ADVANCED BOTOX ANATOMY: How to avoid nasty lower-face side effects [Aesthetics Mastery Show]
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- เผยแพร่เมื่อ 10 ก.พ. 2021
- Advanced Botox treatments in the lower face can be transformative for your patients, but are also much more likely to cause side effects than upper-face toxin.
As Dr Tim explains in this week's Aesthetics Mastery Show, the reason is that lower third muscle anatomy is much more complex.
As well as a very helpful anatomy tutorial, Dr Tim also puts the spotlight on four advanced Botox treatments in particular: masseter reduction; downturned mouth; gummy smile; and platysmal bands, also known as Nefertiti lift.
He examines why particularly upsetting side effects from Botox are more common in these areas, and shares what aesthetic clinicians can do to avoid the worst happening.
Here is the beautiful muscles anatomy poster Dr Tim designed specially for aesthetic clinicians: drtimpearce.com/product/top-3...
Here is the Deep Fat pads Aesthetics Mastery Show Dr Tim mentioned: • DEEP FAT PADS: Dr Tim ...
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Podcast: open.spotify.com/show/20kUIxU...
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![MUSCLE ANATOMY: How to avoid side effects & maximise Botox efficiency [Aesthetics Mastery Show]](http://i.ytimg.com/vi/lsyvrIcGZoQ/mqdefault.jpg)
![MUSCLE ANATOMY: How to avoid side effects & maximise Botox efficiency [Aesthetics Mastery Show]](/img/tr.png)
![NEEDLE DEPTH: How to choose best depth to avoid complications & get results [Aesthetic Mastery Show]](http://i.ytimg.com/vi/VCztOZGageg/mqdefault.jpg)
Wowwww! Thank you Dr. Timmmmmm
love it so informative
Thank you, doctor ❤
Amazing Thank you DR Tim 😘
Awesome advice! Thank you
fantastic video. thank you!
Thank you both for these videos. I appreciate the information very much.
Excellent ❣️
Thank you very much, Dr. It is really helpful.
great lecture
Excellent video. I’m a new sub. Thank you so much.
Thank you again i could watch you guys for hours i have learnt so much more than my teacher !
i really enjoy Dr Tims webinars and you tube videos . He really understands the intricacies of aesthetics and helps me to feel more confident with my practice and i really value all the support and advice he gives .
Love these videos even for experienced injectors thank you Tim 🥰
I am so excited every time you post. Thank you
thank you,the video it really does a difference for me.
Thanks very much. Your exlanations and descriptions are really well thought out and easy to follow.
Thanks a lot for your generous sharing🙏 I am gone add these advices into my practice
I appreciate your videos so much! Informative, concise, easy to incorporate into practice. I second that they are great even for (especially for??) experienced injectors.
Loved this
So pleased, thanks Stephanie.
Thanks for your advice, I have had Bells Palsy for 10 plus years and still trying to find an injector that could actually treat is correctly. I know this is not good but now I do my own and have been for 3 years and getting a much better result that any of the injectors I had been to in the past. I have researched for years to gather as much info as possible before I started doing my own.
Go you, all the power to you :)
we are same 🥺🥺🥺i can't smile
@@anneamoguis8259 it’s a blow to the ego but it gets better with time. 🙏🏻❤️
Totally Deena...Great job 👏
@@Michelle-kq9yf I have to disagree. I suffer from Hemifacial Spasm and I think at this point I'd rather casually place my hand on my face to cover my mouth during a spasm than lose my smile or end up with an uneven smile. My 40th reunion was devastating as it was next to impossible to avoid the cameras. Still, when I look in the mirror I want to see me, and my smile is a big part of that.
Thank you for addressing the dental related issues for treating Masseter hypertrophy. In my dental office we see a significant number of younger patients with malocclusion issue that also express jaw pain or migraine type headaches. These patients often are also taking Adderall or other stimulant type prescriptions and generally have some work-home stress that all exaggerate the malocclusion issues. Some of them have received botox from other providers without also considering treating the Temporalis muscle and have chronic headaches as a result.
I am impressed with the clarity and detailed explanation of the anatomy and effects of Botox on various possible treatment areas. Thank you Dr.! 😊
Love your channel
Thanks for that!
Thank you for the support :-)
I watch your context as a patient!! I want to be educated so I can spot a good provider from a bad one!!
