Monthly Archives: February 2019

Botox isn’t for Freezing

When patients call and schedule an appointment with me for Botox, they often times don’t get Botox. Why? Because what they were really making an appointment for was an unwanted appearance of something but they weren’t sure what procedure would remedy the problem so they assumed it might be the ever so popular Botox cosmetic. Maybe a line or wrinkle they didn’t like, maybe sagging skin or maybe they feel they look angry or tired when they don’t actually feel that way. I always address the issues and where we want to enhance beauty and then I recommend filler, botox, devices, lasers, topicals, surgical consults or all or none of the above. People don’t ever initially come in for Botox and say their complaint is that their face moves. Most people like their face to move naturally. If you have met me you know I like to make facial expressions, I don’t want my face to not move. However, I don’t like the lines that some of my facial muscle movements make in my skin. This is why I love Botox and I think it is so fun to inject. When I inject Botox I’m not just thinking about how to make the line go away but I’m also taking into consideration how that relaxation of the muscle can change the shape of the eye or the length of the forehead or the placement of the eyebrows or the shape of your smile. For example, if someone does not like a line directly above the tip of their eyebrow I usually do not use Botox. Botox in this area can drop the eyebrow and flatten it or even cause eyelid ptosis (dropping of the upper eyelid). I tell clients to keep the line or use topicals, laser or filler to enhance the beauty in that area while getting rid of the unwanted wrinkle. What’s interesting is my longtime patients will sometimes say “freeze me” I don’t want any movement at all. That is because they have become addicted to the smoothness of the skin that Botox gives when they are moving less. They get the impression that less movement will mean less wrinkles. That might be true but it also may mean less beautiful results. The real reason we all get Botox is to enhance our beauty. So this is my PSA. That person you know who took injectables too far and looks fake, (they aren’t my patient) they became obsessed with chasing the line and “freezing” the face. Don’t do that. Get yourself an injector who is an expert at beauty, not a line chaser. If you go in and ask for Botox and they didn’t recommend anything else for your skin then eventually you will look Botoxed. Your forehead will be 29 and your lower face might be 49 and that looks Botoxed every time. Don’t become obsessed with that one little line. Remember the reason you started getting Botox. To enhance your beauty. Not to be frozen or filled up. These are the keys to looking naturally injected. Small tweakments over the years. What is so ironic about this post is when I am due for Botox I often tell Dr. Sandy to freeze my whole face and raise my brows to the Gods. I’m grateful she knows what I ACTUALLY want and injects me to perfection. Just one more reason to find an expert injector. An expert injector enhances your beauty and knows what will look good even when it’s not what you asked to achieve.

Want to come naturally age backwards with me? E-mail and set up a free consult. I would love to help you meet all your skin goals. Once you get a little Ninamen C I hope you feel more beautiful, not frozen.

Stay moving, stay beautiful, stay skintastic, Nina


How many units of Botox do I need?

Every patient that sits in my chair gets a full consult. I suspect the most frequently asked question I get in regards to Botox is “How many units do I need?”. Interestingly, almost no one that has had Botox before actually knows how many units they have had in the past. My experienced, Botox savvy patients usually know but most do not recall. I find it interesting that people ask how many units they need but what they really want to know is something completely different. Like “how much will this cost?” Or “how bad are my lines?” Or “how many needle sticks do I have to have”. In our clinic we usually do not sell Botox by units. As a matter of fact we don’t really sell Botox at all. We sell beauty. We sell results. Most patients invest in packages that will make them feel their best Skintastic self. Packages include products, lasers and/or injectables that target a concern. Either way I thought I would try to explain to everyone how many units you really need.

In my opinion, how many units you get is more related to how long your Botox lasts and not necessarily what it looks like. I think that what your Botox results look like are more related to where your injector places your Botox. For example, if I get 40 units of Botox in my forehead and around my eyes it looks exactly the same as if I get 50 units in the same locations. The difference is that 40 units only lasts me about 2.5 months and 50 units lasts me about 4.5 months.

It’s also important to consider what has been studied and FDA approved. That is 20 units for the glabella(the area of the forehead between the brows that makes the “11”lines), 20 units for the frontalis(the muscle that raises the brows that causes horizontal forehead lines) and 24 units for the crows feet. Those are the dosages that have been shown to last 3-4 months. If you get less than that you can expect to either not have satisfactory relaxation or results won’t last the entire 3-4 months.\

Every person is likely to need a different amount of units. Men tend to need more than women since they tend to have bulkier muscles. Every single person is different. We all are born with a gallbladder. Some of our gallbladders come out at some point due to malfunctions and some of us keep our gallbladder our entire lives. Even though it is the same organ it is different in everyone. Same goes for our muscles. One patient may get 20 units in their crows feet and it look perfect and last 4 months and the next patient gets 28 units in the exact same location and it only last 3 months. Their orbicularis oculi muscle is the same muscle injected just different from person to person.

The moral of the story is get an injector you trust. You can’t figure out how many units you need on your own. You need to come in and let me look at your muscles. Let me assess you. Then stay with me. Let me check you in 2 weeks to make sure your botox is perfect initially. Let me make adjustments every 3 months as needed. When I know where I injected last time and can see what adjustments we make your Botox injections could quite possibly get better and better. It’s hard to know who the expert is and who you can trust. I encourage you to make an appointment with my cosmetic coordinator, Margaret by e-mailing and find out exactly how much you need to reach your goals and stay in your budget. You will never pay full price at Johnson Dermatology because we offer brilliant distinctions, elite program and more! We are just an e-mail away to help you reach all your skin goals. And FYI, one of my favorite patients told me this weekend that she needed to come in for her “Ninamen C” so for the record that is what I will be referring to Botox as from here on out!

Stay skintastic, Nina