Lessons learned from thousands of Botox treatment procedures I have made since 2002

2002 Yılından Beri Yaptığım Binlerce Botoks Uygulaması Bana Ne Öğretti?

I still remember that day...

Date: September 20, 2002, Friday

I’ve opened my clinic, and for the first time, I have to apply a Botox injection to my patient.

At first, I went through special training, read the latest literature on this topic, and conducted trial procedures under the supervision of experienced colleagues. But here I am all on my own, and I am about to independently carry out a procedure without any mentors. Below there is a photo of that day. Time flies ...

I’ve purchased a cold-packed drug that was very expensive at the time. I diluted it in appropriate conditions and calculated the dose for my patient. Then I disinfected the injection area and injected the drug. Everything went smoothly. We got a good result. But all the arrangements, drug preparation, and the procedure itself took me 4 hours that day. I was exhausted as if I had to heavy lift for half a day.

Today it takes me only 5 minutes. Of course, the arrangements and preparation process is facilitated by my helpful assistants.

Today I can make Botox almost with my eyes closed. It is not a joke. I, of course, do not make injections with my eyes closed. But once before the Botox procedure of my friend, I asked her to strain and relax the facial muscles. Then I closed my eyes and marked with a pen all the injection points on her face. We checked them according to the scheme, all points were spotted perfectly.

How did I do this? Years of experience of injecting Botox certainly matters. However, the face anatomy, facial muscles, the structure of the nerves, and blood vessels are very complex systems. The facial muscles determine the shape of our faces. If you do not know the structure of the muscles and the degree of their contraction, Botox will not bring the desired result. Since I know the structure of my face well, I make Botox to myself. You can read about it here blog/story-of-the-dermatologist-who-self-injects-botox

And despite many years of practical experience, every time I take a syringe in my hands, I should act as if I am about to make a Botox injection for the first time. No, I'm not worried anymore, but I concentrate and get focused like it’s the first time. Each patient has an individual muscle structure and features of muscle contractions. To achieve the perfect result, the analysis should be carried out meticulously.

Nowadays, Botox is the most popular cosmetic procedure in our country as well as throughout the world.

Why? Thanks to undeniable and unparalleled effectiveness.

I participated in dozens of dermatology conferences, both as a listener and a speaker; I discussed this topic with my colleagues for hours and, most importantly, conducted thousands of Botox procedures, which greatly enriched my knowledge and background in this area.

This article instead of telling the well-known facts about Botox, but about the intricacies I have learned through the years of my practice.

Nuances about Botox based on the first-hand experience

1-The very first Botox procedure may not give the maximum result.

If a dermatologist takes this patient for the first time, he/she needs to analyze the facial structure, observe facial movements and calculate the appropriate dose of Botox.

I am very serious about this survey. However, there are indicators that are impossible to obtain in advance. There is no way to understand the individual strength of the facial muscles of the patient, and how they will react to the relaxing effect of the drug prior to the procedure.

Therefore, I could not achieve the ideal result from the very first Botox procedure in one-quarter of my patients. Reasons explained in detail:

Some muscles may be more resistant to Botox. And sometimes the right side muscles and the left side muscles react to Botox differently. I can easily understand this, since the dose on both sides is the same, and the degree of muscle relaxation is different.

Even if I assume the degree of muscle relaxation of the patient, I always prefer to start with a small dose of Botox. Because if the estimated dose is too high, and the effect is too strong, there may be a frozen mask effect that is difficult to reverse. You have to wait until the effects of Botox will pass. If the dose is insufficient, it is very easy to fix it by making an additional injection. That is why I always call my patients for the control follow-up 10 days after the procedure. If the patient came to Antalya for a holiday and has to leave before the 10th-day follow-up, then I apply the calculated dose completely.

The follow-up visit after the Botox procedure is of great importance. I have already said that since the very first Botox procedure in 2002, I would always definitely assign a follow-up visit to all my patients. I compare the photos of the patient before and after. All pictures of my patients are stored in the digital archive of the clinic. I open them in two clicks and see the condition of the skin before and after the procedures, the dose, all the details related to the muscle response to the drug. I save this data in the patient's file. This is how I know that from the very first procedure 75% of the patients get the desired result, and in 25% of the patients, the ideal result is achieved after applying an additional dose.

Why do I need such precision?

These details help me get the perfect result from the second procedure. I study the patient's file with the details of the first procedure, the response to the doses administered, and the volume of additional doses. This data allows me to achieve perfection in the second procedure.

2-The regularity of Botox injections is not just important. It is crucial.

Wrinkle formation is highly dependent on facial movements. Mimic wrinkles begin to form after 20 years and deepen with age. At first they become noticeable with contraction of the facial muscles (dynamic wrinkles), and over the years they become visible even when the face does not move (static wrinkles).

Botox makes the target muscles relax thereby preventing the formation of mimic wrinkles.

Botox is known as an effective anti-wrinkle medicine, and this is true.

Based on my observations I can say that the regular use of Botox prevents wrinkle deepening even after its effect is over. Moreover, it contributes to the elimination of wrinkles already formed.