Thank you very much Dr Pierce!
Thanks for watching and commenting, appreciate that.
You are welcome!
It would be great to ad more visuals … this is great education…
Wonderful reaching moment, as usual. I have a question about injecting orbicularis and avoiding zygomaticus: besides injecting superficially, how central we can go when the wrinkles go farther than the corner of the eyes? Thanks to both of you!
Thank you!
Thank you Alina
You're welcome!
Thanks so much! Very informative.
Hi Kathleen. So glad you enjoyed the video and it served you. Thanks for watching.
Great! Tks
Thanks Marcia
You two and your chemistry! ❤️💕❤️ So refreshing!
Ah, thanks Lisa!
I am a professional aesthetic practitioner so yes It is absolutely imperative to evaluate each individual patient. I appreciate you consistently teach individual procedure mechanisms. I do have to say if you are not a practitioner/Medical professional particularly aesthetics, you may experience confusion. That is however, how we learn and discover what we truly love to do.
I appreciate these videos so much, it really does a difference for me. This is gold ♡
Thanks so much Selma, so pleased it helps.
You're so welcome!
Many thanks Sir for a very good explanation, its much better then where I have been thought
Please I would like to have a References of it plz many thanks 🙏
It shows that you love what you do, and you do it well and with ease. This is the best way to transport information.
That's so true, thanks Linda.
Would you kindly share your injection pattern for Nefertiti lift? There are different ways to do it. And starting doses… Thank you.
Thank you so much for this information. I went in for a consultation for my downturn smile and the "injector" did not know what I was talking about. He brought in the director and she said they would not dare inject that area because it would leave me with an awkward smile. I thanked them for their honesty about not knowing how to inject that muscle and I actually found a doctor, not an injector, (afterward) in my area who talks about injecting the DAO with 2 - 4max units. I went to a different place recently and the nurse wanted to do 40 UNITS!!! I am so glad that didn't seem right and I walked out.
40 units!??? 😂😂😂😂 hell no I would’ve walked out too ! 4 units is the usual max on each side divided into 2 injections each
I am having trouble finding someone to do this where I live...
Another great eye opening video; I will watch this again and write some notes. Thanks
That's wonderful to know it's helped you, thanks for the feedback Sam.
Glad it was helpful! Thank you
I find that they make a really good duo. She’s really good at asking the right questions and he’s very informative
Could you please do a video talking about the technique for smoker lines treated with botox?
Great videos. Where can I find the link to the muscle poster? Thanks
Wow this was so informative, I have a partial paralysis right side of my face, 1st time the neurologist did an awesome job, but the second time around he injected way too much, woke up to a swollen more lopsided face, during my birthday and anniversary week🤦🏾♀️Longest 6;months of my life for the Botox to wear off! Recently went to another doctor, she did an amazing job,she started with a small amount just like the doctor said, I am 😊 happy
what a Gem that I have found your chanel. Helps me iwth my practice here in the Philippines!
You’re very welcome
Thank you Dr Tim and Miranda for this video. I have a question. Can Botox be done to areas around the mouth eg DAO, to help slow down deepening of nasolabial folds at all? Thank you.
So true ! I had 3units for gummy smile and it destroyed my smile for months
5:50 I agree. I had my gummy smile corrected a few times and people who know me said that I look weird when I smile. But for me its still better than showing all that gum. And I think its worth mentioning that it does not completely eliminates gummy smile
Consider having a gingivectomy. It's permanent and can be done by a laser with minimal healing time.
@@bellakim9404 Ive done it :D but gum grew back i would say more than 50%
Love the content as usual. Dr. Tim, can injection for gummy smile or in the depressor septi nasi cause increase in nasolabial fold and alar flare?
Yes, absolutely- there are many example of certain muscles increasing in activity when a nearby muscle has been relaxed.
Hi thanks for your videos… love them. At 17.40 min into this video you talk about injecting close in the buccinator muscles different technique. Do you have video on this different technique to lift the area? Thx
Very informative video.. My TMJ is out of control.. I’ve gotten injections, but they were not placed right, My smile looks like I’m bearing my teeth…😬
Dr. Pearce, I have been doing Botox injections for about 2 years and almost all my patients usually complement my results. I thought that I know enough about Botox injection by now. But your video still provokes so many thoughts for me. It is excellent! Thank you for sharing!
