Botox Beyond the Brow: Jawline Slimming, Lip Flips & Migraine Relief

Dr. G (00:02):
You're listening to another episode of All the B's with me, Dr. G, and my scrub tech, Bri. Nearly 10 million Botox treatments were done in the US last year. Can you believe it? That's according to the American Society of Plastic Surgeons, making it the most popular non-surgical cosmetic procedure again. Every year it's the most popular procedure. But what most people don't realize is it's not about erasing lines and we definitely know it's not about erasing lines. So it's been used for a lot of other things, headaches, masseter relaxation and the lip flip. So today Bri and I are going to give you an inside scoop on Botox for the masseters lip flip and how this toxins move beyond the forehead. Right?

Bri (00:52):
I just want to say I feel like I'm definitely at least 2% of that 10 million appointments.

Dr. G (00:59):
That's right. Those of us that are repeat offenders are driving those numbers up. But of course we got to do some celebrity news. So let's hit the Brittany Snow. I mean, the Golden Globes, a lot of people looked amazing.

Bri (01:14):
Yeah. I just love her so much because I loved all the drama between her and her ex- husband and the fact that her ex- husband left her.

Dr. G (01:21):
Yes.

Bri (01:22):
Mind blowing.

Dr. G (01:23):
I know. What a moron. He's like some real estate.

Bri (01:27):
She has the shoulders I want, the little clavicle.

Dr. G (01:33):
Yeah. She has some great posture, which you're going to have to sit up straight in that dress for sure because it looks so beautiful. I don't know why she is firing back at plastic surgery rumors. I don't know.

Bri (01:47):
She almost just looks too perfect.

Dr. G (01:50):
She looks great. She says she does a little bit of Botox and then she also talks about doing lasers. And I think she doesn't mention it. She either has some amazing makeup or she has lip filler. I mean, let's get real. I don't know why you would deny that. But yeah, I think lasers and really good skincare and taking care of your skin can achieve this look. She's 39 and she looks great. And you know you're leading up to the golden glome, so don't try and cram it in at the end. It's called maintenance for a reason. So I think that's important and she really does look good. So I think it's funny that people are trying to find that she had plastic surgery. And I was like, no, she just looks good, man.

Bri (02:36):
Yeah, she just looks really good. I don't believe she has a little bit of Botox, but a little bit to everyone is different. And a little bit to me is different than a little bit to a 20-year-old. I got a

Dr. G (02:48):
Yeah, what's a little?

Bri (02:49):
100 units shoved everywhere versus. But I think that maintenance thing is super important because a lot of people think that they can just ... Well, maybe not a lot, but they can just get Botox once every six months to a year. And you don't have to get a lot, but you have to keep up with it because once it comes back.

Dr. G (03:10):
It wears off and once it wears off, you're back to where you started. So yeah, you definitely have to continue to do it. I do think her skin looks great. So she talks about doing lasers. There's no ... I can't underscore how important routine facials and skincare and sunscreen and all those things will keep you looking as glowy as she does. And she also is taking care of her neck and her chest. I mean, otherwise you wouldn't be able to get away with wearing that dress. So it looks good. But I think if you scroll down a little bit, there's a photo of her from a way back and part of it's just a contrast between good lighting, bad lighting, right? The hair, the-

Bri (03:58):
She has to have a little filler on that upper lip.

Dr. G (04:00):
Yeah. So I was like, the only real difference there though is a little upper lip filler.

Bri (04:07):
Yeah.

Dr. G (04:08):
And then also just using what's available today, which is better lighting, better makeup, better hair color, or I don't know. I feel like she just has an orange filter in that.

Bri (04:20):
Have you seen that 2016 trend where it's a post? I'm like, oh God.

Dr. G (04:24):
I know.

Bri (04:26):
10 years ago, we were rough. No one wants to see that. Okay?

Dr. G (04:32):
I know. It is kind of weird. I saw, I was going through old photos and yesterday and there was one of me and my kids at Disney World and I was like, oh, I remember those sandals. Those are tragic. They're not that bad. They're just like, I would never wear them now. It's just weird how you're like, I thought they were so cool.

Bri (04:50):
Oh my God. I would put concealer on my lips and it would wear four tank tops layered and I had my choker and I was like, now I look back in it and I was like, who let me? As a mother, why did my mother let me do that?

Dr. G (05:05):
I mean, it was trending. You look like everybody else, so it's fine. Yeah. All right. Moving on. Speaking of fake plastic surgery news, Kendall Jenner is insisting she's never had plastic surgery. Girl, just go. Get out. I don't even know.

Bri (05:21):
She can't.

Dr. G (05:22):
I feel like she's just trolling us.

Bri (05:24):
She can't. Her nose.

Dr. G (05:29):
Everyone in your family is famous for having plastic surgery at this point and they're not gatekeeping. So why would you?

Bri (05:38):
Yeah. I mean, I just don't believe-

Dr. G (05:40):
She says she doesn't even like Botox.

Bri (05:44):
I can't even get behind that. And I love her and I fully support her. But if you've done the side by side pictures of her-

Dr. G (05:52):
There's a side by side in there.

Bri (05:53):
All right. We got to go to that.

Dr. G (05:55):
She attributes the change in her nose to Accutane. I was like, "Just stop."

Bri (06:00):
And the filler and her very plumped lips.

Dr. G (06:03):
And the removal of maybe buccal fat and- A

Bri (06:06):
Hundred percent. The slim jawline, not a wrinkle in sight. There's just no way.

