NEW BOTOX PATTERN: Dr Tim analyses much-talked-about new glabella pattern [Aesthetics Mastery Show]
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- เผยแพร่เมื่อ 12 มิ.ย. 2024
- In April 2021 Professor Sebastian Cotofana published an important new paper exploring an alternative botulinum toxin injection pattern for glabella treatments, with the goal of avoiding medial brow ptosis.
In this week's Aesthetics Mastery Show, Dr Tim explores the potential pros and cons of the new 3-point technique, including the alternative angle of entry, and asks whether injectors should abandon the licenced doses altogether.
Here is a link to Professor Cotofana's paper: Respecting upper facial anatomy for treating the glabella with neuromodulators to avoid medial brow ptosis-A refined 3‐point injection technique pubmed.ncbi.nlm.nih.gov/33817...
You should go follow Professor Cotofana on Instagram where he shares a great deal of value for aesthetic clinicians: / professorsebastiancoto...
Here's the 26 Essential Botox Patterns download that Dr Tim mentions: drtimpearce.com/resources/26-...
More useful links:
Sign up to Dr Tim's free webinar about how to free yourself from complications anxiety: www.aestheticcomplications.co...
Facebook: / drtimpearce
Instagram: / drtimpearce
Website: drtimpearce.com/
Podcast: open.spotify.com/show/20kUIxU...
#dermalfiller #medicalaesthetics #aesthetics
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My Goodness! I have been using this "new pattern" since 1998. I find I must always explain to the client that my technique is different than most others in town. I have had no droops. Great video. Thank you
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Me too!! I thought I made it up.
No drops.
Most of these "new" techniques many have already been using for a long time. It's just that not everyone publishes or broadcasts their technique because it's a lot of time, effort, and money to do so.
I am a new injector (first client scheduled tomorrow!), I am soaking up as many of your videos as I can. I like your conservative and anatomical approach and am so thankful for all of your instruction and wisdom!
Your videos are always so educating....i loving them and enjoy every singel time.Great job!!!!!!
Thank you Dr Tim and Amanda. Your videos are so valuable in my learning process.
I find a pearl of wisdom every time I visit your site. I have been using this technique on myself through this past year.
Thank you so much for this continuing education that you are so generous to share with this community. I love your explanations and you always seem to find new and interesting information to share! You're the best!
I have been using this pattern for the same reasons you explained for many many years. Excellent!
Thank you for the continuing education. You are absolutely the best!!
Always enjoy and appreciate all the info you share. Thank you!
Thank you Liat 😃🙏
I’ve been wondering about this! I’m so glad you covered this!
Super glad it served you Allyson :-)
Excellent. I'm your new biggest fan. . I find your holistic and ethical direction to integrate aesthetics within well being medicine really quite fantastic. 👋👋👋.
thank you for all of your vides.. love your sidekick Miranda! also loved your video on criticism it was helpful and funny.
I really enjoy the content you put out and all the educational material (including the incredible posters for sale on your website). You and Miranda really care about your audience (and patients) and it really translates in your work. Thank you both.
That's so incredibly kind of you to say, Kali. You're right that we care. Thank you again
Yes I’ve been using this technique often for a long time - excellent results thank you excellent video ..
Another excellent and educational video from you two beautiful people! Many thanks 😊
😊😊😊thank you for watching
Miranda you always ask the right questions. Your a brilliant together for a pod cast. Thank you both very much
Hi Geraldine, that's so kind of you to say, thank you!
Another great instructional video!
Hi you2. I absolutely enjoy your show. I my self have many years of practice as an injector and your tips gives me moments of dejaveau and aha experiences in combination with giving me new perspectives of my work. Thank you very much. Been to Korea lately and learned about the Korean facelift technique with Dysport(small molecule)and Botox(big molecule)in combination which I have had much pleasure working with. Something to take up in the show🙏🏽🙏🏽🙏🏽👍🏼👍🏼👍🏼
I really enjoy you and your wife! Thank you so much for offering your pearls.
Thank you for this video, I really really needed this in my life 👏👏👏
So glad it helped 😊
Excellent depth of explanation into the anat of these technqs. Thx Dr. Tim
I'm so pleased you find it valuable, thanks for the comment.
Thanks your training was easy and straight to the point amazing 🤩 thanks 🙏🏽
So glad you found it useful Lisa, thanks for the comment.
this man is fantastic. I don't understand how he is not on that BBC doc for non-surgical procedures
That's kind of you Wiam, thank you
Definitely not miss out the second corrugator. Seen loads of practitioners do it and you can see strange pulls after. Always do all the corrugator, it’s easy to avoid lid complications if you are taught what to look for and what to do.
