Thinking About Botox? Let's Talk Neurotoxins!

Cheap Botox ads and “natural Botox” hacks are everywhere, but the real story is what happens behind the syringe. I sit down with board-certified dermatologist Dr. Gary Goldenberg to explain neuromodulators in plain language: what Botox actually does, how it softens forehead lines, crow’s feet, and the glabellar “11s,” and why the best results leave you looking rested, not overdone.

We also get into the safety questions people are often afraid to ask. While the word neurotoxin can sound alarming, cosmetic dosing is tiny and highly controlled. Today, the bigger concern is counterfeit product and questionable sourcing. We break down the red flags, why deeply discounted pricing can be a warning sign, and why choosing a board-certified injector using FDA-approved product matters more than any trending brand.

From there, we cover who is a good candidate, why pre-tox can help with prevention, and how a “low and slow” approach with a two-week follow-up can help avoid a frozen look. We also discuss pregnancy and breastfeeding, alternatives during that time, and what really affects longevity, dosing, and the rare cases when Botox seems to stop working.

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Transcript

Botox vs Other Neuromodulators

SPEAKER_01 0:00

I would say 99% of the time is going to be the the original recipe, Botox. I do use Disport from time to time, especially in patients who come in and sometimes ask for it. So I think if the price is too good to be true, you have to be beware of where it comes from. And there are some products that are fake that are imported from other places. There are people using veterinary products. To me, that's just an added benefit. This is all about making somebody look better and feel better.

SPEAKER_02 0:27

Who is a good candidate and who would you say isn't a good candidate for getting that done?

SPEAKER_01 0:32

Well, you know, it's like uh when a patient comes in and says, Do I need Botox?

SPEAKER_00 0:36

Welcome to Dermot Trotter, Don't Swear About Skin Care, where host Dr. Shannon C. Trotter, a board-certified dermatologist, sits down with fellow dermatologists and skincare experts to separate fact from fiction and simplify skincare. Let's get started.

SPEAKER_02 0:55

Welcome to the Dermit Trotter, Don't Swear About Skin Care podcast. On today's show, we've got Dr. Gary Goldenberg. He's a board-certified dermatologist, recognized as one of New York's top docs. He's a leader in medical and aesthetic dermatology and appeared in more than 700 publications and media outlets. So, needless to say, he's an expert, especially in all things cosmetic. Welcome to the podcast, Gary.

SPEAKER_01 1:18

Thank you so much for having me, Shannon. I'm excited to be here and I'm excited to talk to your audience.

SPEAKER_02 1:23

Well, we've got a great topic here today. We're talking about neuromodulators, but most people think of the household term Botox comes to mind. Especially, I think, for a lot of our listeners and patients out there. And I was gonna have you really just kind of run us through a great overview of Botox other neuromodulators today and talk about, you know, what exactly is it and how does it actually work?

SPEAKER_01 1:44

It's uh it's definitely a uh topic that I'm passionate about. Uh Botox or vitamin B's, uh, I know it in my office, is something that uh we do day in and day out. It really is the most commonly performed cosmetic procedure globally. It's also one of the safest procedures globally, and there are different iterations of this product in the world. In the US, there are multiple approved products. I tend to use the original recipe and then some of the other ones sometimes as well. But um I love I love using Botox itself. It's a it's really a great product. And essentially what it does is it relaxes muscles of facial expression. So instead of looking angry or surprised or um having those crow's feet when you smile, it just relaxes that area quite a bit so that you don't have those um those lines at rest and you're still able to express yourself and people know when you're mad or happy or angry. You just look a little bit softer, a little bit more relaxed, kind of like you took a vacation. And that's really the goal of any aesthetic treatment, if you ask me.

SPEAKER_02 2:48

When you mentioned kind of other reiterations of it, I think you know, Botox has that household name, right? I think that's what most people think of when they think, oh, I'm gonna go improve these wrinkles. Do you mind commenting a little bit on some of the other players in the market and why you might potentially use one of those? Or do you feel like it's more personal preference for the injector?