Dr. G (06:14):
Just stop.

Bri (06:17):
I just feel like we're in the point of just own it. What is that? She looks phenomenal. Wait, go down to the car selfie. I know there's filters on it, but you're telling me there is no filler in those lips or Botox or nothing.

Dr. G (06:35):
Get out. Okay.

Bri (06:38):
That's not just all PRP.

Dr. G (06:42):
The other thing I think, I mean, we can talk about it, but Botox as ... If you've got the funs, which all of these celebrity people do, you can put it in your facial. You can microneedle it in. And it doesn't last very long, but it tightens up your pores. It's like a really, really bougie facial. It makes your skin all glowy. And your face still moves. It's not paralyzing anything. It's just tightening up the pores around your cheeks and whatnot. So I mean, that's another way to use Botox if you want to say you're not getting injected with it, but I don't know. And also, you're in your 20s. Why be so aggressively anti-Botox? You're not even in the demographic to use it anyway. So right? She's late 20s.

Bri (07:30):
I just feel like she prides herself on being so different from her entire family that now she just has to stick with it.

Dr. G (07:36):
Yeah.

Bri (07:37):
She's just like, "Hate everyone. Hate people. I'm all organic. Let's ride horses. I want to be out of the spotlight, but my entire job is in the spotlight."

Dr. G (07:49):
Move over, Kourtney. Yeah. Anyway, but you're a model. So that's your whole job, is to look-

Bri (07:58):
She's gorgeous. I just don't believe that she's had nothing done.

Dr. G (08:02):
Yeah. Okay. All right. And then moving on another no plastic surgery. And then a highlight for medical grades skincare is Jennifer Gardner, who is an example of aging super well and doing it naturally and not screwing things up, man.

Bri (08:20):
Yeah.

Dr. G (08:20):
She looks fabulous. She was also at the Golden Globes. She hasn't changed. There's certain things about her that have been ... She has a little bit of a gummy smile when she smiles. You can see it in the older picture and she has it now. She decided not to change that appropriately and it looks good. She didn't operate on her nose, which is actually really nice to start with anyway. Her features are her features. She still looks like her and she just looks well maintained, which is not really shocking because she just looks like she's been taking care of her skin, wearing sunscreen. What do they mean by medical grade skincare, do you think? What are they throwing around there?

Bri (09:05):
Not the stuff you get at Target.

Dr. G (09:07):
Sephora or Amazon.

Bri (09:08):
Not saying Ives body apricrot scrub. Yeah.

Dr. G (09:14):
So you want products. I know we go through this with patients all the time. They buy stuff they see on TikTok Shop or at Sephora or CVS. But if you're going to invest in skincare or even at Nordstrom, if you're going to spend money on skincare, spend a little bit more and get something that you know is working.

Bri (09:35):
Even the antiage line we carry here, they have an antiage and then they have the antiage MD.

Dr. G (09:41):
Right. You want the MD.

Bri (09:43):
Yeah. You want the good stuff. Do stuff that's actually going to penetrate and get into your skin and do something and not just make you break out everywhere. Like the bubble skincare my kid uses.

Dr. G (09:57):
Or it has active ingredients. So in order to be medical grade, you have to run through the FDA, you have to have active ingredients that are tested, you do research. Whereas you can slap a label on whatever you want for regular over-the-counter skincare. And you can list it as an ingredient, but you might have just a whisper of it. And that's why it's okay to say, "Oh, we have retinol," but you just put a teeny tiny drop of it and then it's already deactivated when it hits the bottle. And so it's inexpensive to make. And they spend most of their money on the packaging, on the way it smells, on the feeling it gives your skin, but not necessarily on what it's doing.

Bri (10:44):
It may look cute, but don't buy it.

Dr. G (10:47):
Yeah. If you're going to ... And then things like La Mer make me crazy because you got no active ingredients, but you're spending a ton of money. Then you definitely need to be doing Antiage MD and getting some actual growth factors for reels.

Bri (11:02):
Yeah. Get the actual good stuff.

Dr. G (11:04):
Yes.

Bri (11:05):
Especially if you're also spending all these money on lasers and treatments in Botox. Why would you stiff yourself at the skincare, which is the also most important part?

Dr. G (11:15):
Yeah. It makes no sense, but it does. And so it's the same thing. You go to the dentist and get your teeth cleaned twice a year, but are you not brushing your teeth every day? You should be brushing your teeth twice a day and flossing. So don't just go get the teeth cleaning. Don't just go get the laser. You need to be doing something on the daily to maintain your results. But yeah, I think she's done a great job of not doing aggressive filler. She has some movement in her face because she's an actress or actor, but then doing, I'm sure, Botox as needed to keep any lines from becoming permanent.

Bri (11:53):
Yeah.

Dr. G (11:54):
And I'm sure lasers as well. Props. She's doing it properly.

Bri (12:00):
Yeah. She looks great.

Dr. G (12:02):
And then now from some stories related to today's topic, which I feel like we've already been kind of covering, but Meghan Trainor, sigh, I just can't with this woman, honestly. She was involved in that whole toxic mom group situation. She's part of that.

Bri (12:20):
The Ashley Tisdale ... Or no, Hillary Duff. Wait, no. Was it Ashley?

Dr. G (12:24):
Ashley Tisdale.

Bri (12:25):
Okay.

Dr. G (12:25):
Also now known as Ashley French. But yeah, the toxic mom group that was anonymous until it wasn't anonymous. I'm sure Meghan Trainor's a lovely person.