Hi Guanshu. That's so wonderful to know that you found the video informative. Love that your patients compliment your results too!
Hi, great video but i can not see the link to the muscles poster ??
Hi doctor. I have semi-facial spasms on the right side of my face so my neurologist suggested Botox treatments to ease the twitching. I’ve been a few times already and the treatments help but now I have an asymmetrical smile. I’m really self-conscious of it. What area should the injector avoid?
I have mild heavy lids. No matter who does a brow lift I always end up looking worse. Id love a brow lift that actually works 😒
It almost feels like you are a happier couple than when you first started! love the energy you guys have. GREAT, great content as usual!
It's been really hard trying to create these videos during lockdown, many I was doing the video and sound without our videographer... It was not that fun! I think we are settling in to a new stride now. Thank you for the astute observation 😊
Thanks for this insight, Yexina! Yes, I suspect we're getting more and more comfortable with the format as we go on. As a couple we've been together 22 years so we're over the initial awkwardness haha. Thanks for watching 🙏
Miranda Pearce beautiful reality and bright future you two are creating here For others and yourselves too!
@@Learn2SingInEnglish thank you so much for these kind words
From your understanding of facial muscles, do you reckon they eg levator labi superioris, zygomaticus minor, major, obicularis oris.. can become bigger and firmer if they are being exercised regularly as in the case of face yoga?
Subscribed you're a G :)
Thank you David!😎
For the platysma strips, can we start the injection close to the jaw or lower on the strip ??? because some start close to the chin and go down to the bone!
Dr. Pearce...I do not see the link for your poster of facial muscles.....
love your videos. perfect background. however. im a visual learner so i prefer see a dummy or patient then listen to lecture
Oh I am confused…. Some injectors say that deep fat pads are under the muscles but you say they are on the muscles. Which is which? Thank you.
What do the 2 injections about lip level but maybe 1/2 to 1" outside the lip extremity address? HOw could they effect a younger looking picture and what is the theory
How to fix if the LLSAN were over treated 🙀Thank you
I have a rare neurological condition called ADSD and grind my teeth and carry huge tension in the masseter area but the last thing I want to do is slim down my lower face . Any suggestions ?
My smile and lip got crooked after filler done 10yrs ago still not normal even done lipo face removed stubborn fillers what can i do???? Only left side but right side went back to normal 10yrs ago
What Muscle have i gotten botox into if i can't raise my bottom lip away from my teeth.
QUESTION PLEASE-One side of my face - the lower lip- falls n at one point looked like I had a stroke😡 was that because they damaged a muscle on that side n why didn’t it ever fully correct? It’s been 4 years with zero injections
Please please advise! An endodontist caused me to get soft-tissue-TMJ by doing abnormal-extensive work - 2X in one week on tooth #30. It was his error. See, my Primary DDS had said "your rot is deep, you need an endodontist for root-canal". Yet, when i visited the endodontist for a consult, he told me "I can hug your tooth with a crown so you won't need root-canal". Thus, not only did i get 3 injections that same day of Sept.8, but also another three (to root-canal me) on Sept.13 due to pain & looseness of the #30 crown he'd done. This, despite that I relayed i can't handle anymore injections. Nor could i handle more prolonged open-mouth. Since then, i've been to primary doc., ER doc., pain doc., MRI & oral-surgeon. The pain-doc. had ordered MRI, then said cartilage is a mess & i should see an oral surgeon to ask if botox/cortisone are indicated. And so Dec.7th I saw an oral-surg., who said its probably the masseter, as the muscles feel hard. QUESTIONS: (1) if indeed its masseter, why is my cheek swollen under right eye? (2) Why do i feel a sorta puffiness in lower-lip ever since the Sept.7 injections (even though the injections were not at front?) (3) Why is my root-canal #30 now in pain, as of this month?
This is great! Just wondering, how deep do you inject in mm to relax the masseters and would you still use an insulin syringe? How many units do you reccommend for the first visit?
Thanks
You can do it with BD syringe with compression, but better if you can get something a little longer- say 12mm/ half an inch. I use 20 t0 30 units per side.
I have a hypertrophic risorius muscle unfortunately and I don't see any procedures that could help with that but Botox. I'm aware that it will effect my smile for a few months but I'm willing to do it just as long as my smile comes back afterwards. It seems to be the only way to shrink this muscle so I'm up for it! Any thoughts Doc??