SPEAKER_01 3:08

I do think it's more personal preference. Most of the products that I use in my office, I would say 99% of the time is going to be the original recipe, Botox. I do use Disport from time to time, especially in patients who come in and sometimes ask for it. Uh and some of the other products like Javaux and Zeumen and Doxify, which is the newest ones, I think they're fine. But in my hands, uh, for my patient population, I really feel that uh Botox is the product that I choose the vast majority of the time, and it's the one that my patients expect me to use.

SPEAKER_02 3:42

So somebody's coming in to get one of these done. We kind of refer to this group of medications, you know, neuromodulatory drugs or some people call about neurotoxins. I wanted you to talk about the toxin part because there's probably people out there hearing, like, I'm not putting that in my skin. And you already talked a little bit about the safeties. So can you explain about you know why we think of this as, you know, what they call the neurotoxin term where it comes from, and then really speak to the safety of these medications.

Neurotoxin Language And Real Safety

SPEAKER_01 4:09

Absolutely. I mean, look, the word comes from botulism, which really is a toxin, but it all depends on the dose. You know, in general terms, if you think about it, all medicine is a little bit of poison or toxin, if you wish. It just depends on using it the right way, the right amount, uh, et cetera. And and Botox is very safe in a wide range of doses. Certainly, you and I will never reach the kind of dose that maybe our neurology colleagues use, or you know, people who treat migraines or muscle spasms, et cetera. So the term really comes from botulism. That's where it was discovered because it stops muscles from moving. You purify it, you put it in a vial, and you let us inject maybe 30 to 50 units at a time, and it's highly effective and extremely, extremely safe.

SPEAKER_02 4:56

So, in all those crazy articles were coming out probably not too long ago, people were freaking out about getting botulism from Botox. Can you talk about what was really happening? Because I know that instilled a lot of fear in people, even in our office here, that were scared to come in and get their Botox.

Fake Botox And Price Red Flags

SPEAKER_01 5:11

Yeah, I think it's nearly impossible to get botulism from Botox unless somebody injects you with so much Botox, then you actually are going to reach toxic levels. But it really has to be a lot. One of the issues, and um, we actually saw this in New York within the past year or so, is some people will import fake or use fake product. And it has to do with the price of the product. And, you know, you I see this advertised sometimes around the New York City area, and people are selling their product for for less than what it costs me to buy without even marking it up at all. So I think if the price is too good to be true, you have to be beware of where it comes from. And there are some products that are fake that are imported from other places. There are people using veterinary products and injecting them in humans. You know, this is why I always say you have to go see a board certified physician who is using a product that's FDA approved or something that's been uh manufactured in an FDA-approved lab. You don't want to be a case of an experiment uh just to save a few, you know, save a few bucks. So go to somebody who knows what they're doing, have experience, and they use an FDA-approved product.

SPEAKER_02 6:24

That's a great thing you highlight from the safety perspective, because I I know some of my patients when all that was coming out, you know, they were really freaking out that we were literally going to give them botulism. And I was talking to them about the craziness of yes, people using product from other countries that doesn't have the regulation oversight that we're lucky to have here. But kind of ironic too, some of my patients that said that they believe more in a natural approach to anti-aging or reversing some of those fine lines and wrinkle, they said they like the concept of using Botox because it was naturally derived. And I said, I've never thought about it that way. But I said, what a great idea.

SPEAKER_01 6:56

Definitely natural. Definitely comes from botulism, comes from nature.

Candidates And Preventative Pre Tox

SPEAKER_02 7:00

Exactly. I said, that's a great way. I'm gonna have to sell that for some of my patients that are afraid of it, and that's certain terms. But I thought that was a great highlight. Now, if somebody's thinking, you know, I want to get Botox dyspore zero index, they're just considering, you know, I'm looking at getting one of these. Who is a good candidate and who would you say isn't a good candidate for getting that done?