Bri (12:40):
I didn't hear what the actual toxic part of that was.

Dr. G (12:44):
They were planning things and then she was maybe not invited, left off the group chat, and then there would be a thing- Not the

Bri (12:51):
Group chat.

Dr. G (12:53):
Yeah. It's very high school. Or yeah, it was basically that. There would be things and they were like, "Oh, we forgot to tell you about it, " or something like that. And then-

Bri (13:02):
So she wasn't really in the mom group?

Dr. G (13:04):
She was. And then after a year-

Bri (13:06):
Doesn't sound like it.

Dr. G (13:07):
... she started getting left out and she said that when she joined, there was somebody else that they were kind of leaving out. So she was getting squeezed out.

Bri (13:15):
Is this like a you have to get hazed into it?

Dr. G (13:18):
No, she was in and then sort of left off after a while because who knows? And then anytime she would be like, "Did you guys forget to tell me about ... " The thing about this is that it's ... So let's say my book club decided to do a book club without me, like an extra month or something, I don't know, whatever, and I got left off the group chat, I wouldn't know. But this group of women post it all over Instagram. So my book club just meets- That's dumb. ... and has some drinks and that's it. And if you didn't go, you didn't go. And sometimes we mentioned something that happened at a previous book club, but if you weren't there, you have no idea what we're talking about, but we don't post about it. So you could easily-

Bri (14:07):
No one would know.

Dr. G (14:08):
... add a second book club in session and no one would know. But this, they hype it up. Everyone's posting and tagging and they're all following each other. And so- Is

Bri (14:19):
This very mom talk?

Dr. G (14:21):
It is very mom talk. I just feel like it's so immature, which was one of her points. But then the one guy's ... Was it Hillary Duff's husband that came after her, did a post where he made fun of her and said, "Well, maybe it's you kind of situation." Oh, you didn't see that?

Bri (14:38):
No. Yeah. Then maybe she shouldn't be in the group.

Dr. G (14:42):
So she's not in the group.

Bri (14:44):
But if you literally have one group chat for your group and you're not in it, how does that even make sense?

Dr. G (14:54):
It doesn't. It means you got excluded and her feelings are hurt, which I get. It would suck. I don't know if everybody went out on a boat to watch the summer. I'm just kidding.

Bri (15:06):
I'm going to throw a punch you.

Dr. G (15:08):
I am just kidding. His post basically said if you weren't such a, I don't know, obnoxious person to be around, maybe you'd split. It was something-

Bri (15:22):
Yeah. So instead of just confronting her and telling her that you don't want her part of the group, they just decided to-

Dr. G (15:27):
They just were silently-

Bri (15:30):
Silent exit.

Dr. G (15:31):
Yeah, silently excluding her. That's what it sounds like. Who knows? Anyway, Meghan Trainor in this group, this girl cracks me up, man, because she, again, I hate saying something about somebody I don't know anything about, but she seems so picky, such a pick me. So she's on the show and she's talking about how she did Botox lip flip and that she can't smile afterwards. And it's a funny article because first of all, that's not how it works. I'm just confused. How can you not smile after a lip flip?

Bri (16:05):
I've got a lip flip and I can smile.

Dr. G (16:07):
It just doesn't-

Bri (16:07):
There is a lot of things you can't do.

Dr. G (16:10):
But that's not one of them.

Bri (16:10):
But that's not one of them.

Dr. G (16:11):
And then even in the article when they reach out to plastic surgeons or dermatologists, they're like, "It's not a known complication." They're trying to ... I'm sure everybody they called were like, "What? What do you mean you can't smile? That doesn't even make any sense." You can't spit. Maybe she meant her smile was different, but struggling to smile is not a side effect.

Bri (16:43):
Where would you put Botox that that would make struggling to smile difficult?

Dr. G (16:49):
I mean, I guess what do you mean by you can't smile? So you can't raise the corners of your mouth? I don't know.

Bri (16:58):
You know what? Who cares anyways? We don't want people to think we're that friendly.

Dr. G (17:01):
So you could ... I don't know where you could put it. The only way you could really jack someone up is maybe if you go up by the crow's feet and you got into the zygomaticus major or minor and then you couldn't raise ... That would be a no smile, but that wouldn't be from a lip flip. It would be from ... Or maybe they tried to, if you have a gummy smile and they went way up high and got into that muscle, then you wouldn't be able to raise your cheek. But a lip flip, you're right on the border of the lip. It's only affecting the orbic, which is a muscle that goes around your mouth. And the idea is you're weakening it a little bit so that it can't make that little circle. So when you purse your lips to suck on a straw or play a musical instrument like a trumpet, or I don't know, or purse your lips, you can't do it.

(17:51):
It's not as strong. And then it helps even out those little fine lines and it everts your lip. So yeah, it's the straw or when you're trying to suck water out of a water bottle, same thing that has a straw. You can't bring your upper lip down.

Bri (18:06):
Sometimes I just hold it a little bit on the straw.

Dr. G (18:08):
I just don't put that big of a dose in. I can't with that. I got an extra dose the last time Dr. Chow did it because that's how she does it. And I was like- And it's hard. What the hell? I can't ...

Bri (18:22):
My PSA is if you were just starting dating somebody new, don't do it.

Dr. G (18:29):
My PSA is if you're new to Botox, probably don't start with the lip flip or make sure your person is doing a tiny, tiny dose.