The effectiveness of preventing new wrinkles formation with regular Botox injections is well known and scientifically proven. I want to show you the results of a Botox study conducted on twins. One of the twin sisters was regularly given Botox injections, while the other did not have Botox at all. The photos below show the difference in the appearance of these twin sisters in late middle age.

I will give you one more example from my own patient archive.

Below are the pictures of one of my patients who has been having his Botox done regularly.

I'll tell you his story.

In the two pictures on the top, you see the longitudinal mimic wrinkles on the forehead of my patient 11 years ago. Even when static these are very deep permanent wrinkles. He has a strong muscular structure which causes the formation of highly visible wrinkles.

This patient regularly comes for the Botox injections for 11 years. The touch of grey hair in the last photo helps us understand that 11 years have passed.

The two photos in the bottom were taken 11 years later before the next Botox procedure. Please note that these photos were taken before the injection, and there is no Botox effect yet. But there is an effect of the regularity of procedures during 11 years. The current appearance of the patient is much better than 11 years ago.

Regular Botox injections not only prevent new wrinkles but also smooth the old ones. Turning back the clock.

(These photos are used with the permission of the patient and do not reveal his face.)

3-Botox is a budget-friendly procedure

Why?

There is no need to praise Botox and prove its effectiveness. Everything has long been known and proven. But I often hear complaints about Botox being very expensive.

Let's make a comparison. Anti-wrinkle creams (cosmeceuticals) usually contain active molecules of peptides, vitamin C and retinol. Money that you spend on affordable antiaging creams annually and the cost of annual Botox treatment are almost the same. Expensive antiaging creams will cost you more than Botox.

If the annual cost of antiaging creams and Botox can still be compared, the effect is simply incomparable.

If the creams are “one syllable, maximum a word”, then Botox is a whole novel consisting of three volumes.

4-Botox does not cause a frozen face

Lack of facial expression and unnaturally static face even when you laugh or get angry is called a frozen face effect. We see such faces on the screen and hear that Botox is to blame.

At the same time, the “frozen face” or “natural-looking Botox” depends on the dose administered during the procedure. I want to show you this on the example of celebrities.

In the first picture (left) we see an excellent result of the Botox procedure, and in the picture next to it the frozen face effect is striking.

I will tell you a secret. Every day you come across women and men who have their Botox done but you notice only those who have a frozen face. Others simply pass by or chat with you in a cafe for hours and you do not even suspect that they have Botox too. All thanks to the experienced and skillful doctors.

Botox, of course, can create a frozen face effect. But this is the preference of the patient.

Frankly, I can understand those who want to have the frozen face-effect. The skin becomes so smooth as if you are 20 again. I have patients who sacrifice their lively facial expressions for the sake of the complete absence of wrinkles.

But at the same time, I want to recommend you the following. Use Botox so as to minimize wrinkles, but at the same time keep a couple of small natural fine lines. It will provide aesthetics but keep your looks natural. For example, take a look at Gwyneth Paltrow’s picture. How natural her face looks. The difference before and after shows a positive effect. This is a great example of a natural appearance after Botox injections.

5-The effect of Botox does not cut like a knife.

As you know, the effect of Botox lasts for 4 months. But, to put it scientifically, it lasts from 3 to 6 months.

I also need to emphasize that after 4 months the effect does not stop instantly. After approximately 2.5 - 3 months it gradually weakens, and after 4-5 months the face returns to the state as before the procedure. I will try to explain it to you on the example of the photos below.

Photo 1: face before Botox

Photo 2: the full effect of Botox

Photo 3: the effect of Botox 3 months later; the effect is less, but still remains.

Photo 4: 4 months later. We define this stage as the end of the Botox effect because the movement of the facial muscles returns. However, at this stage, the face looks better than before the procedure. After a while, the effect will disappear completely.

Some patients come to me after 3 months complaining that the effect has passed. These are usually new patients. We immediately photograph them and compare the pictures with the pictures taken before the procedure. We see that the effect goes on. I remind them of this with their own pictures, and most of the time they get convinced. But, to be honest, sometimes I cannot convince some patients. They consider this my mistake. And only after having done their Botox injections to a couple of other doctors, they understand how it works. Then they come to me again admitting that their conclusions were unfair and hasty.

In this regard, I want to mention two points, one positive and one negative.

First, there really are cases of early loss of the effect in Botox. This can occur as a result of regular use when the muscles develop resistance to Botox. This is a solvable problem. In our country, there are two licensed brands of Botox drugs: “Botox” and “Dysport”. After several applications of the drug of one brand, I change it to the other brand, thereby preventing muscle resistance.

The second point is positive. With regular use, the effect of Botox can significantly lengthen. Usually, it reaches 6 months. This is financially beneficial for my patients. The annual consumption of Botox is reduced by one-third. Instead of one procedure in 4 months, they come every six months.

6-If I had to choose only one procedure, I would not hesitate to choose Botox.

You can guess that as an owner of a dermatological clinic I can access many possibilities of aesthetic medicine.

Naturally, I use most of them on myself. And most often people ask me this:

“If you had the opportunity to have only one procedure, what would you choose?”

Considering that this is a procedure with a very powerful effect, having no alternatives and is very budget-friendly compared to other methods, I always answer:

"Botox".