George C. Yang, MD

Hi Tom,

I read the blog, and it makes some interesting comments and references, but from a very superficial and uninformed point of view.  If a patient with Body Dysmorphic Disorder (BDD) intentionally wanted to have zero movement and zero facial expression to their face, this is possible to do this with botox.  This is the point of view the blogger is coming from, but how many people actually do this?  Few if any.  This point of view comes from some  television personalities who have recently had some Botox injections prior to the television taping, or from movies which may satirize the used of Botox and fillers (Tim Allen and Goldie Hawn). The initial complete paralysis can appear to be an unusual appearance for the casual viewer and may elicit certain preconceptions of Botox.  So there is some truth to the Blog, but I have to disagree.

The real life scenario for most physicians and surgeons who administer Botox is that patients have "stubborn" lines which make them look angry when in fact they are not angry.  So just as we don't want a person to be expressionless, these people don't want to have a negative expression imprinted on their face.  The old wive's tale for children making funny faces is, "Don't make that face, or it will stick that way" is essentially the repetitive habit of making certain facial expressions.  Botox is essentially trying to temporarily break the "bad habit."  Of course, with anything, food, exercise, grooming, etc, if these things are used in moderation, it's fine, but when it is used to an excess it can be detrimental.  So for some people seeking "perfection" the blog may have a point, but in general real life situations this is not the case.  Most "regular" people who have Botox are not "wrinkle-free" nor are they seeking to be "expressionless."  The opposite is true, most people have gradually worsening wrinkles which were not there in the past, and now makes them appear to have a negative emotion, when in fact they aren't feeling that way.

Most of my Botox patients are on a budget, so I guide them towards an effective and cost-reducing means of spacing out the injections over time as well as treating only the problem areas, where the lines are starting to imprint themselves onto the skin.  If the lines are not too deep yet, and they are truly tight on their budget, they can either wait longer to treat the lines or only treat the worst areas first.  So, I beg to differ with the blogger that I am trying to make my patients "impoverished."

Botox is a controversial issue, and I think that education and better understanding of an "unknown" always puts things into better perspective.  I educate my patients using a lot of analogies which makes understanding these concepts easier.

This is the analogy I like to use for how Botox works.  If we imagine our faces as a crisp white dress shirt, if we regularly iron this shirt it should stay relatively wrinkle free over the years.  If we wear the shirt and it accumulates a few wrinkles which are not deep, a "single-pass" with an iron should be sufficient to eliminate the wrinkles.  This would be similar to what a single treatment of Botox can do.  If a person has a wrinkle which is not too deep yet, it would be helpful to Botox (iron-out) that wrinkle before it gets too deep.  This way a person would not allow themselves to get deep creases which may not be able to be treated non-surgically.  Hopefully people will see this as a preventative measure, and not such a "bad thing."

There are some people who have such deep frown lines (elevens) that one treatment of Botox will not smooth out those lines.  At that point it may take many consecutive sessions of Botox (every 3-4 months) to smooth out the deep wrinkles or it may not be able to be completely smoothed out (another possibility.)  The shirt and iron analogy would be leaving the white shirt crumpled up at the bottom of the hamper for weeks, then finding it completely wrinkled with deep creases.  A single pass of the iron will unlikely smooth out the creases, but it may take several passes with the steam burst on to smooth it out.  Instead if we take care of the shirt by ironing it periodically, it would not need such an "intense" ironing treatment.

So for people who use Botox, but now feel the crunch of the economic downturn, they could allow the wrinkle to form just deep enough (but not too deep) to be completely eliminated with a single treatment of Botox (maybe 5-10 months+), instead of getting Botox every 3-4 months based on a calendar schedule.  

Best,

Dr. Yang