(18:37):
I think starting small on these things is the way to go. When people start asking, and when we talk about these kind of lower third of the face Botox, if you've never done Botox, this is like varsity moves and it does affect the way you talk and spit and suck. And you put too much in the lip, but you can start biting on the inside of your tongue or your cheek. There's some things that are compensatory. What I think with the lip flip is like when you go to open your mouth to maybe take a bite out of a burger, you need your upper lip to come down and around to take the bite. And when I can't do that, you look crazy. So those are sort of the maneuvers.

Bri (19:23):
I have literally been out in public and I go to take a sip of my drink and it just dribbles down my mouth and they're looking like, "Are you okay?" I was like, "It's just the Botox." Literally dribbling down my shirt. Yeah. But it is worth it. It looks great.

Dr. G (19:38):
And you can still smile. I think there's so many things that the lip flip and Botox around the mouth in general can impact, which is why I'm pretty careful on the patients that get it and that's not one of them. So it's just classic for her to raise an issue that doesn't exist, but God bless her heart. Bless her soul. Bless bless. All right. So let's move on. Hello magazines, Mark Consuelos calls out wife Kelly Rippa for getting Botox. I mean, she's been doing it forever, so I don't really understand what the article was about.

Bri (20:16):
Was this a bad call out? Like don't do it anymore. Oh, no, he was being funny. I just want to say somebody tells you-

Dr. G (20:24):
They're too couple, honestly.

Bri (20:25):
Not get Botox. You just leave them. Just find someone new.

Dr. G (20:30):
I feel like it's- They are a

Bri (20:31):
Super cute couple. I love them.

Dr. G (20:32):
One of my girlfriends was telling me she was in some Facebook group where this mom talked about how she got Botox and her son and husband were livid about it. And I was like, why do they even ... First of all, if you hadn't told them, they weren't unnoticed, period. So just who cares? It's your ...

Bri (20:52):
I don't know. Some people are like that. I always know when I need to get Botox. The other day we were in the OR and somebody said something stupid and I looked at them and they're like, "Oh my God, I can see your expression. You need more Botox." I'm like, oh. You're not supposed to know what I'm thinking over here under my mask and my cap.

Dr. G (21:14):
Yeah. You have a very narrow exposed area in the OR.

Bri (21:17):
Just right here.

Dr. G (21:19):
You really got to Nicole Kidman that shit with your eyes with your Botox.

Bri (21:23):
She daggers with my eyes and the second I could move, that's why I have to get Botox.

Dr. G (21:31):
I know. I can just direct my headlight at people annoying.

Bri (21:34):
Yeah, she just blinds me in the eye. She's like, "You have something to say. You're not going to be able to see the next 30 seconds, but it's fine."

Dr. G (21:42):
You're done. I know. I don't really appreciate because I'm the only one wearing the headlight.

Bri (21:47):
I'm going to start wearing a headlight.

Dr. G (21:49):
But when I was adjusting it the other day, I turned it on as I was adjusting it in that little mirror we have in the PACU and I was like, "Oh my God." Reflected back at me.

Bri (21:59):
Blinded herself. Now you know how I feel on the daily.

Dr. G (22:06):
It was like a terrible magic trick. I was like, "Oh, great."

Bri (22:10):
Yeah, I'm actually going to do that one day. You're going to come in. I'm just going to have a headlight on.

Dr. G (22:14):
Super. It's annoying, but so effective. You really need the headlights. You do. Every time I don't wear it, I'm like, oh, you do had it on. Yeah. So Kelly Rippa has been getting Botox forever and I'm happy for her. And I think she gets it for teeth grinding. I can't remember what the ... I mean, for all the things, but ... Was it? Might have to refresh my memory on it.

Bri (22:37):
I don't know. Jaw tension and grinding her teeth at night.

Dr. G (22:41):
Oh, that's why he was complaining about her. I mean, yeah, you could do a bite block or you could just put some masseter Botox in, which is, I think, the way to go. I just put some in because I found myself ... I don't grind, but I was starting to clench at night in my sleep and nothing's worse than getting what you think is a good night's sleep and waking up with a headache because your teeth, you've been biting down. It's annoying.

Bri (23:07):
I get that really bad. When I got my veneers done, there was a month between getting your teeth done so that you have these temporary ones on and it's giving me PTSD, but I would grind my temporary ones off at night and I'd wake up and I would have a little nub and I'd look like a meth addict. It was crazy because I grind my teeth so bad.

Dr. G (23:30):
That's wild.

Bri (23:31):
Yeah.

Dr. G (23:33):
Yeah. Okay. So Botox can definitely help that. So it can be for a couple reasons. The reason masseter Botox, one of the reasons it came into play is because for people who have more of a square face, you can put Botox in the masseters, which is that muscle that kind of wraps around your jaw and it's in the kind of back part of your jaw angle. I don't know. I don't know how to describe it. I just know where it is. It's

Bri (23:59):
Right here.

Dr. G (24:01):
It's a muscle that if you bite down, you can feel it.

Bri (24:05):
I have a very strong jaw.

Dr. G (24:06):
By the angle of your mandible. And I know there's probably other words for that. I like

Bri (24:12):
Jaw angle. We'll go with jaw angle.

Dr. G (24:13):
Jaw angle. Yeah. So-

Bri (24:16):
Your Jankle.

Dr. G (24:18):
You can use it and if you put a big enough dose and you do it consistently, over time that muscle gets weaker and atrophies a little bit means it gets smaller. And so it has a facial slimming effect. It is very subtle and it takes months to kind of reap that benefit. I remember Ashley used to do masseter Botox and you start to think, oh, maybe it's not doing anything. And then she had looked up. If you look at photos of yourself from a year to two years before, you're like, oh yeah, that is having a slimming effect if you have that wider lower face.