SPEAKER_01 7:18

Well, you know, it's like uh when a patient comes in and says, Do I need Botox? The answer almost never is no. It's almost always yes. And I think we're seeing this in younger and younger patients who are getting what they're calling pre-tox because preventing those 11s or 111s or the lines on the forehead or the crow's feet or then the nasal lines, preventing those lines from happening is perhaps even more important than treating them once they they occur. And what I tell patients is a ring, a wrinkle in your skin is like a wrinkle in your shirt. The more it folds onto itself, the deeper it gets, and the harder it is to iron it out. So preventing it uh starting when you're maybe younger as opposed to waiting until you really have those strain tracks on your face is is um, I think is a good idea. And I'm a I'm a case, you know, N of one. I tell all my patients that my forehead has not moved since 2006. I've literally had Botox every two to three months and you know injected into my face since 2006. And I think it really does prevent those lines from coming. I think it also improves the way your skin looks in general. It gives you what people call a Botox shine, which I think makes your makes your skin look much more beautiful, much more even toned. And look, it's it's a starter, it's a starter cosmetic procedure. It's the one that most patients probably get first, unless they've had laser hair removal. I think those two are the top two that people usually kind of try out first. And then they move on to maybe something else like laser, filler, you know, liposuction, et cetera. But I think if somebody has lines at rest that can be relaxed by um by Botox or botulinum toxin, I think it's it's it's very good to try. Now, my approach always is to if you come in in the first time, I'm gonna deliberately under-treat you. I'm gonna give you less than what I think you need, bring you back in two weeks, because it does take two weeks to see the full results. And then two weeks later, when you come in, we can always add, augment, and optimize your results. But if you're happy with how it looks, that's all that matters. Um, I don't know how it is in your practice, but you know, the days of making people look like they're completely stoic, no facial expression, overdone. I think those days are really over. People want a natural correction. They just want to look more relaxed, less angry, less worried, especially as they're staring at their computer screens all day long on call, you know, Zoom calls all day. It really makes a big difference.

SPEAKER_02 9:45

Yeah, I would agree with you. I do think that tendency toward a more natural aesthetic or just looking like a better, refreshed version of themselves is definitely caught on. I feel like in the Midwest, we we might have had that a little longer than sometimes, you know, our colleagues practicing in the in the coastal regions or even down in, you know, Florida and other parts of the states where almost having that overdone look was the desire. People wanted to look like they had something done. But I definitely feel the natural look is becoming more part of that equation. And I think people just simply look better too with it. It's a more realistic approach because you've probably seen these trends too, especially with younger people coming in, you know, wanting to freeze their forehead, you know, in their 20s and some, you know, talk about what could be the ramifications of that over time. Do you counsel younger people about an appropriate way to use it if they're looking preventatively and maybe not going for the frozen look? Or do you like to approach it a different way?

SPEAKER_01 10:37

Yeah, I I think in New York in general, things are sort of, you know, understated. We call it quiet luxury. Where I think you go to California, um, Texas, Miami, things are still, for my taste personally, maybe a little bit overdone. Um, and I think that the sort of the understated quiet luxury look is is catching on. You know, I'll go to Dubai a couple times a year to see patients, and I even see there where everyone used to be overdone, and everyone now a lot of patients want to be sort of more subtle and have a more subtle correction. So I definitely think looking natural is the best way to go. And I always tell my patients, look, I can't make, you know, if you're 50, I can't make you look 25.

SPEAKER_02 11:19

Right.

SPEAKER_01 11:20

And if I did, imagine your face is 25, but the rest of you is 50. It it still doesn't look great, right? So, you know, the idea of any aesthetic treatment should be to make you look the best that you can look for your age. For where you are in life, you want to just look your best. And that's really the goal here.

SPEAKER_02 11:39

So somebody's thinking about, you know, taking that leap and getting, you know, a neuromodulatory drug or, you know, doing, you know, a Botox or something else. Well, what what when you take their history? Is there anything that you're like red flags? Sorry, you're just not going to be a good candidate, or contraindication for doing it.

SPEAKER_01 11:56

I mean, look, if someone's allergic to Botox, you don't want to inject it into their skin, but that's a that's about the only contraindication that I would foresee. Um, I mean, I I have had some patients who've had, you know, by 50, they've had a dozen or so plastic surgeries. And sometimes that makes me worry that their expectations are going to be so high that I or or no one else will ever be able to meet those. So that patient does need more counseling. But if somebody comes in and they have, you know, 11 lines and they have some crow's feed, they have some lines across their forehead and they want to soften them, I I, you know, I don't see a reason why you wouldn't be able to do it for them.