Would love Tim’s perspective on this
Botox for stiff back muscle area, is that done?
You might consider reviewing studies on the “association between magnesium deficiency & bruxism”
Most dentists are unaware of this.
750mg mag citrate is the RDA & will bring good results
Thank you that's great info. I take Magnesium myself and was aware of many benefits but not this, Thank you! I found some info mentioning calcium and vitamin d too.
@@DrTimPearceit’s magnesium that is required in great majority Any condition that is spasm focused
In vegetarians zinc 30mg
However magnesium citrate 800 mg daily is essential in all cases
I had botox for gummy smile more than 2 years ago and one week after the injection my nose tip and nostrils became swollen. The swelling is still there 2 years later and changed the shape of my nose, making it heavier and droopy. Could you tell me how could botox have done that and how it could be fixed (without surgery)? Thank you
Hi Anna. If you are experiencing something years on it wouldn’t have been caused by a neuromodulator as the results last somewhere between 2-6 months max.
Maybe this is something unrelated or something that that you always had but became more honed in on once you had a treatment. Many people critique their faces more and see things that they never saw prior to treatment.
Either way, neuromodulator are very short lasting with their results/ side effects.
Kind regards Mary. Clinical advisor for Dr Tim
Bonjour je viens de faire de l'acide hyaloronique s'est normal que sa gonfle et qui a un peu de douleur
I had a hilarious and insanely crooked smile. It wasn't so devastating. I kept laughing till I cried when I looked in the mirror
I had an underbite when I was young and fixed it with braces. But my jaw was still in the wrong place. Couple years back I had upper jaw advancement surgery. But the TMJ has actually gotten worse post surgery. Could that be the face getting used to new placement? My doctors just kind of told me to give it time.
I’m sorry you are struggling with this problem, but unfortunately I can’t answer this question with certainty for you as it’s not our specialty I’m afraid. Keep touching base with your dental surgeon as they really are the specialists this field.
Clinical advisor for Dr Tim Pearce.
How can I correct my smile? I received a masseter injection and now my left side lip corner is crooked. I need help. I can't handle 6 months with this smile.😢
I can’t thank you enough for your teaching. There’s nothing equal in TH-cam. I wanted to ask you about the injection in the Masserer on older female clients with history of teeth grinding. Can an injection in the masserer cause more jowls because of the loss of volume?
That is correct. As it atrophies a jowl can become worse. This needs to be explained to your patient during consultation so they can make a decision on which bothers them the most.
Kind regards Mary. Clinical advisor for Dr Tim.
That’s so true . I grind my teeth and chew the inside of my mouth corners because of the medicine I have to take ( Elvanse Adult ) an ADD medication. I have taken it for over a month now and have noticed that my masseter muscles have gotten more pronounced but the positive thing about it is that my jowls and cheekbones have been more lifted whereas before they were more droopy . ( I’m 40 years old ).
So I would never get a Jawline reduction in my 40‘s …
I got Botox in my depressors and in my chin. After that I had muscle spasms in these places for 3 months as soon as I touched them a bit more (e.g. when putting off make-up, scratching...). Nobody knew why, do you have an explanation?
And due to the injections in my masseter for bruxism, my whole lower half of my face is now sagging. 😔
Possibly because the whole area of that muscle wasn’t treated. A couple of fibres of the muscle still being active will create movement. A little more toxin might have been your answer.
Kind regards Mary. Clinical advisor for Dr Tim
Ever since getting horrifying chin filler, I am hyper aware of the dimples and dents in my chin that occur when I speak and smile. I’ve had the filler disolved, and I am wondering if botox can make it so my chin just doesn’t move when I speak or smile? It makes me really insecure. I just wish I had a normal chin.
Botox is certainly what could help, It’s the muscle causing the dips as the muscle tone is changing over time. We can’t guarantee perfection but it’s certainly able to soften. Kind regards Mary. Clinical advisor for Dr Tim.
