, which is what the massacre was designed for. Two.
I think it softens the angle so much that you
lose that transition and your mandible kind of just blends
(09:40):
into your neck. The reason it became very popular esthetically
is actually in the Asian community, right because they're one
of the only, really the only community who has a
lot of jaw angle and maybe could benefit from a
little bit of so called slimmy But that's more of
(10:01):
a Korean like. They like heart shape, not square shape.
But I would tell you ninety nine point nine percent
of times I'm aesthetically striving for an angle, So I
would caution you. I think I never inject more than
fifteen units, So it's usually ten to fifteen units. You
see most people they're dropping twenty five units per side
or more. I think you're going to get into trouble.
(10:24):
Another area that I find really effective is injecting the
chin pad, right, and why would we inject the chin pad?
Speaker 2 (10:31):
Are this little temple?
Speaker 1 (10:33):
Yeah, I call it cobblestoning or pew the orange pew.
The orange is orange peeling, and it usually occurs for
people who are straining this muscle. The mentalis muscle helps
keep the mouth shut, and some people just animate forcing
their lips together.
Speaker 2 (10:51):
It's a little overreactive, and some people don't realize that
they even tend to do.
Speaker 1 (10:55):
Ninety nine percent of times where I do chin I
mentioned yeah, because it's one of those things that you
only do when you speak, and when you're looking in
the mirror, you're not speaking, so you don't see it.
So then it's one of those things that I generally suggest.
The beauty of that area is it's like five units.
It's like it takes nothing. An area that's Another area
(11:17):
that is effective but needs to be thought through a
little bit is neck bands. So neck bands is a
little you gotta be careful number one. It's a large muscle,
so you can drop a ton of money and a
ton of neuromodular for little gain. So, for example, I
(11:40):
do it a lot of actors and actresses people that
are on camera because of the band when they speak
and they animate, it sort of bounces and they see.
I stood in people who really don't want to have surgery,
but this is the caution. It must be exclusively muscle
(12:03):
and unless you're super young. Yeah, I'm talking early forties
or younger. I find that as you get into your
late forties and fifties, now you're having some skin accumulation,
so its skin and muscle, and then you'll inject these
bands and maybe it's a little better. Maybe it's a
(12:24):
little worse because now the muscle relaxes and your skin,
which needs a neck lift, becomes more prominent. So this
is neck bands. I don't think are a treatment for
people who are older and their necks starting to sag
and they need a facelift or a necklift. It's a
good thing in young people that have hyperactive or overactive necks. Yeah,
(12:47):
I agree. We have some areas that I don't love.
We have the DAOs. I'm not a fan. Some people
are what is the doos and what are they for?
Speaker 2 (13:03):
The dios pulled down the pretty much the lateral sides
of your mouth, So it's the ones that make you
frown like that, right, They're.
Speaker 1 (13:10):
The muscles adjacent to your mentalis, and when activated, they're
attached to the corner of the mouth and they pull
the corner of the mouth down. The idea or the
objective is that when you inject it and it relaxes
the muscle, the corners of the mouth wise up. My
(13:32):
experience has been that because that area has a cluster
of different muscles, there's actually not just one muscle there
that if it's not exactly done correctly, it causes actually
animation deformity, like you're talking and your mouth is just
off and like one side's higher than the other. And
(13:53):
for many years I found it to be very difficult
to get a super smooth outcome. So I personally have
stopped doing it. I just it's just too much of
a headache for me. Do you play with it sometimes?
Speaker 2 (14:08):
It really kind of just depends per patient, piece by case.
Speaker 1 (14:11):
Yeah, we have actually not very effective, but people who
have what do you call it smoker's lines upper lips.
Smoker lines when you pucker your lip like for a straw.
So that's a big complaint for a lot of people.
There is no perfect solution. It's a combination of things.
(14:32):
But putting in the tiniest amount of botox weakens your
obicularis and then it softens those wrinkles. But remember it
also affects your ability to speak, and it affects your
ability to pucker and more importantly, whistle or drink from
a straw. So when I say tiny, I mean tiny.
(14:56):
What other areas are there that are sort of more
random that people do?
Speaker 2 (15:02):
The Barbie botox.
