This is District of Columbia from 2012 who has volunteered to do some
Botox with us and gain a little bit of benefit from it. Obviously, she's
young. It's really for prevention. I've kept talking about prevention
being the most important thing about Botox. Most people think of Botox
as needing Botox once you hit your 40s and 50s, but really, the most
important thing is understanding that if you're expressive, if you're
forming expression lines in the 20s and 30s, you should start doing
Botox to prevent lines from forming because once the lines formed, then
we have to think about chemical fields and lasers and other various
techniques and fillers. So in this case, obviously, we have a beautiful
patient where it doesn't need a whole lot of work, but the prevention is
in areas that everybody forms certain lines. We're talking about crows
feet lines and some forehead lines. And I want to talk about the anatomy
of this. I've talked to Erica about this. Basically, the forehead lines
do bother her, but when we discussed what's realistically possible,
we've chosen to stay away from it, and I'll tell you why. I want you to
raise your eyebrows for me.

And you can see as she raises her eyebrows to blow dry her hair or put
eye shadow, things like that, she notices these lines getting worse. You
can do some Botox to help those lines, but as you Botox the muscles, she
can't lift her eyebrows and she prefers to have that arched. She prefers
to have the higher eyebrow. And I can certainly smooth out her
forehead with Botox, but then what's going to happen? The brow will feel
heavy and lowered and that's not something she's interested in. If she
wanted to do something like that, in about five or ten years later, then
she can think about lasers and brow lift and upper blepharoplasty. But
at this point, we're just going to leave it alone for now until it gets
to the point that she definitely chooses to do some Botox over the
position of the eyebrows. She does forms some smile lines. It's not that
aggressive. Go ahead and smile for me. And you can see that the eyes
tend to close up a little bit. Again, it's not terrible. She has nice
volume to her face, but it's really to prevent these lines from getting
deeper and starting and forming those permanent indentations that we
want to avoid.

So we're just going to do a very conservative Botox. And if you've seen
me in the past when I do Botox on the crows feet, I usually have four
spots. Below the eyebrow to keep the eyebrow arched, lateral canthus
crows feet area, the interior portion and then I come to the lower
eyelid area and that's the very well-known thing that I do with most of
my patients. I probably say about 95% of my patients get the lower
eyelid injection, but we're going to avoid that for her because she's
really not forming lines there. She does have a little bit of a tear
trough here that can make that worse. So until we take care of the tear
trough and [inaudible 00:02:40] for her, we're going to leave that Botox
and observe. It really will be just three spots and I'm going to show
you how I'm going to do that. Are you ready?

All right. So we're going to start and we talked about the three points
that I'm going to do on her. The first one is about a centimeter and a
half away from the lateral canthus. This is really important. You just
want to just put the tip of the needle under the skin barely penetrating
and then create a bleb. You can see the bleb and that's the Botox. If
you go deep, you're going to hit blood vessels and you're going to get
bruises. But if you stay very superficial, you don't get that. The
second one is underneath the brow and you really want to lift the
eyebrow to pull it out of the orbit and you go below the brow because
again, you want to create a little bit of a lift to the brow and it goes
right there. And the third one -- You're creating a V-shape fashion -
The third one is going to be in this area. Just the head of the needle
goes in and you create this little bleb and you can see the bleb get
elevated, and that's it.

Those are the three spots and I'm going to have her bring her left hand
up and hold the pressure here while I go to the other side. We're all
the way up to the eyebrows [inaudible 00:03:53]. We're going to do the
same thing here. We got about a centimeter and a half. Just the head of
the needle is going in and raise this bleb. You can see this bleb and
barely the head of the needle went in. That's where you want to do it
around this area. I lift the brow up, I go underneath it, place a little
drop right there, and then I come down, create V, place another drop
here. That's essentially it. that's all she needed. I want to have you
to hold this for me….

Preventative Botox Injections for Developing Crow's Feet

See Botox as applied at the corners of the eyes, just under the outer corner of the eyebrow, and at the outer tear trough.