@@DrTimPearce Thank you so much Dr. Pearce for your response. I am encouraged and am looking forward to my apt next week with my nurse to hopefully get it done. Thank you for being informative and helpful as always! 🙏🏻
Hmmm love this show but just a little comment, everyone is trying to wear blue blocker glasses, have night mode on their devices, but none of this can reduce the amount of glaring blue light searing into my retina
I have marionette lines and my esthetician wants to do PDO threads and I don't want to do that. How do you feel about PDO threads? I've had filler in the past five years, and Restalyn and Juvederm Voluma worked wonderful.
i have had threads for around 18mnths & they are transformative. Pcl threads have more longevity, but pdo are great for building collagen in the skin.
@Camille Anderson // so do you have pdo or pcl? Can you feel them? Does it hurt? Would you do it again?
@@Donna-vh5ym i started with pdo smooth, then progressed to plla. Im now graduating to pcl, for the longevity. I found the lips a little sore, but the lidocaine really helps lol! Im definitely sticking with threads as they give the skin the bounce, firmness and tightness i want.
Dr. how can we fix a crooked smiled caused by botox in resorius?
I’m afraid there is not much that can be done. Encourage as much muscle use as possible and time will heal you. Sorry you are having to deal with this.
Kind regards Mary. Clinical advisor for Dr Tim
Hi I have an ongoing issue with my injector not getting my left dao but instead getting the toxin in my left dli n my left side lower lip does not pull down when I try. It stays resting against my teeth. But also the left side of my smile no longer lifts as high as the other side. My face is not symmetrical and we have tried injecting dao lower on the face. She always seems unsure of where to inject and always nervous. But my left side of the mouth comes much further around my face than the right. It’s aggravating. Can u help
I’ve shared ur video it doesn’t matter But when j speak my mouth pulls to the right on the bottom and IS SHOWING ALL TEETH ON THE LOWER RIGHT SIDE. I HATE IT
Damn..run like hell
I’m a diyer and how can u correct a asymmetrical smile I got exactly what you described my mouth or lipid pulling to the right side is there away to correct it ? Help😢
What about mentalis muscle?? How do you prefer to treat?
Depends if it is more central or has two skin attachments. I usually use 6 units, straight into the skin insertion point. Staying medial protects the depressor labi which is vulnerable.
@@DrTimPearce do you go deep or just in de insertion with the dermis? Usually one injection in the center or two?
I would stay medial and that should avoid the DAO and DLI whether you are deep or more superficial. I ask the patient to lift their chin and then it is pretty easy to inject into the mass of the mentalis. But would love Tim’s feedback on your question.
@@libanabdul2513 I’m afraid we only do consultations face to face in our Manchester based clinic. You can find more information here - www.skinviva.com I hope this helps
Clinical advisor for Dr Tim
I have gotten masseur muscle Botox and my smile has just become a bit disformed. I feel on the inside of my mouth there I a bump on the side that is disformed. I don’t want to go in to get more Botox because I feel that it will mess up my smile more, will this herniated muscle go back to normal on it’s own?
Referencing 9:45 in the video!
I got botched just like the cover photo on your vid. Can my nose be distorted forever? Or will it go back to normal eventually?
If it was Botox treatment you will 100% recover, don't worry.
@@DrTimPearce thank god.. i was worried because its a less ‘strong’ muscle that i feel is effecting the shape of my nose. :/ thank you.
I got trigeneral neuralgia from radio frequency microneedling over a yr ago I got Botox for my jowls and turkey neck now all the sudden my ear jaw neck where I got the radio frequency injury is not hurting everyday since Botox could the Botox have triggered my past nerve injury
I had a bad habit of pouting my lips when I was young and also didn’t smile wide but held it in. On top of that stress and clenching. Which made my muscles around mouth of my corner I would say where all the muscles overlay each other. And now i look like I gained fat but it’s all tense muscles. Can Botox solve it?
Botox in the corners of the mouth isn’t advised. Like you said it’s a bunching of all the ends in one and if we botox that but all the muscles can be affected.
Targeted muscles only I’m afraid but with all muscle build when you don’t use it they will reduce themselves.
Kind regards Mary. Clinical advisor for Dr Tim
I was injected in the middle of my cheeks with Botox when I asked for TMJ shots. My muscles all look like they fell down.the muscle that pulls my smile up is not looking how it did, it dropped down like I am elderly but I am only 35. I saw others this happened to saying it was still that way four and a half months later.will it go back to normal? Will the weakness of the muscles age my face or displace a fat pad?
Did you go back to normal ?
Wonder if you have any advice. I have Bells Palsy and cannot seem to find a way where Botox can stop my left eye from closing.a bit when I smile and talk and when I open my mouth wide my left eye tends to want to close. What muscles do you treat for that?
yes, I think so - you could treat parts of the orbicularis oculi
@@DrTimPearce okay, it’s hard to find someone in Australia who will treat me unfortunately. I have been to 16 doctors and they don’t seem to know how to treat Bell’s palsy. Would they need to treat under the eye section of the orbicularis oculi or above the eyelid. Do you know any doctors in Australia who treat Bells palsy with Botox? Thanks very much for responding.
Where r u located??
I have a slight facial paralysis due to a non cancerous brain tumor on the 7th nerve on the right side. I had micro botox injected very superficially under the lower lip in the fine wrinkles on the left and right side , unfortuneatly, the right (paralyzed) side was really affected by this and I am biting my inner lip on the bottom and can barely speak. the injections were done 2 weeks ago. is there any way I can speed up getting this out of my system.? it was literally only 1.5 units injected just under the skin. it did not affect the left side like this though. Im very upset with myself as I made myself more paralyzed! any advice will be appreciated.
Oh Debbie this is really unfortunate. Unfortunately not. You can try to use the muscles as much as you can and it will come back a bit quicker but with a palsy is much trickier I imagine. Some say you can use the back if an electric toothbrush on the affected muscle regularly to help reactivate muscle too. These tiny doses don’t last as long as doses done in the upper forehead. So hopefully things will be a little better soon. But I cannot give you a time frame unfortunately.
Kind regards Mary. Clinical advisor for Dr Tim.
@@DrTimPearce thank you for your advice and kind words.
@@DrTimPearce I am now at 4 months post botox and I am still suffering. It is wearing off but very very very slowly. Do you think it is taking so long to wear off because the muscle is not a regular working muscle due to the paralysis?
@@debbieg8260 Good evening Debbie. I think yes. Your naturally deactivated muscle won’t be encouraging you muscle to build back so quickly as something with muscle memory would have. Its good it is coming back though, and regular massage, and as much natural muscle use as possible will help. Its maybe because your muscles have had a bit of an extended holiday due to the botox and havnt quite got the idea they’re back at work. So use movement as physio to build back that muscle memory.
It would also be advised on the safe side although I’m sure it’s more toxin related but a check up with your doctor maybe a good idea to ensure nothing has changed medically.
Fingers crossed your getting over the worst. Kindest regards Mary. Clinical advisor for Dr Tim.
@@DrTimPearce thank you from the bottom of my heart for replying to me. I knew I could count on you. I will keep trying to work the muscle as much as I can.
My neurologist gives me botox in my legs, for Parkinsons, but he won't do my upper and lower lip which turn inward and I have to pull my lower lip down to to talk, this is a new symptom which happens from medicine during off time cardopa/levodopa, but Dr. said problems with drooping so he doesn't want to give botox. Do you have any suggestions. Thank you, Maria
Hi Maria. Thank you for your question. The degree of lift we achieve with lip toxin is literally only about 1mm. I’m not sure it’s going to be the support your after. The neurologist is right that for larger doses you would be left with too much relaxation.
Kind regards Mary. Clinical advisor for Dr Tim
@@DrTimPearce Thank you so much for replying 😀
I have Bell’s palsy since birth i can’t really smile 😭 I don’t if can still fix this
Just had Botox to around my mouth area and chin to correct a downturned smile. Now I cannot lift the right side of my bottom chin so my smile is completely off and I cannot talk properly or open my mouth correctly. I feel some muscles are numb or frozen. What can I do about this? I have an asymmetrical smile and I’m freaking out! Please help thank you doctor ❤
Just happened to me - is your wearing off now.lopsided smile
Seeing Miranda’s posture made me straighten my gargoyle back
I was once injected and it did look like a joker smile. Kind of weird.
hi Dr. Tim , I'm a medical student and I had masseter botox for grinding my teeth now my risorius muscle is paralyzed my smile looks fake. How can I fix it and will my smile return back to how it was ?
Selam aslı,
Diş sıkma İçin bende yaptırdım maalesef yüzüm uzadı çok ama çok mutsuz etti beni. Düzeldi mi gülüşün acaba ? Sormak istedim.