Amazingly, despite the drumbeat of negative business news about the economy, record numbers of people are requesting Botox treatments from Maine Laser Skin Care this year, definitely outpacing our previous record pace from last year. Although I have written extensively about Botox in prior newsletters and blog entries, several questions come up recently and frequently enough to warrant further attention here.
“How do you (Dr. Burke) decide how much Botox to use?”
As many of you may know, Botox is measured in units as opposed to milligrams which most other medications are measured in. The amount of Botox units that I recommend depends on the area of the face involved, whether the person has had Botox in that area before, and finally how strong the muscles are in that area. In general, facial muscles in younger people are stronger. The muscles are also stronger if Botox has not been used in that area before.
The glabellar area (between the eyebrows and just above the nose) possesses the strongest muscles of the upper face and therefore requires the most Botox, especially for the initial treatment. I generally start with 20 units spread in 3-5 injections, although some younger and first treatment patients may require up to 30 units in that area.
The forehead area wrinkles are formed by a much weaker and thinner muscle called the frontalis. In this area, I start with 12 units in 4-6 injections and I generally don’t have to go above 15 units.
The “crow’s feet” areas around the eyes are formed by the orbicularis oculi muscle, which is also a weaker muscle compared to the glabellar area. It is also a circular muscle and very shallow below the skin close to the eye. I use 12-15 units in 6 injections divided between the two sides.
My philosophy is that in this area of medicine, there is a lot of art involved. Before the operations, I always have people smile, scowl and squint to show me how their muscles function to form their individual wrinkles or lines and how strong these muscles are. This gives me a good idea of how much Botox to start off with, especially in this initial evaluation and treatment.
“How do you decide where to inject the Botox?”
When I was initially trained in the use of Botox a number of years ago, I reviewed the anatomy of the facial muscles and learned about the recommended sites of injection. Since the upper face is the most common site for Botox injection, it is important not to inject Botox too close to the eyes. In those initial courses, precise measurements are made and marks are made on the face to designate the sites of injection.
As anyone can tell by looking at different people’s faces, everybody’s face is slightly different. Some people have high or narrow foreheads; some have high cheekbones or narrow eyes. As a doctor, I have to analyze each individual person’s face and decide the best sites for Botox injection. Just as a surgeon does not mark the abdomen when he/she performs an appendectomy or a hair stylist does not have to measure the length of hair that he/she cuts, I no longer mark the person’s face. Having injected Botox for over 5 years and having treated over 200 people with Botox in 2008 alone, writing on a person’s face is thankfully no longer necessary for me.
I have found that for each individual person’s face, my adjustment of injection sites and the dosage of Botox creates the best results. By using this method, my patient satisfaction is very high and most patients want repeat treatments when their previous Botox wears off.
I hope that the information above answers some of your questions. If you have any other questions concerning this article and any other skin issues, please leave a comment on this blog or call our office directly at (207) 873-2158 or email through our website.