Thanks Tim and Amanda love your content xx
Thank you Sarah :-)
Thank you for your time, great video, before and after pictures would be great so we can see the different.
Amazing content as usual 👌🏼👍🏼😊
wow, just love the content from you two xx
I'm so pleased it helps, Mollie :-)
I absolutely love your content, i learn a lot (new injector here- from AUS). Miranda, your questions are so good- exactly what is on my mind and then you ask it! I would've loved it if Dr. Tim showed us the new technique on a model or dummy.
Thank you Natt. I really appreciate your kind and thoughtful feedback. We'll try to build it into the system in the future
I am a patient Aus and have had brow ptosis multiple times from different injectors - can i come see you Natt?
Medicine is always a dynamic discipline. You should embrace new findings and not be scared of it
HE is a hot candidate for the Nobel Prize for the detailed and inimitable contribution of modern aesthetic medicine
really interesting and so well explained
Just fantastic. Thank You.
I've never been afraid of going blind etc until I started watching a bunch of videos!
Just subscribed to your channel, can't wait to share the information.
Thank you so much for sharing this!! I am a new injector and have only injected family members at this point! 😂. This video gives clear instructions, which I need! I’m a fan of 90 degree injecting so this technique really speaks to me. I am a big fan! Thank you 🙏🏻
Haven't your injected non-family members during your training?
Thank you, very helpful your video.
Love you, as always, more pearls.
Thank you Robin
Thank you for the video, i love u guys!
Thank you Olga, much appreciated
Anatomy anatomy anatomy 👍🏻 great as always.
Thanks Anne :-)
Thank you so much 🙏🏼
Dr Pierce- What is the difference in terms of the injection angle with the 3-point technique? I asked this question a while back in a previous comment but never got a response. I would be oh so grateful to hear a quick answer to this!! Love your videos.
I think we need to still assess the mvt of the patient and the goal of the treatment. I have been using this intermittently and it’s not always a success.
Often at the follow up, we need to address the tail of the corrugator.
As well on occasion I’ve had to skip treating the procerus. But it’s always nice to hear outcome of new studies and it’s application. I’m a big fan of prof Cotofona and you two actually ;)
Good point Elizabeth, consultation is key as ever.
Yes I get that too. I'm new to this,. Abd to me you must look at each individual person muscles some people don't need 5 point and 3 would be perfect and if say some do need the 5 point like you say one doesn't fit all
Thank goodness
I wish you could do mine. So knowledgeable
Great video! Whats your opinion filling HA to buccal cheeks hollows?
You’re the best! ✨
Thank you for sharing your analysis and expertise.
Thank you Erin
Hey Dr. Tim, Hi Miranda!! Omg thank you for covering this I agree 100%. It’s so ironic that you posted this because I recently found myself choking on my thoughts over a recent bit I stumbled upon where DIYers are trying to learn technique off of a DIYers. So someone asked “so then, I should always inject the corrugator deeply to pass the frontalis to prevent droop?” My mind was blown by this! That someone out there probably armed with a 1cc syringe and no idea how to handle a syringe was asking this. Not once nor ever was the levator palpebrea even mentioned, as injecting the corrugator more latterly you definitely do not want to be as deep or migrate into that muscle to cause lid ptosis. Sure eye drops might help some to activate the mueller muscle, perhaps a mm at best. With luck a minor lid ptosis might be temporary (weeks) or perhaps you’re stuck for the duration of the tox. I actually love this simple medial injection pattern, I feel the (Botox) label dosage and “dots” only confuse and are too “cookie cutter”. Agree 100% as well on injectors with blinders on, thinking “oh go a bit higher because this is safer” or “do the dots” when on the contrary it’s the opposite and then you are risking brow ptosis. It’s a funky balance and as always case to case. Myself personally, I can do this pattern you describe and never get “spocky” (in fact can use the lift) BUT...that’s JUST ME! I’m so glad you took the time to share this and always mention the less is more rule. Or as I like to say.... “you can’t un-ring a bell”. You can always see how it settles and top off accordingly. I will definitely check out the links you provided on this topic. Apparently, I’ve torn my ACL so will have a bit of time on my hands as no injection is gonna fix that lol. Hopefully can even catch you guys on a Thurs. some time. Cheers!
Check into prp to help your acl year. Extremely helpful
Thanks 🙏 😊
Our pleasure 🙌
Can you do something o. The corrugator incision and migraine botox
You can always bring them back and add a little more as needed.
