Today's cosmetic patient expects the highest level of care and treatment outcomes. Rightfully, people want results that are both natural and enhancing. We have dedicated ourselves to meeting this demand by not only providing excellent care but also leading the way with innovative applications and teaching others in our specialty- with the ultimate goal of advancing the entire field.
The key to a natural and effective treatment outcome is based on experience, judgment, and a thorough understanding of the injectable product that is being used. Dr. Karam has extensive experience in advanced and innovative non-surgical facial rejuvenation techniques.
He is frequently invited to lecture at national training courses on the latest uses on injectable products and is a speaker and national trainer for Allergan the makers of Botox, Juvederm, and Latisse. He frequently trains physicians and other allied health professionals around the country on the safe and effect use of non-surgical injectable approaches to facial rejuvenation. He has become the trusted source for excellent and consistent outcomes, with patients consisting of other cosmetic professionals, physicians and industry leaders. His patients travel from throughout the country for their treatments. Carmel Valley Facial Plastic Surgery, is among the highest volume providers of cosmetic injectable treatments, earning the Platinum Provider status, by Allergan.
In short, Botox can not only enhance your appearance by softening your expression lines, but it also prevents aging of skin of the upper face.
Botox works by decreasing the strength of muscle contraction. Essentially, when botox is injected into a muscle the muscle is not as strong. So, how is this used to enhance your appearance and to slow the aging process? To understand this, we first need to understand how a wrinkle is formed. Anatomically, our facial muscles exist under the facial skin. When the muscle contracts during facial expression, the skin moves and a crease is formed. Normally this is not a problem, but as we age, the skin thins and the elastic property of skin diminishes. So, with each expression, a line starts to form which gets deeper and deeper with time. This is the evolution of a wrinkle. The upper face is the best example of this process, as most of the wrinkles in this region occur as a direct result of muscle contraction.
So, when botox is injected and the muscle is weakened, the skin never creases and a wrinkle is never formed. This is analogous to a shirt that is hung versus crumpled into a ball. Botox keeps your skin wrinkle-free by keeping it hung (in a sense!). This preventative process has been well-established in an identical twin study. One twin received botox starting in her mid-thirties while the other did not. 13 years later, there was obvious difference in the presence of wrinkles between the twins confirming the preventative value of botox ( ref: Long-term effects of botulinum toxin type A (Botox) on facial lines: a comparison in identical twins. Arch Facial Plast Surg. 2006 Nov-Dec;8(6):426-31).
1) If I inject Botox, will I look frozen or expression-less?
The answer is no. If Botox is injected in a well-thought out way by an experienced injector, the dose and distribution can be controlled so you get a softening of the expression but not a complete loss. This is the real goal of advanced Botox injections. When done well, no one will even know that Botox has been injected.
2) So, where can Botox be injected?
Glabella. Botox is FDA approved for injection in the Glabella (the vertical lines between the brows that appear when you frown). This is perhaps the most common area of injection. When this area is injected, the expression appears more relaxed, calm, and pleasant.
Forehead. When you raise your eyebrows, you see horizontal lines running across the forehead. This muscle, the frontalis, is the only muscle that lifts your eyebrows. So, injections here needs to be done with caution to avoid eyebrow droop. This is prevented by proper injection technique and by choosing the right dose. If high doses are used, the brows and eyelids may feel heavy. When injected well, the horizontal lines that run across the forehead will soften and in most cases disappears while allowing you to still move your eyebrows.
Crows Feet. These are the smile lines that form around the corners of your eyes. They are caused by the contraction of the obilcularis oculi muscle. Repeated contraction of this muscle, leads to fine lines and wrinkles along the lower eyelid and around the corners of the eye. When treated with botox, the lines and wrinkles are softened and the transition to permanent lines and wrinkles around the eyes are prevented.
Brow Lift. A small area along the end of the eyebrow has a muscle that pulls the end of the eyebrow down. When this segment is injected, the tail of the brow can raise 2-4 mm giving the appearance of a brow lift
Neck Bands. Some forms of neck bands are caused by strong muscle contraction. These may appear as vertical bands that run down the neck. They can appear tense. In these cases, when Botox is injected the bands can relax, improving the contour and shape of the neck. Great care needs to be taken during this injection, as the neck has many important structures.
Downward Turning Corners of the Mouth. A small muscle that inserts into the corner of the mouth called the Depressor anguli oris muscle is partly responsible for turning down the corners of the mouth. A small amount of Botox into this muscle can help turn the corners up, decreasing the sad look caused by this muscle.
Facial Asymmetries. Patients suffering from facial nerve disorders resulting from tumors or Bell's Palsy can be helped by strategically treating different facial muscles to improve the balance of the face.
Treatment of Migraines. Certain varieties of migraines and headaches have been shown to improve with the proper placement of Botox in certain muscle groups.
3) How long does it take for Botox to start working?
Botox takes anywhere from 1-3 days to start working and takes approximately 2 weeks to reach peak activity.
4) How long does Botox last?
The typical duration of Botox is between 3-5 months. The duration of Botox is dependent on 2 primary variables: 1) The strength of the muscle and 2) the dose used during injection. Simply, the stronger the muscle or the lower the dose the shorter it will last. Conversely, the higher the dose (to a point) and the weaker the muscle the longer it will last. Each patient has a specific dose that is ideal to achieve the desired effect. Some of our patients' who are in front of the camera or public speakers, will get lighter doses more frequently so that they can look natural yet get the benefit anti-aging properties.
5) What are the side-effects?
Like anything, Botox has potential side-effects. Each prospective patient needs to review these in detail with their physician and understand the potential issues. Having said that, Cosmetic uses of Botox has been shown to be very safe when injected by experienced hands. Common side effects such as eyelid ptosis (the most common side effect), brow droop, or asymmetries are typically related to injection technique and can be minimized by an experienced injector.
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Dr. Karam voted
"2010, 2011, 2012, 2013
Best Cosmetic Surgeon"
Ranch and Coast Magazine
Readers Choice Award