SPEAKER_02 12:35

What are your thoughts on pregnancy and breastfeeding? Because I actually had a colleague, a physician colleague that was breastfeeding that was really insistent on getting Botox. And I was really surprised just coming from somebody in the medical field, even looking at some of the data, I didn't know what your comfort was with that or what you tend to counsel patients on because I feel like that gets brought up more and more. I'm surprised because people have had it maybe, maybe they've forgone it during pregnancy and they're finally like, I can finally do this because they're ready for it and they've missed it. How do you approach that with your patients, the whole pregnancy breastfeeding?

SPEAKER_01 13:03

Yeah, I just don't do it. I I don't do it. I I I I I think it's not worth it. God forbid something happens. Sure. And it's just you don't want to be, you're, you know, you it's not that I don't want to be uh found guilty of it. I just wouldn't want to be responsible for something like that to happen. Is there is the chance of that happening low? It probably is extremely low, especially if a mother is nursing. But I just I wouldn't do it. It it wouldn't be for me. I would just say just wait until you're done with your pregnancy and nursing, uh, and then we can do it. A lot of my patients, when they know they're gonna start trying to get pregnant, they'll come in sort of like they'll get everything they can done before. And then as soon as they're done nursing, they'll come back and then we'll get everything done again just to kind of tune them up.

SPEAKER_02 13:50

Yeah, I I kind of take the same approach. I was a little shocked. This was an internal medicine colleague that came to see me and very insistent on doing it, and she was very disappointed that I wouldn't do it. And I said, Hey, I just don't think it's worth the risk. You may find a colleague of ours that disagrees, but totally agree with you. Why take the chance? And I said, I know it's a few more months, you know, without Botox, but I I think you're gonna do okay.

SPEAKER_01 14:11

So I think going back to You know, especially since there are other, sorry, just there's so many other treatments that you can do while you're pregnant or nursing that are safe, like laser, like microneedling, like like platelet-rich plasma. Those are all things that I am comfortable doing while a woman is pregnant or is nursing. And I think you can sort of kind of hold them to where they want to be with those treatments without injecting something like Botox or filler or something that has the potential of getting into the bloodstream and you know, affecting a baby in an adverse way.

Is There A Natural Botox Substitute

SPEAKER_02 14:45

That's a really great point because I think people get so hooked on, you know, they've been getting injected for, you know, years or months, and to take that break really frightens them. But it's also an opportunity maybe to focus on some other cosmetic procedures that would be safe to do and then kind of get the best of both worlds, go back to getting their neurotoxin once they're done with pregnancy and breastfeeding. So I like that angle because I think that would give people reassurance. Because sometimes, you know, I think you know, when we're pregnant, we feel like, gosh, we can't do anything. And you can feel a little beat up, obviously, going through pregnancy, and it's nice to do something for yourself. So good to know there's other options that can still, you know, look at anti-aging treatments that are going to be considered safe as well that they could potentially pursue. Now, I we talked a little bit about the natural part of Botox. I I think what I wanted to ask you, maybe not referring to like Botox itself or another one of you know, the medications in this category, but what about is there truly like a natural form? Because I think at one point it was all the rage on social media that like banana peel facials could give you natural Botox effects, or there there's truly natural Botox that can deliver the same results as what you're injecting in office. But I'm passing the baton to you, Gary, to set the record straight about what really exists and if if there really is a substitute out there.

SPEAKER_01 15:54

I mean, look, I I don't think that that there is anything that does the same as as Botox. I don't think there is another injectable or topical that's going to prevent your muscles from moving so that you're you're not wrinkling your skin, you're not getting that deep wrinkle every time you make an expression. So I think from that perspective, I think the answer is no. However, I think there are other options for treatments like laser, um, like skin tightening, um, like uh like platelet-rich plasma. For somebody who doesn't want to inject something into their skin, it certainly is something that you could consider. But I think it's very important to explain that what Botox does compared to all of the other modalities is very different because there isn't another treatment that can make your muscles relax. So it treats the wrinkles that you have now and it prevents wrinkles from happening down the road. Um, I'm not aware of anything else, maybe you are, Shannon, um, that of that does the same thing. That's why I think Botox works very well with all of the other cosmetic procedures that we do.