Speaker 1 (15:03):
Traps definitely, in my opinion, a disaster. Yeah, no, no, no,
no no. Once you start getting to huge muscles, a
trap muscle first of all, Like the whole point of botox,
in my opinion, is because it's temporary, it has to
be cost effective. Yeah, So let's say I had a
(15:24):
procedure for you. It was three thousand dollars in every
three months you had to redo it. Like, what kind
of stupid procedure is that? So the beauty of these
other eras is they're like ten units, fifteen units, et cetera.
So the trap is huge. The idea is that it
relaxes the muscles, it causes soft kind of swimming down,
(15:46):
and then it's been associated with all kinds of other conditions,
breathing issues and things of that nature because you're now
injecting a lot of botox in critical areas and it's spreading.
So it wasn't there a lady who was on a ventilator. Yeah,
on Instagram she was literally on a ventilator because they
did I think trapped too much, trapping jobs. So I
think that's just again like everything, people are going to
(16:09):
be in a spa, they're going to sell you the product.
You know, they want to make more money, and I
just think it's overcare.
Speaker 2 (16:14):
And then with that too, a lot of people don't
realize that doing that much botox in that area, your
body is going to overcompensate for the lack of use
of these muscles, so then people start to get sore
backs and.
Speaker 1 (16:24):
Sore stupid idea, in my opinion. Another area that's kind
of interesting that I found in some people really love
it and it's a tiny amount is a lar flaring.
So some people when they speak or they talk, their nostril,
the roundness of their nostrils flares. It's it's a muscle
we use for deep breathing, Like if I ran a marathon,
(16:44):
at the end, I bet and my nostrils. But some
people just do that in conversation and it takes like
it's painful as hell.
Speaker 2 (16:51):
It's painful. I've tried it. It's very painful.
Speaker 1 (16:55):
It takes a dog, but it is.
Speaker 2 (16:57):
It's just a tiny drop, and it does make a
nice difference ending on the person that's you know.
Speaker 1 (17:01):
It makes a difference. There's the flip lip, yet another
one of those that I don't love, but I know
that you had dabbled in, and you do it here
and there, the idea being.
Speaker 2 (17:10):
Yeah, And even with that, I'm very selective on the
patients I like to do it on. I really like
to do it on patients who when they smile their
lip upper lip really curves in or have a gummy smile,
because it does relax the upper lip enough where you know,
it doesn't show.
Speaker 1 (17:24):
So gummy smile is a different story.
Speaker 2 (17:26):
Yeah, they're just doing a tiny little.
Speaker 1 (17:28):
I think gummy smile is a phenomenal use for it.
So what is so there are people when they smile
just regular, their upper lip gets pulled up so high
that in addition to their teeth, they see a lot
of gum and it's generally not a very attractive look.
And by dropping a tiny amount of botox in the
upper portions right at the pure forms where the nasalabia
(17:51):
folds are. It softens up muscles so that you don't
retract it up as high, and I have actually found
that in some people it's very very effective. The next
thing is philosophically, I have for twenty years been injecting
half the dose that is normally injected everywhere else. I
(18:13):
want you to just want you to listen to me here. Recently,
I just love all these stupid marketing names. They call
it baby botox, and it's like baby botox, What the
fuck is baby dough botox? We're not injecting babies. So
what it is is they realize For me, when I
came out of training, there's the sort of guidelines, right,
and when I interviewed a bunch of nurses, it was
(18:34):
obvious to me that they're all trained with these stupid guidelines.
Who makes the guidelines, the companies that sell the product.
And the idea is that like a forehead is twenty units,
let's just use that as an idea. Between the eyes
is twenty units. Each eye for the crows feed is
ten and ten, which is twenty units. So the average
(18:55):
patient who goes and gets these products gets fifty to sixty.
I inject for twenty years, twenty to twenty five units,
the occasional thirty unit. And when I interviewed a bunch
of people, I had them come in, and I had
the one easy way to just check check their preferences
(19:17):
was to ask them. They'd walk in, I'd be like,
all right, here's Gail. Gale's my patient. How much do
you inject? And they're like, oh, fifty five units? And
like I'd open up Gale's chart and I'd be like, look,
Gale's been coming to me for fifteen years. Every single
one of these is twenty twenty two, twenty five, twenty two,
twenty two, twenty five. And the reason is that people
(19:37):
in general want to look natural. What makes you look
not natural is it's just too strong, and you get
frozen forehead, your brows drop, you animate weirdly when you smile,
like nothing moves, but some like muscle way back. Where
So this idea of baby botox is ridiculous. It just
means injecting the correct amount. And ironically, in men, I
(20:04):
inject less botox than I do in women, yet they
have stronger muscles. Do you know why?
Speaker 2 (20:11):
So that it doesn't freeze the area, and it looks
a lot more natural.
Speaker 1 (20:14):
Guys look ridiculous, ridiculous when frozen women, we have a
different esthetic for a woman. It's more glossy, it's more polished,
it's more smooth. Men. The reason we do botox is
to just slow down the wrinkle formation. So number one
reason why I inject less in men than women is
they just look odd, sort of, that whole masculine element
(20:37):
of them goes away. The second reason is because in
general men's brows, a man's browseits lower than a woman's brow.
So often if you meet a guy and you're like, hey,
have you tried botox? Oh no, no, no, I'm never
doing that again. Well what happened? Oh my brows were
so heavy and I well, that's because you went to
someone they injected you with botox. They relaxed the muscle
(20:59):
and it dropped your brain and as a result, you
hated your experience and now you stay clear of botox,
when in reality you should be staying clear of that injecty. Okay,
So that's that another thing that I'm we need to
clarify about, which I hear almost every day. The idea
is like, hey, doctor Rebond, can you put some botox
(21:19):
right here on the outer brow? Why would you want
me to inject you there? I want my eyebrows to
go up. So wait, you want me to put botox
in the corner of your eyebrow, so your eyebrow goes up.
You do know that if I put botox in the
corner of your eyebrow, your eyebrow will go down. Right, Wait,
what do you mean? So let's talk about this idea
(21:42):
of browlifts. So when you put botox, and again we're
using botox as a global term, anywhere it paralyzes that muscle,
then that muscle doesn't work. Then what that muscle was doing,
it doesn't do anymore. So your forehead muscle lifts up
(22:02):
your brow. So anywhere you inject it drops the brow. Yeah,
so how do we get a browlift? Then it's certainly
not from putting the botox where you want it lifted, right,
So tell me how we get a browlift.
Speaker 2 (22:16):
Then I do a little bit on the ubiculous oris,
because that is a muscle that does do a little
bit of a depression. So remember botoxas the opposite of
what it is supposed to do. So oftentimes if you
do a tiny drop there, it'll just give a little
eye opening effect.
Speaker 1 (22:30):
Right. So the two ways that you can raise the
brows that can be done individually or together is one
knock out the obicularis which is the crow's feet, which
then relaxes right, relaxes, and that lets the brow free
and goes up and or inject the middle of the
(22:51):
forehead and not the outer part. And that allows the
middle not to move and the outer to move, which
will then lead it to lift high. So it's a dial.
In some people, that's exactly what they don't want, and
that's exactly what they tell me they want to avoid,
is that spark. Look, I don't want my eyebrows in
(23:11):
the eye up in the air. And in some people
their brows are super flat and that's what they're begging for.
So that's why you are provider needs to say, Hey,
you're a bad candidate for raising brows, and you're a
great candidate for raising brows.
Speaker 2 (23:25):
I've had I've had inchecktors want to raise my brows
every time, and I'm like, do you see these browsies
are natural? Like I do not need a brows whatsoever.
Please do not touch that.
Speaker 1 (23:33):
It's gonna look. I'm gonna definitely look in surprise. Yeah,
all right, son, So let's go over what is the
when when a patient comes in they're having botox done
for the first time. What is the recovery so to speak,
because like, oh, there's been so many things about what
I can do and I can't do whatever, So what
do you what do you tell them is they're recovery.
Speaker 2 (23:53):
Recovery is very mild with botox. You know, you could
come in and do it. It takes about five ten minutes
to do and afterwards, you know, you might have a
little bit of some tiny, little pinpoint bleeding in the
areas that were injected, very tiny, maybe a little swelling
from the bowtox itself, but those bubbles will go down
in about twenty minutes. Other than that, the rest of
the day you're pretty free. I just recommend patients don't
(24:15):
go to the gym right afterwards. No hot tubs on
the steam rooms lay up right for about three to
four hours, but pretty wild. Can you turn to your normal
activities the next day?