Bri (24:52):
I had the most gnarly jaw. I'm just going to have to show a picture for reference, but I had the craziest jaw muscles and my left side has always been so much more bigger than my other side. So I do a little bit more on this side. But yeah, no, it has slimmed down my face. I can never not do masseter Botox again. I'm going to look like that guy from the, who has this big square cartoon character head.

Dr. G (25:17):
So many. SpongeBob. I don't know.

Bri (25:20):
No. Okay. So-

Dr. G (25:24):
Mr. Incredible, what are you talking about?

Bri (25:25):
Yeah, someone like that. I just had a very light- Oh, Squared off.

Dr. G (25:29):
Yeah. So it's pretty popular in South Korea because Asian women want that kind of slimmer, lower third of the face. And then the other reason you can use it is if you grind your teeth, it helps with that as well because you can't do it. That is probably the more popular reason we do it. Less of our patients are trying to slim down their masseters, but it is very effective and can be done relatively infrequently if that's the reason, like every six months or so. And the dose varies. I usually start with like 10 units per side. Some people get away with those little six. Some people need a lot more.

Bri (26:08):
Yes. Thank you. That's literally like hair and all. That's what I look like. I swear.

Dr. G (26:15):
Square jaw. Yes. So I was reluctant to use it because my jaw is the opposite of that, pretty narrow. And so I didn't want to be any more narrow and long, but I do a little bit just for the clenching and tension headaches effect. So love it for that. So then we have one last person who weighs in Haley Bieber who has a strict no Botox rule with one exception. What's her exception? I don't know. In her facials, question mark. You have the eyes.

Bri (26:48):
No Botox except for in my face. Oh, in her jaw for TMJ. So she has masseter Botox.

Dr. G (26:55):
Yeah. Okay. Yeah. But again, isn't she like 20 something?

Bri (26:59):
She said 28 or 29.

Dr. G (27:00):
Okay. So you're fine. You don't need it yet.

Bri (27:03):
And then you can start using it like everything else. Consider it until she turns 30. That's fair. I mean, she doesn't have a lot of wrinkles.

Dr. G (27:09):
She doesn't need it yet. Use your over-the-counter skincare girl and ...

Bri (27:15):
There's nothing wrong with preventative Botox though. All these people make it seem like Botox is killing you.

Dr. G (27:22):
Yeah.

Bri (27:22):
I'm very confused.

Dr. G (27:24):
Yeah. Why they're so anti-it is kind of wild. Because unlike fillers where you can overdo it, I guess, and look a little wild, Botox is usually not associated with looking weird. It's associated with maybe being a little frozen, but you can just do enough to weaken stuff so that you're not creating wrinkles and you won't be frozen. So I don't really know what the big ick is, why people feel the need to discount it.

Bri (27:54):
I guarantee you're putting a lot worse stuff In your body.

Dr. G (27:58):
Yeah. Yeah. It can't possibly be that Botox is bad. If anything, it's just expensive over time. It's like a maintenance thing you have to commit to, just like medical grade skincare. You cannot roll into the office at 45 or 55 and have a big 11 crease between your brows and be like, "I just need some Botox to fix this. " It's going to take a really long time once that wrinkle is permanent to unfurl it and you're going to need years of Botoxing it consistently so that it finally relaxes and maybe resolves. But if you can keep it from forming, so you want to be able to move your face. And so people are always, maybe they're doing their forehead and their glabella with me, but they're like, "When do I start with my crow's feet?" Well, once you start, you usually don't stop. So you got to budget for it.

(28:56):
And I think once you think that you're squinting enough and you're maybe seeing some fine lines that aren't leaving when you're not squinting, then you need to jump on Botox because you don't want those lines to become permanent. So once they're permanent, once they're what we call static, so they're not just when you move your face, they're when you're not moving your face, you can still see those wrinkles, then it's already generally speaking, a little late to get on the Botox strain. So yeah, Haley Bieber doesn't have a freaking wrinkle, so she doesn't really need to do it. When she starts making ... I think I was in my early 30s when I started seeing the little crease in my glabella, so in between my brows and I was like ... And started doing Botox, and that was that.

Bri (29:43):
Must be nice. I had that at like 20. Yeah, but I also had two kids by the time I was 20.

Dr. G (29:50):
Yeah, I was keeping my head down in general surgery.

Bri (29:52):
Did you say I've been around?

Dr. G (29:54):
No, I said you've been around the industry, not around, around.

Bri (30:01):
Clip that one, someone.

Dr. G (30:02):
I think if you're around it ... I was just a general surgery resident, so I wasn't in the realm of plastic surgery. I was just grinding away in the hospital. But yeah, I think I was early 30s, which is, I mean, I feel like also because of my general surgery residency, starting to get some permanent creases in my forehead. And I was like, "Yeah, we need to put a stop to that. " And I had access to it. So it's a good time to do it.

Bri (30:33):
Yeah. Is there any people that you would suggest don't get Botox?

Dr. G (30:40):
No.

Bri (30:41):
Good answer.

Dr. G (30:42):
I mean, who wouldn't benefit from it?

Bri (30:44):
I have no idea. No. I just wanted to make sure.