SPEAKER_02 17:04

No, I agree with you. I think it's a wonderful complementary aspect to the things we can offer. And then what I do like is there can be a preventative aspect of it. You know, too often people are coming in late in the game where they've already developed those fine lines and wrinkling. And I know there can be some controversy and people have discussed, you know, the ethics of when do we offer these types of things and how do we treat patients appropriately. But I do think there's a role for it in prevention for the right patient and realistic expectations and trying to offer them more of this natural aesthetic that they can potentially get ahead of the game. And that's, I think we're all healthcare focused, right? We're trying to work on prevention. Yes, this is more on the cosmetic side, but I think it falls in line with that nicely that you can have a conversation with the patient and really talk with them about, hey, this is the benefit. We can prove what you have potentially right now. But the other plus side is we're really working to preserve your face and prevent some of the sprinkling in the future, especially if you're going to be bothered by it. So I wholeheartedly agree with you. Love the prevention piece.

SPEAKER_01 18:02

And look, I think there's there's a lot of evidence that um injecting Botox actually helps with mental health. There are several studies that show that it's good for depression. And it's not just about looking better and seeing a better image of yourself. There's actually, it's actually been proving that, proven that if you frown less, you feel less sad and less angry and less depressed. So that's why, you know, if you're having a bad day, they say to smile because it does, it does help, right? And I think there are some studies that clearly show that that biofeedback, that to your brain, if you can't frown as much, if you can't wrinkle your forehead and growl as much, actually does help with with depression and and other mental uh mental health um issues. But that's not why we're here, right? That's to me, that's just an added benefit. This is all about making somebody look better and feel better. And look, I'm in private practice, you're in private practice. We don't have to treat everyone that comes through our door, and not everyone has to come and see us. It's a choice, and you could you could practice the way that you see fit. I think as long as you're staying within the safety parameters of what the FDA has outlined, I think that's fine.

SPEAKER_02 19:10

One kind of burning question I have, because you obviously have been doing this for a while and have great expertise in this area. And for those of us that have started using it with patients or even noticed on ourselves, I you know, I've had the residents practice on me for years, or occasionally if we're doing some trainings here in the office. So I feel like sometimes my use of Botox or Dysport, the two that we mainly have, we've had also Daxify as well, has been intermittent. But one thing I have noticed, and I was curious if you see this trend with some patients, that I I've noticed for me sometimes Dysport seems to last longer. And I and I've always wondered, is this more about the molecule or you know, people talk about Botox resistance or how the molecules are wrapped a little bit differently, and maybe there's antibody formation. I wanted to get your thoughts on that, because that is something one of our patients, you know, asked me the other day. She said, it just Botox doesn't work for me anymore. I had to go to something else. And I wanted to get your thoughts on, you know, what the data really shows or what you've seen in your own clinical experience regarding that.

SPEAKER_01 20:06

Yeah, I think with Dysport, I think that the the conversation people use when it first came out is that it works faster and it lasts longer. And I think the reason for that is that we wouldn't initially, at least I was trained, to use three units of Dysport as an equivalence of one unit of Botox.

SPEAKER_02 20:23

Same for me.