Speaker 1 (24:25):
Yeah, So here are the things that Number one, it's
if done correctly, you should come in, inject, go back
to work within thirty minutes. Number Two, usually I would say,
in all the botox I've done in twenty years, maybe
one percent of people get bruising. Yeah, very little, it's
very unlikely. Number Three, you can resume everything you were doing.
(24:50):
Oh I heard, I can't do this. No, I can't.
You can do everything. The only thing we suggest, and
this is really more of a suggestion, is we just
injected you with this that is sort of going to
attach to something. It's going to attach the muscle. So
we highly suggest you don't do things that make you
sweat a boatload early on right away. So exactly I
(25:11):
wouldn't go and do like a major cardio class. I
wouldn't go in a sauna, steam shower, jacuzi whatever, because
you're heating up. What can I do tomorrow? Everything? The
only other thing I also to tell you is don't
do the injection and then go lay on a massage
table with your face in a table, point down, pressure
on your face for three hours that same night. So
other than that, go to a dinner, go to a movie,
(25:32):
put on makeup, whatever. So it's really actually a very
simple and easy recovery. How often do I need to
get the boat.
Speaker 2 (25:42):
Talks usually three to four months on outage.
Speaker 1 (25:44):
So I want you guys to listen to this concept
because it's very important for you to understand that I
can inject you with a boatload of boatox and it
will last six months. So you come in twice a
year and you'll be frozen like for the first two
and a half months, you'll be frozen. Or I can
inject you with less botox more often, in which case
you'll look natural. At the end of the year, you
(26:06):
will have spent the same amount of money. So it
is the idea is less more often than more less often,
and the less I inject more often, the more natural
you will look. So we have found that that happy
place where I'm not in here every three weeks and
I'm not coming in every six months is three to
(26:28):
four months. Right around three months, it'll start giving way,
so that when you get to four months, you're due
and there's probably ten to fifteen percent of it's still left,
and you kind of just pit it again and let
it go, and hit it again and let it go.
So that's usually the timeframe that we would suggest, which
is the best. Three times a year is really what
it takes. Let's talk quickly about complications. So complications, you know,
(26:56):
what could go terribly wrong.
Speaker 2 (26:58):
Honestly, really cruising if you can bruise for a couple
of days. But again, like you said, that's going to
be very minimal. Other than that, I mean unless you
have a severe allergy. I haven't really seen any complications
unless it's overly injected.
Speaker 1 (27:12):
Yeah, so that Yeah, the things that can go wrong
are very very minimal. You have to remember something about
this drug. This drug has been around for now thirty
forty I don't know many many years, and it's been
injected in over billions of people. So let's take any
(27:32):
drug and let's say the complication rate of a drug
is I don't know one percent. I make it up.
That is a lot of complications. Yeah, right, you would.
It would be on the internet, it'd be everywhere. So
the reality is like point zero something. The things that
are very the things that are inject or driven are
(27:54):
someone can over inject your brows and then your brows
drop and now you're like, god, damn it, my brow
is so heavy. Hey doctor Bond, I need you to
fix this. There ain't no fixing it. Yeah, there is
a drug that was recently discussed where it can reverse botox,
but I don't. I don't think it's made to the
(28:18):
market so for now and has been forever, you own
it for three to four months. The second thing that
can happen, which is ten times worse than dropping your brow,
is you can drop your eyelid. Then you're really pissed,
which means the muscle that keeps your eyelid open, the levador,
is right underneath your eyebrow. So if someone injects you
(28:42):
right over your eyelid and it's too much or it spreads,
it'll drop into your eyelid and then it'll knock your
eyelid out, and then your eyelid will be droopy and
you'll be really annoyed for a couple of months. Yeah,
that's the next thing it happened. It's pretty bulletproof. Pretty bulletproof. Yes.
(29:03):
Bruising is usually if you're a bruised and you're like,
every time I go, I'm hella bruise. Something's not right.
Either you have a bleeding disorder or your injector's a hack.
But it should be boom boom boom boom in out
and you go about your business. But yeah.
Speaker 2 (29:16):
Other than that, I say, majority of the times, even
if you absolutely hate the botox, it'll wear off in
three to four months, everything goes back to normal.
Speaker 1 (29:24):
So yeah, yeah, I mean doesn't happen. The one beauty
of botox is that it's one hundred percent reversible. And
so if you have a bad experience, and my suggestion
to you is if you had both, if you did
botox and you had a bad experience, you should just
go to another provider, not eliminate botox. It's just too
valuablellet tool to help you maintain a overall beautiful esthetic.
(29:51):
So here is my philosophy about boatox, and I think
this is really important for you to understand. Who should
do botox? Everyone? Wait, come on, doctor Von everyone everyone
at what age? Mid twenties? Yeah? What? So here's the
basic principle. Botox is misnamed as preventative. Preventative means I
(30:14):
do something and it prevents something from happening. It is
not preventative. It is delayative. It delays something from happening
that will happen. So we know for a fact that
every human being after one million, two hundred forty seven thousand,
two hundred and four animations meaning moving my eyebrow. Smiling
(30:36):
then makes a wrinkle that is temporary, Like my son
makes wrinkles when he smiles, and then when he's not smiling,
he's porcelain smooth. At the age of thirty seven or whatever,
that wrinkle he has will become permanent. He'll not smile.
You're just standing here and there it is. Look at
that wrinkle in your forehead, and then after a certain
period of time it's etched in. It's actually a scar.
(30:59):
It is a embedded in your dermiss. So if there's
a treatment that's relatively affordable, relatively low risk, easy to
do that eliminates or slows down the progression of these wrinkles,
why on earth wouldn't you do it? And so the
(31:21):
reality is the sooner you start, the longer it takes
for those wrinkles to become permanent and irreversible. If you
show up in my office at sixty and you've never
done it before, I cannot get you to a place
where you're going to be like, oh my god, that's beautiful.
(31:41):
The botox will help a little bit. Then I got
to resurface your skin. Then I got to inject the
wrinkles with thiller. However, if you come here and you're young,
and I don't need it, exactly precisely, you don't need it,
you're not doing it because you need it. You're doing
it because you will need it. So the difference is
when my niece or my young patients come in, I
(32:03):
put an eight tiny amount, tiny tiny like fifteen units,
and when someone comes in and they need it, I
put in still very little, but more. The idea being
I put less in people who don't need as much
of it because I'm trying to just slow down the progression.
So I'm a big, big, big, big fan of neuromodulators.
(32:26):
The number one key to neuromodulators is less is more.
That's all you need to do. Literally, Oh my god,
doctor ban I'll go nowhere else. You're incredible. And I
keep telling them it's just I'm really conservative, and so
when you're conservative, it looks great. Why aren't other people
doing it that way? They make money? Listen, it's very simple.
(32:52):
They're bias. If I inject you with fifteen twenty units
for a unit of time I'm here, you're standing in
front of me, I'm injecting you with fifteen to twenty
units or forty to sixty units, which is better for me.
That is the answer of why people are frozen across
this country, because people are just getting over injected with botox.
(33:15):
And we'll be talking about filler in our next episode.
And this is the same shit there too. The whole
duck effect occurred because I make money injecting you. Holy shit,
all of a sudden, now you need two syringes instead
of one. I think that's really about it. I'm I
think we hit all the key points. I don't think
there's anything else. Is there anything else on the neuromodulators?
(33:35):
All right, guys, I hope you like that tutorial, that
basic intro, that basic if you will overview on neuromodulators,
come and check us out. Come to our new restore
by Ramon MD. I refer to it as a wellness
center because in addition to all the esthetic treatments that
we offer, which is botox, fillers, micro needling, lasers, PRP skincare,
(34:01):
in addition to all those things, we're gonna hopefully be
adding wellness and ad drapes, vitamins, things of that nature.
So all right, that's a rap. As always, if you
like our show. Do me two favors. One go write
up great reviews and number two, share this information with
people you love. At the end of the day, the
purpose of this podcast is educational and you just simply
(34:24):
don't know who knows what and who doesn't, So share
this with your friends, download and subscribe. All right, guys,
that's a rap. We will see you next week on
Plastic Surgery Uncensored. As always, your host, doctor Rodney rab
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