Dr. G (30:47):
Yeah. I mean, there's really no one that couldn't benefit from a little bit after your ... I feel like once you're in your 30s, it probably doesn't hurt. And if you want to push it down the road, that's fine too. But it just also depends on how expressive your face is.

Bri (31:02):
Yeah.

Dr. G (31:02):
I think certain people are way more expressive, and if that's the case, then you're going to want to jump on that earlier. And again, it doesn't make sense to just do Botox and not do sunscreen or any of the other ... Or smoke cigarettes or whatever. All the things.

Bri (31:17):
So Botox itself, I know we're talking about the Botox specific brand, but what are your thoughts on Botox, Dysport, Daxify? Yeah. There's a lot. Is there anything you recommend someone start with or don't start with? Or what's the difference?

Dr. G (31:37):
So I would say that there's a bunch of neuromodulators out there. The reason everyone just refers to it as Botox is because it was the first one out and it's been out for a while. So it was the OG, sort of like Kleenex or people refer to Coke as Coke, even if you're talking about some other product. So Botox has been around the longest. So it has all the safety data for it. It has the most studies. So it's a good place to start. Allergan has been behind it for a really long time and most spas or offices, doctor's offices will carry it. And then there's a bunch of litany of other players. The next two on the timeline that came to market was Xeomin and then Dysport. And Xeomin is interesting because it's not bound to a human protein. It's like a little bit different.

(32:34):
It's a good product. I think sometimes if you are starting to get resistant to Botox because it's changing things up. And Dysport is very similar to Botox. It has a little slightly different spread. And there's all this debate. Does it kick in faster? Probably kicks in a little bit faster. Does it last longer? Not really. So it's just another alternative. Some people prefer it. I think it makes my head hurt to use it because the units are different. So when we're talking about Botox, you're doing ... The standard is like a 20 units into the glabella, right? Well, Dysport's 50 or 60 because it's kind of a three to one reconstitution, blah, blah, blah. So then I have to do math in my head and it's annoying. And then next on the market was Jovu, I believe, which is very similar to Botox. It doesn't really offer any alternative advantages as far as I can see. So it sort of came and went or is still around. Yeah.

Bri (33:33):
I don't even know if I've heard of that one.

Dr. G (33:35):
They came out with a splash and they were going to be like ... So Botox has both a cosmetic and a therapeutic indication. And so they have some kind of stringent, like if you get Botox therapeutic, which is used for muscle spasms and some other medical indications. So I think their advertising plan is different. I don't know. That's what Jovu was arguing, that they could do more direct marketing because they were only a cosmetic indication. I don't think that's actually ... It's not how it panned out. I don't really care, but if people aren't calling for it, then why am I going to carry it? They just call and ask for Botox and that's what I will deliver.

(34:11):
And then most recently is Daxify, which is the longer acting version of Botox. And it lasts about twice as long as Botox does. So it's a nice product for people who are hoping to come in less often, or maybe they feel like their Botox is wearing off on the shorter end of things. Now it's supposed to last two and a half to four months, Botox. Most people, you're at that two and a half and it starts to wear off, and then at three months it's kind of almost gone. You're lucky if you can get four months out of it. So if you only get two months, then you could get four months out of Daxify, ideally. And everyone's a little bit different in how they metabolize it. Then Latibo just came out, which is a Korean ... They're client trying to market it as a Katox.

(34:57):
And the thing you have to remember in the United States, the FDA used to be pretty ... I mean, I think they are still kind of stringent about things, but there's multiple botulinum toxins, neuromodulators out in the Korean market and the European market. And the same goes with fillers, but getting brought to market in the US is pretty tricky or has a lot more hoops to jump through. And so we have less of a catalog to work with, but that's been changing over the years. So from a surgeon standpoint, what they're offering is a cheaper cost usually. They're trying to get you to offer this because it costs you less to purchase than actual Botox. But that only makes sense if you're going to sell it to the consumer, to the patient at the same price point as Botox. So that's where I think Dysport initially fumbled because they tried to make it as a cheaper alternative, but then we're all just doing the same work and making the same margin, so it doesn't make any sense.

(35:56):
So I don't want to sell a premium product, but no, I'm paying less for it. I mean, I guess that's great, but then I also have to market, have to convince ... If the average person, my average patient's coming in and getting Botox and has been happy for years, and I'm like, let's try this Latibo.

Bri (36:12):
I'll convert you.

Dr. G (36:13):
Yeah. I would also be a little suss about that. Okay, because it's different. Yeah. Like why? Oh, it's cheaper for you? Okay, great. I mean, it's fine. It's equivalent, but it doesn't ...

Bri (36:28):
I don't know. I tried it one time and I was very underwhelmed.

Dr. G (36:31):
Yeah. I didn't love it either, but ...

Bri (36:34):
Now, would you recommend if you're doing Botox all the time? I know some people say you should do Botox and then switch to Dysport to help them not metabolize it as fast, or is that just a myth?

Dr. G (36:47):
There's no studies to prove that, but I think it doesn't hurt some ... And people who really feel like it's wearing off, then I think switching it up doesn't hurt. I've done it before and I feel like I definitely have been doing Botox for a long time and switching it up sometimes does make it last a little longer because it just has to do with the proteins that are bound to the product. So it's not the actual neuromodulator, but then there's different things like how much protein you're ingesting, how much cell turnover you have, all these other things that are causing you to metabolize them. You're not metabolizing the neuromodulator. I don't want to really get into the science of it, but yeah, there are some things where you're going to make those connections between the little neurons that are firing the muscles that might happen faster. So that's what we need.