Thanks alot.you prefer to inject Glabella from hairy brow or above in vertical position
First of all .I appreciate your efforts. I believe that this modification of injection is surely reduce brow ptosis and eyelid ptosis but still not the best way of injection . If you stuck with it your patients will end up after many treatments with mark on skin at the mid portion of eye brow due to function of the lateral belly of the corugator musle .
I suggest superficial injection of a low dose of Botox in this piont .just intradermal and I never had any case of drooping .
Ive always done 3 points injections for the glabella region... never had a ptosis... also never heard about that 5 points for the glabella
The licence in many countries, UK and USA for sure, is 5 points.
Can you do a video on treating the Depressor Supercili? I have one brow that is much lower medially
The link to Dr. Cotofana's paper is just to the abstract. Is it possible to have access to the complete journal article?
2 outer made mine flat line just two weeks ago. We went in and hit the #2 and #3 injection area lil more but went up a tad higher. It worked. Pretty happy with result. We also did not do middle of forehead. So glad we did not at all, could have really went heavy and that you cant tweak very well. Once falls from center injection, you stuck with it lol
OMG
I have been doing this myself on me realised too much frozen areas in the middle area meant all around would not be able to lift. And as you mentioned the eyelid would be dropping especially the older the person is. Every person should be treated differently older and younger especially. I always think of botox as time goes by as glue that goes in the right areas and leaves the untreated muscles to do the work at lifting the face. I have never been trained but learned a lot from having it done to me and by watching TH-cam clips like this. Now I'm the happiest with my results doing it myself. 🙈😁. I'm 54 now but no one believes it 😜☺️.
I think i would be an incredible 💉 injector but I never been trained and I would like to try.
Where u bought these botox i am from pakistan
I had Xeomin (4 units) for an overactive brow that likes to shoot up when my eyes are open and it caused it to droop significantly for a week. I don't trust injections over my brows now.
I am 38 (soon to be 39) and began Botox around 33. I had moderately heavy horizontal lines on the upper forehead, but my main issue was the "11" wrinkles between the brows on top of what feels like a "dent" in the actual bone between my eyes, which will visually go away depending on where I have toxin injected. I say visually because if you rub the area, you can still FEEL the dent. I've found that each injector I've gone to has different explanations for the "dent" and how to treat it, with only an injection straight into it actually ever temporarily solving the problem. I'll literally ask for Botox (or Dysport, which I prefer, but I cycle between the two) to be injected into the dent but I am often told no...if we do that, the toxin will drift. So I'll be injected at other various spots which help the 11s but not the "dent". Lame. Secondarily, I have noticed a very subtle drop to my brows in that area (the "11"s area) which I dislike, as well as gentle "humps" above my eyebrows in that same area which I have been told are muscles over compensating due to toxin in the upper forehead. Say what?! This area of study fascinates me, and I'm grateful to have people like Tim and Miranda to explain anatomy and so much more for the layperson, because I'm beginning to feel my best course of action is to stop allowing injectors to do what they see fit and to be educated (and brave) enough to simply ask for injections in specific spots. Great content.
Hey Nicole, read this and sounds like you’ve have bad or mediocre injectors. If you stick with properly administered Botox at your age you will probably find that problem will resolve and you will get to where you might only need Botox twice a year as opposed to 4. Cycling between the 2 can also be a good thing (just to shake things up) but personally I don’t care for Dysport. I dunno who’s telling you the toxin will drift, if injected correctly and at the right dilution it should not go where it should not. I wish I could offer better advise but it sounds like you have been going to the wrong people. Best of luck and always beware of those $9/unit or low price/area specials - all they do is cut the Botox to saline to get more units per vial. There are many reasons this is bad.. one being the Botox doesn’t take effect as it should, if at all and another being in heavier dilution it can migrate which is sometimes desired and other times not. Find a qualified injector who fully understands your needs. ❤️
@@NoLightsTillBrooklyn great advice.
@@NoLightsTillBrooklyn Maybe you should stick to one injector. Botox and Fillers are a PATH you and your injector go TOGETHER! So they can also be more „bold“ because they can rely on you as you can rely on them.
May i ask a question in regards to Vollure XC. Today is Tuesday 5/18 and last Tuesday afternoon, I had some filler injected around jawline and outside mouth to fill a few lines. My doctor was running over an hour late. The only reason I became pissed was because I knew he’d had a shitty day and could care less about my injections that I’d driven over an hour for the appointment plus another hour wait with no explanation.
I came wanting some work done and of all days, he went conservative which was a good thing at this point. My filler as of today still feels like it needs smoothed out some. It was too sore up until now for me to touch it but would it be safe or a good idea to navigate it around a bit mildly? Just to smooth it out or is it too late? It’s not possible to drive an hour any time soon for him to check on it. If there is any advice you may suggest that is safe, I’d be so appreciative.
I got it down in Jan 2023 and my entire forehead and eyelids dropped. You can visibly see a ripple of botox stuck in my brow line and it’s Oct 2023. It’s progressively worsened, i have extreme crows feet and my face sides have dropped. A plastic surgeons assistant here in nyc did it and there’s been NO help. I called and called every day for 3 weeks straight after it and was totally ignored. They called back weeks later when i already had to see a Dr for it for damage. I’m still dealing with it. After getting preventative for 10 years, this injection was so painful and bad that it undid years of what i had done to prevent this. I’d say a gross amount of prions have brow ptosis. My nose bridge was swollen for months and o still jab pain in the injection spots.
I usually have botox around my crows feet and elevens area, but I had a brow lift with botox and my eyelid drooped terribly. Does this mean that it just wasn't injected correctly?
What is the best treatment for extremely strong n stubborn glabellas?
My trainer said I must do both elevator and depresor muscles.. And yet I am seeing people just doing the glabellar or just the frontalis??
How many units of Botox are suggested for the 3 points?
Basic principles but individual client and muscle strength assessment ??
Can filler and Botox be dissolved in the glabella area?? I had filler and Botox over a year ago and my glabella is still puffy like there’s fluid in the area between my eye above my nose. I never had swelling puffiness’s in this area until the doctor injected there. Is it possible that the filler is still in there? How can I shrink that area naturally? I’m nervous to go back have anyone inject anything in that area ever again.
Hi I like to learning how injecting how can took the course
I wish you can do mine, I had 1st time botex injection 6 month ago and my brow was lifted like I have surprise expression on my face, never go back that firm again, which country are you practicing? I am in USA Los Angeles.
I base my injection technique based on the patient in front of me and their specific needs.
Chat's great but pictures would be better.
This resource might help you: drtimpearce.com/resources/26-essential-injection-patterns-for-botulinum-toxin/
Dr. Pierce! Quick important question - you state in the video that with the modified, 3-injection-point technique, that "the biggest difference is that you're not injecting the lateral part of the corrugator muscle; there's also some difference in the angle of injection" - but you don't elaborate further on the angle of injection/injection technique with the corrugators here. Can you please explain / reply and tell me what the difference is with the corrugator injection angle when doing the new 3-injection glabella technique? do you inject more in the middle portion of the corrugator or do you still insert the needle in the medial portion? What exactly is different?
I showed this video with my injector and I am interested in having her try this technique but first just want to clarify what is done differently with the corrugator injections using this technique.
Thank you tremendously in advance for your response I would really appreciate it!!! :)
Alek
I'll add - I did watch your related video about the new 3 point technique but didn't see anything mentioned or demonstrated with regard to what I am asking about.
Did I miss the studied dosage and reconstitution? Is it fair to say this is someone's technique, if it's a matter of proper pt assessment and knowledge of anatomy?
I definitely agree that ptosis isn’t that common
Thank you for sharing this. Love your content and educational videos. Much appreciated! NP_Amber
From where i bought thes injejtion
I have an appointment. I missed it because I’m scared to death of having droopy eyelid & I had a bony grand daughter born, which was the main reason why. I’m 50 and don’t want to stop my Botox and fillers but my eyes have never been droopy until now. My injector doesn’t want to cause my eyebrows to be frozen but when she doesn’t go low enough she leave to massive wrinkles on each side. I need help as to what to ask of her next week. Please help. I pay about 3 grand every time. I last took 56cc of Botox
🇩🇴 thank you
Hi, let you know, that I use your method and guide here in Brazil, no drops, ever, ladies loves the high brow
I'm glad you found this useful- not my invention btw :-)
I'm currently in self isolation due to heavy brow droop, with eyelid that hangs over lashes- just for interest the other brow now is pointing halfway up my forehead. In short, I look like an ogre. This was my second treatment. The first left me overjoyed. All I wanted was just the one line between my brows softened. Never again. And there is no way on earth I would go back for an 'adjustment'. $450 Can. with a 'real' doctor.
What a nightmare!
This is terrifying, I thought that if I went in for just the one glabellar portion, I would be at less risk… is it getting better?
I had a lot of Botox injected into my face on the 2nd July to treat my facial/cranial Hyperhidrosis.
3 weeks on and I have seen no improvement in my Hyperhidrosis and even worse my left eyebrow and eyelid have dropped.
