A surgeon colleague, whom I hadn’t seen in awhile, said to me yesterday – so what do you do with your time now that you’re not operating as much? This pictures shows 10 syringes of Dermal Fillers used today! I didn’t use any Radiesse today though – it is one of my favorite fillers too! You can see that there are 4 different types of Juvederm boxes shown here. Today was heavily weighted with the Juvederm family of cosmetic dermal fillers with a few Belotero syringes too. The friendly surgeon seemed surprised that my day is filled with fillers and Botox.
Purchasing Botox, Juvederm, and Latisse can be costly. In case anyone is wondering, this is what a bill looks like. I usually pay every other month. Thus this is how much is generated with Botox, Juvederm, and Latisse in two months in my Modesto Botox practice.
However, this of course fluctuates. Allergan has been generous waiting for repayment. But I haven’t waited too long; thus I wouldn’t know if there is a late fee. The graphic below – in case it doesn’t show up – shows 80K bill.
Orbital retaining ligament separates the orbital fat compartments from the rest of the face: Superior, Inferior, and Lateral orbital fat compartments.
Cheek fat compartments: Most medial is the Nasolabial fat compartment (the medial border is the actual nasolabial fold), then there is the medial cheek fat compartment, middle cheek, lateral cheek fat compartment
Temporal wasting is also something we should start to address – hollowness from temple area to neck – the lateral projection.
Many patients start by noting nasolabial fold and jowel fat compartments. But this is a symptom, not an actual problem. It may be a symptom of other fat compartments becoming deflated, such as the medial cheek fat compartment.
As we age, we lose these volume in these fat compartments, and in addition to face lifts to tighten the skin, we have to consider filling these areas again to regain some of our youthful appearance.
There is fat superficial and deep to muscle which are compartmentalized
SOOF – Suborbicularis Oculi Fat – underneath the obicularis muscles. There is the medial SOOF and the Laterial SOOF.
SMAS – Superficial Musculo-aponeurotic System
The fat is compartimentalized
Deep fat in the cheek – below the musculature. Can cause a pseudo ptosis of the superficial fat. Over the Maxilla. Medial and Lateral aspect to the deep medial cheek fat. Refilling the deep fat in some patients can create a lift in this area of the mid cheek.
About once a month, I’ll hear someone tell me about this experience. I myself get this problem when I have Botox, Dysport, or Xeomin injected for my wrinkles lines on my face. I also have heard of this phenomenon after facial rejuvenation acupuncture. I think with acupuncture this may be related to the qi which is brought to the face and scalp for facial rejuvenation acupuncture. And I have also heard of this problem after mole removal from the facial area – a procedure I also do often. Thus I’m not always sure that the cause of the headache after Botox is entirely caused by the Botox. It may be from the placement of needles or the stress of having the procedure. Regardless, the headache after Botox should resolve with the use of routine headache medications, such as advil, aleve, and tylenol.
What happens if the after-Botox headache lasts longer than a few days?
It may be possible that a nerve was irritated by the proximity of the needle used to inject Botox. This also should resolve with time.
Most of my patients who get headaches after Botox still feel that the procedure is entirely worth repeating every 3-4 months.