Bri (37:32):
So we need to get rid of our families. Yes. Get rid of our kids, get rid of our husbands that make us make all these faces and fire the ... I got it. I got what you're putting down.

Dr. G (37:44):
So yeah, so there is some variability as in all things, but yeah, I do think it doesn't hurt. They each do also have a little bit of a difference of spread in terms of how far the product spreads at a certain dilution. So there's some nuances, but in general, none of the products are bad. They're all effective and I think it's reasonable to use them.

Bri (38:08):
Okay.

Dr. G (38:08):
If you are getting it for, like you said, like we were going to say, a therapeutic use for migraine treatment or masseters, then there is Botox Therapeutic. So if you're getting it covered by insurance for some reason, Bravo, then you're getting Botox Therapeutic, which is exactly the same stuff, exactly the same price point, but it comes in a vial that says Botox Therapeutic just for fun. I love that. I know. It's kind of wild. So I don't do migraine Botox. It's pretty effective for certain patients.

Bri (38:42):
That's like a lot of units all on your scalp, right?

Dr. G (38:45):
Yeah. I think it's like 60 to 100 units because they put some in the back of the neck and some other areas. And then the other, sometimes people get it covered, most people can't, is for hyperhidrosis. So you can put Botox in the underarm area to keep you from sweating. Sounds terrible. It's very effective. So you really have to have a sweating problem, but it's effective and it lasts for about six months. It's a little stingy because it's a lot of little injections. You do not sound fun. But for the people who, it's usually men who sweat through their shirts and leave pit stains everywhere and it's stressful because they look like they're sweating through their clothes and their jackets and everything. It's extremely effective. And again, the studies with that are done with Botox, not with these other products. Could you use the other products?

(39:35):
Sure. But now you're venturing even more off label than usual. And then the lip flip, which I love.

Bri (39:43):
Me too.

Dr. G (39:45):
So yeah, I guess if you're changing up the product, maybe the spread isn't what you need it to be. So I'd probably stick with Botox or Xeomin or Daxify for it, but you could use anything. And I think personally, I think four units total is plenty, but again, people will put up to eight. What else? What are the other ... Oh, other places you can put Botox. Besides the lip flip, you can treat a gummy smile.

Bri (40:13):
Your nose.

Dr. G (40:14):
You can put it in your nose, but ...

Bri (40:16):
I did that twice.

Dr. G (40:19):
It was okay. I

Bri (40:20):
Just feel like this is stupid and this is totally not medically correct. It made my nose so much more itchy and it could never itch. And I swear I just had more- boogers.

Dr. G (40:34):
Well, the boogers is probably because you can't flare in your nostrils as much. I don't know. I just- I bet that's what it is. It wasn't for me. It probably affected your breathing. Yes. Yeah. Yeah. That one was kind of a little bit of a fail. Yeah. I think the DAOs, so the depressor Angularis auris down here, the frowning muscles are great. I treat those. It helps with resting bitch face.

Bri (41:00):
I have those. Bitch face and DAOs.

Dr. G (41:05):
And in the mentalis, so if you get that kind of orange peel chin, it can help with that. And then there are people with a congenital asymmetric smile. So when they smile, part of their lip comes down and the other part doesn't. And so you can match it by bringing the part that comes down. You can paralyze it so it comes up. If that's something they're interested, that's a really small dose and you kind of put it up by the lip. Those are other lower third of the face options. You can do it in the platysma. It's effective for a lot of people. For me, I'm usually just chasing ... I don't know. I don't know what max dose I would need to take out my platysma, which is the muscle of horror, but I'm never ... As soon as I get one band, there's eight more that sprout up. So for me, it hasn't been very effective. And then you can do under eyes. Yeah.

Bri (41:59):
I've never done that.

Dr. G (42:01):
Freaking hate doing that.

Bri (42:02):
It's like one unit, right?

Dr. G (42:04):
You just put one unit right under your little eyelid, very superficial, and it keeps that little muscle from squeezing down too much, kind of relaxes it. Opens up the eyes if you have narrow eyes. It just feels like I'm stabbing someone in the eye, but it's fun. And then I do like, if you're in the upper third, you can do kind of in the brow, the tail of the brow I like to open up the eye. So I think those are all reasonable, kind of not mainstream Botox situations. And like we talked about, you can put it in your facial if you want to microneedle it in, but it only lasts about three weeks. So it's really for a special event or something. The

Bri (42:46):
Golden Globes.

Dr. G (42:47):
Yeah. If you're going to the Golden Globes, I 100% do that. So yeah.

Bri (42:51):
So what's the spock eyebrow?

Dr. G (42:53):
Oh, the Spock eyebrow, I'm working on one right now, but I'm waiting for my stuff to kick in.

Bri (42:58):
I feel like I hear that a lot from people.

Dr. G (43:01):
It's just when you put the Botox into the central forehead, but you don't come out laterally enough. So your lateral eyebrows can come up, but the rest of your forehead's not moving. So when you go to raise your eyebrows, just the Matt Gaetz part of your forehead moves and you look insane. So yeah, like I said, there's definitely the lower third of the face especially and then the forehead are the trickiest areas to inject. And so you want to make sure if you're a first time person that you're not letting someone put too much in because you kind of can't take it out, but you can always add more. And that they kind of know what they're doing because everyone's anatomy is a little bit different. And so you don't want to end up with some weird side effect that you have to deal with for the next couple months until it wears off.

Bri (43:50):
Yeah.