I’m getting married in 2 weeks so it’s pretty devastating for me. Can anyone here recommend anything to help?
Great video and very informative
Great content. Do u guys have observed edema of the upper eyelid after Ob Label BTX injections? It is really crazy, but I have seen it several times , but people don't talk about this complication after BTX. Maybe you could talk a little bit about this.....🥰☺. Greettings from Germany.
Great suggestions, thank you Mauricio 🙏 I've added it to the list of topics to tackle :-)
I had edema with my severe brow droop. It's been over a month and it's still affecting my vision. Not a good thing.
@@Chahlie I ve seen some cases like this . Its just a matter of time until it goes
Thank you for the content you share ! Im a aesthetic doctor from Ecuador.
I agree with Mauricio. I’ve had a few cases of upper eyelid edema. I’ve related it with an specific toxin brand. It would be great if you can talk about this in a video. 😉
I had 40 units of Dysport in my glabella , 2 injections only, i ended up with Iatrogenic botulism poisoning as it travelled from the muscle to my nervous system with terrible side effects for almost a year and a half.
Damn!! This sounds scary as hell and what type of doctor did this??
How are you now?
@@ikr2377 alot better, but not 100%. It usually takes 1-2 years to recover from .
@@EmmaDee , i had my frown lines done by a plastic surgeon. Never did i think it could spread and go systemic as everyone will say it does not but Allegans 52 page black box warning casualy states it can happen. They are protected from the law because the black box warning casually states that botulism and death can occur. I found a group on face book which answered all my questions about what was happening , called Botox Dysport (side effects) Support. Thousands of people on their suffr from systemic spread which can cause many symptoms including, muscle weakness, anxiety, brain fog, heart palpataions, bowel paralasis, internal tremors, digestive problems, breathing and swallowing difficulty and many more. Worth joining the group for some education about what doctors will never ever admit or know about this toxin.
I’m sorry this happened to you but anyone who is trained should be aware!
Perfeito
Plz answer me, microbotox injection on forehead with multiple injections VS normal botox pattern
Which one is better fore reduce forehead line ?
The dose is probably more important overall than the distribution. Small amounts in many places just gives you more control/ resolution on what works, and what doesn't after the effect is set in.
@@DrTimPearce One more question doctor,
I’ve injected botox to a patient who came to the clinic with the need of lower face lifting,
I injected 2 rows from angle of mandible with one unit each point intramuscularly, now I’m really scared that it might hit both of her risorius so I came here to ask
Should I inject ID instead of IM to avoid hitting risorius or the risk of both techniques is the same?
Is their a correction for a medial brow drop?
This might help: th-cam.com/video/HLIelyKJq9k/w-d-xo.html
I love the content but wish there was less chat before getting to the meat of the topic.
The beauty of fast forwarding past the 'chat' prior to the 'meat.' 💁
@Pagent Pal.... omg relax.... these guys are amazing... if you don’t have time to listen don’t or fast forward to the “meat of the topic”. Or don’t watch at all. It’s an informative show they take their time to put together for everyone NOT just for you. Simply fast forward and give them a like!
@@NoLightsTillBrooklyn people are entitled to their preferences. Either the creator takes the advice or not is their choice, depending upon what their audience is.
Amen
Can’t say anything that isn’t just 100% positive or people jump all over you🙄
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your videos would be better if you explained more with YOUR images pointing to the anatomy instead of talking over stock images.
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😊👍👍👍
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@@mirandapearcemindsetBravo from Greece❤️
has anybody got a free link to the full article?
It's in the description
pubmed.ncbi.nlm.nih.gov/33817912/
Why am I seeing turtles on a Botox video.....stay on topic❗️
The turtles are meant to illustrate a point. We intersperse alternative clips to keep the video fresh.
I think these doctors need to be retrained. The majority are still using the old techniques. How can we get these injectors go back for retraining correctly on Botox fillers?
What are you talking about? Botox is not a filler and Dr Tim definitely does not need to be “re-trained” what “old techniques are you referring to”. This is an evolving art.
It's important to inject right. Wasted the products cost and result.
Common sense
Lots of talking, no demonstrations.
And this technique is not new!! I’ve been doing it for years now
Hi Laleh. Thanks for engaging in the debate. If you would like a tangible resource, Tim's created a free download of 26 injection patterns here: drtimpearce.com/resources/26-essential-injection-patterns-for-botulinum-toxin/ Beyond that, if you don't like the podcast format of this show (talking), I don't think we're the channel for you. All the best, Miranda