SPEAKER_01 20:24

And it turns out probably two and a half units of both of Dysport is an equivalence of one unit of Botox. Okay. So if you're injecting more, you're gonna get a faster result and you are gonna get more longevity. In fact, when when Daxify was just in studies, there were several um studies done with with Botox. If you double the dose, especially in the globella, it will it can last for up to six months. Now, now the the caveat of that is if you drop somebody's eyebrow, you inject too much, you really overfreeze them, it's gonna last for six months. So when I counsel my patients, I tell them everything's a bell curve. For most patients, it's about three months, but the bell curve has two sides. So some patients, it's a little bit underwhelming. Maybe it's really only two and a half months. And then for some patients, it's three and a half to four months. It really is patient dependent. Depends on how fast your metabolism is, how expressive your face is, what kind of work you're in. Are you constantly looking at a screen and scowling? Or are you, you know, out and about in a in a business where people are more, maybe more happy and they're not looking at a screen all day? I think all of these things make a difference. Um, there are some patients who can become um resistant, and I've had patients resistant to every single botulinum toxin that you could you could imagine. So I do a washout for them. I tell them no botulinum toxin for six to 12 months, and then we start one at a time and figure out which one is going to work for them. The antibody piece that you brought up, I think it's I think whether they're present or not is less relevant of whether they are clear. Clinically relevant.

SPEAKER_02 22:01

Makes sense.

SPEAKER_01 22:02

And, you know, I'm a Botox user. I've been since 2006. It's the product I've probably injected into my forehead maybe 99% of the time. I do use Disport every now and again if it's available. And I have not seen a difference. And I think for majority of my patients, I think it's highly effective, regardless of how long you've been using it.

SPEAKER_02 22:21

Yeah, I think that's a great explanation because sometimes I did wonder about the conversion factor and just am I utterly getting more? And again, it's so intermittent and floating back and forth because a lot of times it's what's available and what we're doing for training at the time. But with consistency, you know, I like to see how that works. And I like the idea of a little more, but you're right, we don't want to drop brow for six months. That not be may not be worth the price of a longer time frame of it working for us.

SPEAKER_01 22:43

So, you know, and look, when patients ask me why I choose one product versus another, yeah. I, you know, I tell them, I say, look, this is what works best in my hands. If you go somewhere else, they may offer you a different product because that dermatologist, maybe this is the product that works best in their hands. I know what works best for me, and that's kind of what I stick with.

SPEAKER_02 23:06

So, what do you think works best then for patients once you've done their Botox? What are sort of your do's and don'ts? I think the big one I get asked all the time, is it really true I can't fly on a plane? I'm getting ready to head out, like literally in four hours to catch a flight, and they just popped in to get their Botox done. How do you answer those questions that come up?

SPEAKER_01 23:24

Yeah, I used to go crazy. I used to say, Don't go shoe shopping, don't do this, don't do that. And now I tell them, look, you can do whatever you want afterwards. The only thing is if you exert yourself or bend down, like do yoga for a long period of time or go lift weights or go for a long run. If I was going to give you a tiny boo-boo, that boo-boo may be slightly larger because there's more blood pooling in the area. But I really don't believe in any of this other, any of these other instructions. In fact, I have I have a fairly large international presence in my office. Patients fly in, we'll do Botox fillers, laser, PRP hair treatments, whatever you have, they might be getting on the plane that same day. And I don't think it's an issue. So I I'm now I'm in the camp of if you don't care about getting a bruise, go about your business. If you don't want to get a bruise, ice and try not to bend down for the next 24 hours.

SPEAKER_02 24:18

I like the simplicity of that. That's great. Are there any other do's or don'ts you tell your patients then?

Custom Dosing And Avoiding Mistakes

SPEAKER_01 24:23

Don't come back. Don't forget to come back. That's the biggest, uh, that's that's the biggest do's and don'ts. You know, it does only last for three months. And I think to your point with you know, patients thinking they're getting resistant, you know, as we age, especially once we're sort of in the in the middle age and the in the bell, the media part of the bell curve in the middle age uh where I am, you know, I think our muscles tend to get stronger and stronger. So you are, you may require more, more, more Botox as your muscles get stronger. So I don't think that's really an issue. And I think there are some gender differences. I definitely think that men tend to require more Botox, especially if they want to be more frozen. Um but I think that that's really patient dependent. There are some women with really, really strong uh facial muscles who, you know, need 70, 80 units of of Botox every two and a half to three months because that's what they require, you know, for for a perfect correction. So I think it really, it really is patient dependent. And you have, you know, you can't do the same treatment for every patient. And then you can't do the same treatment every time they come in because their muscles are going to change as one muscle is relaxing, maybe another one picks up the slack. So I think the I remember when I first started on paper charts, I used to take super diligent notes to like a millimeter of where I injected somebody. And now I just put an amount, I inject it in glabella, forehead, crow's feet, nasalis, whatever, because I know that when they come back again, I'm gonna have to retailor their treatment to what they look like that day. It's not necessarily stable. We're always changing and our needs are always going to be changing.

SPEAKER_02 26:04

I I love that you point that out because I do think, especially working with some of the residents or providers listening, a lot of times they just want to do the standard thing. Every time somebody comes back in, they'll look at that previous note. And I'm surprised because just like you said, depending upon metabolism expression, a little asymmetry that we all have with our face and the utilization of our muscles, you know, you might need a little bit more in one area and a little less in another. Or yes, the muscles get stronger, but maybe the left side's a little stronger than the right over time. And, you know, it's broken down a little bit differently, you know, from side to side or in different areas. So I think that's a good clinical pearl that you highlight to really treat the patient when they come in based on what movement they have and what your goal is and not just what you have in the note previously.

SPEAKER_01 26:47

Look, I think if you really examine someone's face, most people are asymmetric.

SPEAKER_02 26:53

Yes.

SPEAKER_01 26:53

And I think making sure that you point that out is very, very important. And I think the other misnomers, like everyone thinks, oh, Botox is so easy, it's so easy to do it. Well, it's easy until you screw up, until you drop an eyebrow or someone has a crooked lip. You know, so you really want to go to somebody who's in who's who's who's um professional, who's done it a few times, and you're not just there, you know, for practice, because I think it's a lot easier to scru if you ask me, it's a lot easier to scrub Botox than it is a laser treatment or even microneedling.

SPEAKER_02 27:29

So in our final minutes here, is there anything else you really want patients to know if they're thinking about getting this done that we haven't talked about, like any key things that you want to bring up for them?

SPEAKER_01 27:41

Yeah, I I think it's really important to kind of go low and slow. You know, start with just, you know, you don't need to get a full correction on your first visit. Start with maybe 50, 75% correction, see how you like it, and you can always come in in two weeks to get an optimization of your treatment. But one caveat that I always turn these patients away. If somebody comes in and says, I just want this area treated, I don't want my forehead, I don't want my crow's feet, I don't want my nasalis treated, I just want my globella, I always tell them it's gonna be a tell. Like in poker, there's a tell. So this area won't move, and then the rest of your face is gonna move and look the same, and it's gonna look so unnatural. So I always counsel my patients, we either do a correction or we don't do it at all. Because those are both okay, but having a partial correction, I think just looks it just looks different, and I think patients, I think people notice it.

SPEAKER_02 28:41

Well, I this is fascinating. I think for a lot of our listeners out there, it's probably opened their eyes to the pluses and minuses and the questions they're thinking about. And I agree with you, it's kind of the gateway cosmetic procedure, because often I feel like once people are comfortable with the thought of doing this, definitely leads to other things down the line. And I I'm surprised at how many people absolutely love it that maybe were fearful in the beginning or it wasn't their thing they thought initially. Uh, and I always tease, you know, if you do this, it's probably gonna be a little addictive. You're probably gonna wanna come back for more, like you mentioned earlier.

SPEAKER_01 29:12

Yes, for sure.

Wrap Up And Listener Next Steps

SPEAKER_02 29:14

Well, Gary, thank you so much for coming on the podcast. This has been great to have a nice overview so people understand neurotoxins more and kind of what they can do for their skin and if they're potentially good candidates and kind of the approach that we take with these in dermatology. So thanks so much for coming on the podcast. I appreciate it.

SPEAKER_01 29:29

Thank you so much for having me.

SPEAKER_02 29:32

And stay tuned for the next episode of Dermitrotter Don't Swear About Skin Care.

SPEAKER_00 29:38

Thanks for listening to Dermotter. For more about skincare, visit dermitrotter.com. Don't forget to subscribe, leave a review, and share this podcast with anyone who needs a little skincare sanity. Until next time, stay skin smart.