Stephen D. Keefe, MD

Dear Seattle Chick:

You are ahead of the question by recognizing that not all “Botox” is created equal.   Much depends on who is doing the injecting.  Unfortunately there is no iron clad answer to your question but there are a few guidelines you can apply to your search.


 
The easiest place to start is to ask friends who they have been happy with and trust.  Look for on-line reviews although bear in mind that many patients are reluctant to post reviews about their cosmetic treatments due to privacy issues.  After that, find out what expertise or specialty of clinical medicine whoever is doing the injections has.  Some States require an MD to perform the injections. Other States require an RN or NP who has been trained and is supervised by a physician. Ask the office when you call who will be doing the injections? If an RN or NP is doing the injection, an appropriate question would be who trained her/him.  Was it the doctor in the current office?  If so, what is his/her training?  During your consultation you should expect for some time to be spent on patient education,  such as risks and benefits as well as pre and post treatment expectations.  Much depends on how well you feel you are being listened to as a patient during your consult. Make sure you ask if a consult can be followed by treatment, or if a consult is a stand alone appointment.  Either one is fine, but be prepared not to have your treatment if you don’t feel comfortable. Because you will need regular treatments look for someone you will enjoy seeing every 3 or 4 months, who you can build a trusted patient/doctor/nurse relationship with, and who will work with you to get the results you want.

In my experience as a reconstructive head and neck cancer surgeon I can tell you that what you describe is normal.   I wouldn't be worried about the dressing being loose as too tight may compromise the graft. It's always appropriate to address your concerns directly with your physician/surgeon.  

For patients who are candidates for local anesthesia this is by far the most popular choice over general anesthesia and over the last five years this has become a preference among my patients.  Those patients who have chosen to have an in-office facelift under local anesthesia have been thrilled with the experience and are very pleased with the results. Local anesthesia  allows a quicker recovery and the risk of complications associated with anesthesia are avoided.  Some surgeons are not as comfortable having the patient awake while they are working.  Every surgeon must do what works best in his hands and also in the environment that is most conducive to produce his best work. Best advice is to find a surgeon who understands what you want, that you can communicate with, and that you trust will work with you to get the best result possible. There are many surgical and non-surgical options for removal of fat under the chin and in the neck.  The Precision-T and SmartLipo combines removal of fat in the neck area and gives the ability to contour under the chin area using both laser and minimally invasive surgical techniques. It is done through small incisions under the chin and possibly behind the ears resulting in little to no scarring,  done under local anesthesia and there is little downtime.