I Learned the Most Important Lesson About Botox in Second Grade

Noninvasive aesthetic treatments like cosmetic injectables, chemical peels, and laser treatments have opened up a new world of possibility for facial rejuvenation with minimal-to-no downtime. Many of these procedures can be performed in minutes – even seconds, and require no aftercare at all. It looks so easy, too: a flash of a laser, the push of a syringe, or the application of a solution. Effortless! And the fact of the matter is, the physical motion often is.

Anyone can do this stuff! And they do. Primary care doctors do it. Dentists do it. Gynecologists do it. Emergency room doctors do it. Medical spa technicians do it. Unlicensed hobbyists do it in their garages. Sometimes, things work out just fine. There are two big ways, however, in which things can go very wrong, and that is what we will discuss here. The first major category of poor outcome is the “unfavorable result” – the treatment was performed in such a way that things just don’t look like they should. The second major category of poor outcome is the “complication” – actual harm was done to the patient. Let’s take them one at a time. And then we’ll tie it back to second grade.

Unfavorable results, for the purposes of this discussion, include aesthetically displeasing outcomes. A “dropped brow” with Botox or an uneven chemical peel would be examples. Unfavorable results tend to occur because although the physical motion of injecting Botox or applying a chemical peel is very simple, knowledge of the scientific principles behind the treatment are quite complex. A board certified plastic surgeon or dermatologist has completed years of training to know not only exactly where the muscles of facial expression are, for example, but also precisely how much Botox to administer so as to achieve a reduction in forehead wrinkles with a minimal chance of “dropping” a brow.

Next, we get to the complications. These are untoward events in which actual harm comes to the patient, and they are extremely rare with these treatments when performed by board certified plastic surgeons and dermatologists. Examples of complications include skin necrosis from fillers (filler is injected into a blood vessel, cutting off oxygen supply to skin in the area) or burns from a laser. Your chances of a bad outcome from a complication is dramatically reduced when a board certified plastic surgeon or dermatologist performs your treatment because his or her training makes the event much less likely to occur in the first place, and that training also makes him or her much better equipped to deal with the complication in the unlikely event that it does occur. Going back to the example of skin necrosis from a filler, a plastic surgeon is trained to immediately recognize this issue and knows what emergency measures to take to minimize the chances of permanent skin damage. Similarly, in the event of a laser burn, burn treatment is an integral part of plastic surgery training. This experience comes into play should this unlikely scenario arrive in the context of a cosmetic laser treatment.

All of this can be summarized by a lesson that I was taught by my second grade teacher: “don’t climb a tree that’s higher than you can climb down from yourself.” Just because a provider can flash a laser, push a syringe, or apply a solution doesn’t mean that he or she can do it in the right place or in the right amount. And it certainly doesn’t mean that he or she can handle the problem that develops when it is done wrong. Get your teeth cleaned at the dentist. Have your Botox done by a board certified plastic surgeon, dermatologist, or provider that works closely with one of those experts.

Office of Darren M. Smith, MD

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