Dr. G (43:50):
The upside is that it will wear off, but a lot of times then those first time people, if they have a bad experience, then don't come back. Which is a bummer.

(44:00):
Yeah. Still waiting for a topical Botox, that would be lovely, I think, but I don't think it's going to happen anytime soon.

Bri (44:07):
That'd be so good.

Dr. G (44:10):
All right. Did we ...

Bri (44:12):
What else do we want to cover?

Dr. G (44:14):
There's a lot of lip flip questions I think we might not have covered. I think a lip flip is a good way to increase your projection of your lip and make it look bigger without actually adding any volume. So if you're really scared about lip filler, I tell people it's a good option. You could do them both together. You can also add volume and then add a little kind of pouty upper lip with the Botox.

Bri (44:40):
Yeah.

Dr. G (44:41):
With Botox in the upper lip, it doesn't last very long. So just remember that too, because Botox is dose dependent, all the neuromodulators are. So the bigger the dose, the longer it lasts. But again, you don't want to go too big in the upper lip because you don't want to completely get rid of your muscle in the upper lip. So the dose is kind of capped out at eight units. And so it's something that you might need more frequently than every three months if that's like the look you like. Or if you really like it, then maybe that's time for you to think about doing some lip filler to add volume, but I think-

Bri (45:15):
Or do both.

Dr. G (45:16):
Yeah. I wouldn't say anybody's not a good candidate for a lip flip. Pretty much everyone is, because it's subtle. If you have a gummy smile, I think maybe not, because you could put some Botox to address that, but you could still do both if you wanted to.

Bri (45:35):
Feel like they're very complimentary.

Dr. G (45:37):
Yeah. And I think lip shape, it's-

Bri (45:41):
It doesn't really create a shape, does it?

Dr. G (45:43):
No, it's just upturning your current shape. So it's not changing your shape, which is nice if that's ... You kind of want to look like yourself, but a little pouty.

Bri (45:53):
Yeah. A little something something.

Dr. G (45:55):
It's really a win-win. And because it's only four to eight units of Botox, it's also a way to dip your toe into the whole thing and try it out. Kind of fun.

Bri (46:05):
10 out of 10 recommend.

Dr. G (46:07):
Yeah. Or you could suck on a bottle cap or something or whatever it is people do to fake it.

Bri (46:11):
Oh yeah. They have that sucky thing and they like ...

Dr. G (46:15):
So dumb.

Bri (46:15):
That probably looks weird.

Dr. G (46:18):
You could do that, I guess. Or I feel like there was a point in time where people were putting glue on their upper lip and gluing it. That's like when I knew my TikTok feed had gone to hell. I was like, "Oh God, take me out of this algorithm."

Bri (46:33):
I feel like mine's recently be coming back to that.

Dr. G (46:36):
Yeah. Now that it's off the heated rivalry.

Bri (46:39):
Yeah. Now that it's off the boy aquarium, we're going back to the big lip challenge.

Dr. G (46:45):
Yeah. We really need one of those two actors to talk about plastic surgery, please.

Bri (46:51):
Yeah.

Dr. G (46:51):
I feel like one of them talked about his skincare, which was as close as we're going to get.

Bri (46:56):
I'll take it. I'll take it. That's great.

Dr. G (46:58):
Let's have them on the show.

Bri (47:00):
Please come on.

Dr. G (47:01):
Please come on our humble podcast. All right. If you have questions and you're like, you didn't answer my question about lip flip or Latibo or some other obscure Botox question you had, you can use it for other things. You could put it in your scalp, I guess.

Bri (47:19):
You can put it in-

Dr. G (47:21):
Your traps.

Bri (47:22):
Your traps. You can put it ... Where else can you put it?

Dr. G (47:25):
Scrotox.

Bri (47:27):
Scrotox. You can do scrotalx. It's trending.

Dr. G (47:30):
Not trending. Not at this office, but if you want to Google that, feel free. And then, yeah, in the scalp people were doing it, which is really expensive to keep your head from sweating so your blowout would last longer.

Bri (47:42):
Wait, that was the dumbest- I put it in the labia, right? Somebody was telling me about that a couple weeks ago.

Dr. G (47:48):
I don't know.

Bri (47:51):
I don't remember.

Dr. G (47:52):
I mean, you can use it for-

Bri (47:53):
Oh, it was for like ... I think the conversation was about stimulation, but I don't know how that would track.

Dr. G (48:00):
I don't know how that would help.

Bri (48:01):
I'm going to have to get back to you guys on that one. Don't worry.

Dr. G (48:04):
Okay. Next podcast, we'll get back to Botox of the labia, which I'm pretty sure I would've heard about, but maybe not. Okay. Yeah. So those are all the other areas. I mean, you can use it in your esophagus, but that's like-

Bri (48:18):
For what?

Dr. G (48:19):
For esophageal spasm and the other end as well. But those are therapeutic indications, that we're not going to cover.

Bri (48:34):
I have so many comments, but I'm not going to say them.

Dr. G (48:38):
All right. Moving on. If you do have questions or comments, please leave them in the comments. And if not, we're going to scrub in.

Bri (48:47):
And scrubbing out.

Dr. G (48:50):
Bye.

Bri (48:51):
Bye. See you later.

Dr. G (48:55):
If you're listening today and have questions, need info about scheduling, financing, reviews, or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. To learn more about us, go to restorestplasticsurgery.com or follow us on Instagram @RestoreSDPlasticSurgery. If you enjoyed this episode, please share it and subscribe to All the B's on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcasts.