Botox and Dermal Fillers

Can botox cause severe complications from distant spread of facial botox?

No deaths were ever reported in cases of less than hundreds of units. One lady died from respiratory complications after spread of 300 units in the legs, patient in this case was given medical botox. One man injected and killed a whole party with Veterinary botox- a massive overdose of thousands of units. This product is different from Allergan Cosmetic botox, which you should only ever receive.

What treatment helps eyelid droop (ptosis), if I am one of the unlucky 1-2% of botox patients who gets this complication after botox injection in the upper face?

Most ‘droopy eyes’ are actually droopy eyebrows due to injection of the horizontal forehead lines. If this is the cause the droop should improve by gently lifting up the brows. You can try to improve this type of droop by adding more Botox into the brow depressors (the frown lines) and by avoiding as much being put into the forehead lines in future botox treatment. If a true blepharoptosis occurs, over the counter Naphcon-A 1 drop 4 times daily can help. Doctor consultation is preferred for exact diagnosis, and a prescription for Iopidine,.5% -2 drops, three times daily. Both Naphcon and Iopidine work by contracting the Muellers Muscle, which is an adrenergic levator muscle in the upper eyelid. Some droopy eyelids are not true ptosis, but dermatachelasis, loose skin on the upper eyelid.Frontal botox patients often complain of heavier eyebrow sensation. That heavy sensation is due to the frontalis muscle relaxing its normally tensioning force on the whole brow area. You can simulate the effect during initial botox consult, by depressing frontal face muscles with gentle downward pressure to about 1/4″ lower.

What if botox accident occurs and a little drop of botox dribbles into my eye?

Yes, I have heard and read of this happening in the past. A patient asked me about it, I researched it and concluded the following… Relax, it’s going to be ok! Gentle irrigation of the eye is all the treatment that’s required. You will most likely not get a ptosis, headaches, or any paralysis or ill effects of this from this. The general consensus of all the credible patient accounts is that this has happened a number of times and never resulted in any negative consequences.

How can I cover a bruise on my face regardless of however it got there botox, fillers or whatever?

Use the color wheel to correct the dark blue bruise color back to neutral before applying your natural skin color base makeup.

What are the advantages of filler treatment with a doctor specializing in the DermaSculpt system?

Less bruising, lower risk of unwanted injection into blood vessels. Unwanted filler injection into blood vessels, is the cause of both ophthalmic artery embolization causing blindness after filler injection, and watershed necrosis of facial tissue following accidental injection of blood vessels in the face. Scare yourself with a simple google of filler complications. The pictures from the lady up in Redding are shocking — a large section of her cheek has become necrotic, and is open and appearing to fester. I hope she finds a great surgeon for a graft flap, and I hope this never happens to anyone else. I will do everything I can to prevent this from happening to any of my patients. Protect yourself with this knowledge and your physician selection.

How does derma-sculpt work?

A very small needle is used to make a very small ‘pinhole’ in the skin. The soft tipped, plastic cannula is then inserted- and the filler is very gently placed after very gently sliding the cannula past blood vessels and nerves-instead of cutting through them like a conventional needle would. The cannula never punctures vessels this way and is virtually pain free as well! Watch the online videos on the DermaSculpt website, and amaze yourself with this new truly revolutionary system. I am not pain, and do not own this company. I pay them for their amazing medical cannulas as a doctor customer, and promote the system because I see how much it benefits our patients with every filler case. Once you get treated with the system, I guarantee you will never go back to a traditional needle using practitioner… and you will hopefully never get bruises again either.

How can I avoid bruising with dermal filler therapy?

Seek a physician using the Derma-Sculpt soft tip cannula injection system instead of traditional needles. Ice, Arnica Montana a Homeopathic remedy, pre-planning to avoid treatment 10 days prior to important events, and avoiding blood thinners like fish oil all help. Lips are very vascular, and are the most common area to bleed when injected.

What is the most common and hated side effect of dermal filler therapy?


What is the most common complaint about botox therapy?

The injections sting for about 10 seconds afterwards.

How much botox is required to treat common areas of the face?

The forehead requires 20 units botox
The frown lines (Glabellar = between the eyebrows) 20 units
The crows feet 18 units

Can droopy eyelids (dermatachalasis) be treated with botox?

No. Droopy upper eyelids get worse with botox treatment to the forehead; it is a contraindication to treatment. Blepharoplasty surgery is the only treatment for this condition, but may leave patients with inability to completely close the eyelids.

What are the major complications seen with botox therapy?

Blepharaptosis (drooping eyelid) occurs in 1-2% of treated patients. Eyebrow ptosis (drooping eyebrow) can also rarely occur.

How effective is botox?

Very. Only 1-2% of the population has or develops autoantibodies to botox, rendering it ineffective.

Who should avoid botox treatment?

Patients who are pregnant or nursing, infections of the face like acne or herpes, recent surgeries, paralysis, weak immune systems like AIDS or cancer, current antibiotics that weaken muscle contractions like calcium channel blockers or aminoglycosides, quinine, active eczema or psoriasis, any form of paralysis or muscle weakness like Bells Palsy, body dysmorphic disorder, or anyone who will be adversely affected by unwanted facial muscle paralysis like actors.

How do Botox, Dysport or Xeomin work?

Botulinum toxin is a natural protein that blocks Acetylcholine release-blocking muscular contraction and decreasing DYNAMIC wrinkles. Over time, long term skin stretching leading to STATIC wrinkles. Static wrinkles respond better to laser skin tightening and fillers.

What are the advantages or disadvantages of these new forms of ‘botox’?

Dysport can be effective in as little as 2-3 days after injection. Botox requires 7-8 days to take effect (though some patients react much more rapidly). Botox has a longer track record for safety, though dysport is gaining widespread approval in the medical and aesthetic community. Dysport and Xeomin may be less expensive.

What are Dysport or Xeomin?

Others branded products containing Botulinum toxin serotype A.

What is botox?

A brand name for a medication containing Botulinum toxin serotype A.

Where do wrinkles come from?

Skin naturally thins and stretches with time. Cumulative sun exposure, a natural decrease in the facial fat pad with aging, and a natural decrease in protein (synthesis of collagen) all contribute to increased wrinkles.

Laser Hair Treatment

What kind of anesthesia can be used for laser hair treatment?

Cold air, a chilled treatment head on the laser, and topical lidocaine are all effective and used to great success in my practice at Santa Cruz Med Spa.

What are the phases of hair growth?

Anagen = growth phase with darkest color, Catagen = regression phase where the follicle dies back, and Telogen phase = rest phase with the lightest color follicles, and the least effective hair reduction treatment.

Why is hair reduction always sold as a series?

Because Laser Hair reduction is only effective on the actively growing portion of hair follicles, rich in dark pigment-melanin. The % hair in active growth (Anagen phase) varies from a high 85% for scalp hair, 70% for beard hair, 65% lip, axillae underarm hair 30%, pubic area 30%, arms 20%, legs 20%. To further complicate hair reduction- the untreatable resting phase hairs vary in duration of Telogen phase from every 6 weeks on the lip, to 3 months in the pubis and axilla, to 6 months of rest for leg hairs! No wonder leg hair is so hard to get rid of!

How does laser hair removal work?

By Selective Photothermolysis, a process where light is selectively absorbed by target molecules (chromophores: in hair = melanin = maximal absorption between 650-1100nm), converting light to heat energy. This destroys hair follicles and the very important stem cells that surround the follicle. If the stem cells survive, then the follicle can regrow, even if ‘destroyed’.

What lasers are FDA approved for hair removal?

None! They have been approved for hair reduction = decrease in the number count, diameter or color of hair.

Why is it beneficial to be treated by a high quality, state of the art laser?

Because many new innovations like q-switching (engineering the laser to fire very intense very brief pulses), and variable pulse width (very long duration light beams to spread out a given fluence of energy over a longer period to decrease pain and risk of burning darker pigmented patients).

What is the best laser for hair reduction?

That depends on the patient’s skin color, as well as hair type and color. For lighter skinned patients (Fitzpatrick skin types 1,2 ,3 or a low 4 with longer pulse width), a diode laser 810 nm wavelength light is best. The Lumenous LightSheer is considered the ‘Gold Standard’ for hair removal lasers. It is very effective, but can hurt. The newest models allow the lengthening of pulse width from 30, 100 or 400 milliseconds-to spread out the laser beam energy over more time, allowing treatment of even Fitzpatrick skin types 5 and light 6’s with a diode laser! Dr Battle at Harvard has an excellent lecture and research on this topic. For Darker skinned patients (Fitzpatrick types 5 and 6), the long pulse nd-Yag laser(1064nm wavelength) light has traditionally thought to be best. It reduces hair with less risk of adverse pigmentary changes like light or dark spots, burns or blisters. The q-switched nd-YAG, is a laser that pulses very briefly in millionths of a second. It runs the lowest risk of burning the patient, but was traditionally thought to provide only temporary hair reduction. Recently, some evidence has indicated the hair removal may be more permanent than previously thought. The q-switched nd-YAG is also one of the ONLY lasers effective for reducing the very fine mustache hair on women’ upper lips.

What are the various useful wavelengths filters from an IPL beam?

640nm light is useful for Hair reduction
530nm-1200nm light for Skin Rejuvenation
510nm-1200nm light for Vascular treatment
420nm-1200nm for Acne treatment
800nm-1200nm for Skin Tightening

How does IPL differ from a true laser?

A laser beam of light has a single wavelength of light, IPL is an intense beam of a range of wavelengths from 420nm up to 1200 nm.

What is IPL?

Intense pulsed light.


How can I treat sun damaged skin?

Photorejuvenation is a process where laser light targets and damages (in a controlled fashion) benign pigmented skin lesions by heating the melanin and oxyhemaglobin in them. They are then eliminated and replaced with fresh skin without the sun damaged pigmented spots.

Are there other benefits to laser skin tightening?

Yes, a rejuvenation process follows treatment. Sun damaged skin with wrinkles, rough surface texture, and dark spots (solar lentigines), all ideally improve after a series treatment.

How exactly does Laser skin tightening work?

Laser energy heats the dermis up to 8 mm deep, causing mild injury which stimulates a healing response. Skin proteins called collagen, are like thin strings which pull on the skin from deep attachments, giving skin a youthful, firm appearance with less looseness or wrinkles. A process called collagen remodeling tightens existing collagen, and stimulates the body to produce new collagen. The epidermis remains intact; no bleeding occurs, and pain is almost non-existent.

How many treatments are recommended for laser skin tightening?

A series of 6 treatments are ideal, a series of at least 3 are recommended: the benefits of laser skin tightening are gentle, subtle and cumulative. The collagen synthesis benefit has been documented to last 2 years after a series of treatments, giving a more permanent benefit than botox which lasts 3 months, or fillers which last 6-12 months.

What laser type is used for laser skin tightening?

Traditionally, IPL filtered to frequencies of 530 nm – 1200 nm is used. Fractional ablative lasers like the erb-YAG and CO2 lasers are effective, but have long recovery time, painful bleeding, and can lead to unwanted light or dark colored skin. Non-ablative lasers including the q-switched nd-YAG =1064 nm light are the safest, have the least down time and pain after the procedure, and the least chance of unwanted pigmentary changes of the underlying skin. The nd-Yag laser penetrates 8 mm deep into the skin surface, a huge advantage over IPL that only penetrates 1 mm deep.

What is laser skin tightening?

Use of light therapy to stimulate collagen synthesis in skin, giving skin more
firmness, elasticity, and reducing loose ‘crepey’ skin appearance.

Is there anything besides botox, fillers like Juverderm or surgery to help facial wrinkles?

Yes, Laser skin tightening.