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Prakash Chandran (Host): Getting Botox can actually be good for you? We all know about the aesthetic enhancement Botox and other cosmetic procedures can provide, but did you know that there are a growing list of benefits beyond just helping us look good? I’m Prakash Chandran; and in this episode of Healthy Takeout, we’ll talk about the benefits of modern-day Botox and cosmetic procedures. Here with us to discuss is Dr. Arturo, a plastic surgeon at Harrington Healthcare. Pleasure to have you here Dr. Arturo. So, let’s get right into it. Besides it’s ability to fill in fine lines and wrinkles, what are some other uses for Botox?

Arturo Aguillon-Bouche, MD (Guest): In general, Botox helps a lot in the appearance of the patient’s physique. When they are talking, a lot of my patients state that after Botox, other family members or coworkers said, “You don’t look as angry as you used to look. You look happier, you look smoother.” So, the ability to present themselves as a better personality, if you will. To show your real inner happiness is more present than without the Botox.

Host: I love what you said there about helping people look less angry. I definitely know a couple of people in my life that could use some of that Botox. I've also heard that there are some benefits beyond making you look for youthful or less angry. Can you talk a little bit about those?

Dr. Aguillon-Bouche: If one starts using Botox early in life, those little wrinkles or deeper wrinkles will not be as noticeable later on in life. The possibility of necessity of surgical treatment will be significantly delayed. That is as far as the [inaudible] on the face. There are other uses as far as sweating in the axila, sweating in the hands that are not FDA approved, but most plastic surgeon, the American Society of Plastic Surgeon, approves it. We’ve been using this for years and it’s very helpful. Personally, I use Botox in my axilas for sweating and it has helped me in the clothing that I use at work and in society.

Host: Yeah, that’s fascinating. I’ve heard that it’s used quite a bit for that underarm sweating. Is it also true that it can help with migraines?

Dr. Aguillon-Bouche: Indeed, for migraines. I personally do not manage migraines. That is not my field of expertise. I have had a couple of patients that because of the distance between the patient and the physician, patients are in Boston or in Hartford. The physician gives me the data that the patient requires as far as dose and location for the injections. As an anecdote, my late wife used to have migraines. I started injecting with Botox for cosmetic reasons and her migraines disappeared. Again, I am not a specialist on headache. So, I do not manage this type of condition.

It has been used also in patient with gastroesophageal reflux, with anal fissures, in patients that have had paralysis of the face for treatments, and other dyskinesias of the face. These problems I do manage, and I have a handful of patients that have these types of problems. I do manage these problems.

Host: Wow. It seems like over time the benefits from using Botox have really just grown and grown. So just beyond those aesthetic use cases for it. You talked about the sweating, you talked about migraine, you talked about a lot of different things. So, before we get too excited and all rush to get Botox, I'm sure that there are actually potential risks or best practices to implement when getting Botox. Can you talk a little bit about that?

Dr. Aguillon-Bouche: The risk of Botox injection is very little. Botox is actually a toxin created by a bacteria and it’s the toxic that causes botulism. The amount of Botox that one needs to die from it 300,000 units. The maximum amount that I have injected is 500 units. So, well, well, well beyond before the dose of causing significant problems as far as the entire health of the individual. Locally, it may… We call it bleed. Which means it moves a little bit beyond the area of injection. If that happens, one can get paralysis of muscles that we did not desire to paralyze.

When we do Botox in the glabella area, which is in the lower forehead in the 11s that people call. One can have displacement of Botox inferiorly and damage the levator palpebrae superioris, which is the muscle that elevates the eyelid and one can have a droopy eyelid. Fortunately, this is temporary. Fortunately, this is partial. This is a most common complication of Botox and it happens in the glabella area.

If one injects Botox in the forehead on a patient that has already a lower brow, it may have consequences as far as the appearance of the eyelid. So, this is the type of discussions that you have to have before injection in the different locations that we can do in the different areas of the face.

Host: It’s really good to know that because I know people are probably considering it on different areas of their body to help them look more youthful or some of the other reasons that we talked about. I want to get a little bit into when… Maybe it’s overusing Botox. You talked about that you're only injecting a little amount, but how often can people get Botox? How much is too much?

Dr. Aguillon-Bouche: I don’t believe there is any plastic surgeon that will inject too much Botox. As I said before, the amount of Botox that you need to cause a significant problem as far as the health of the individual is very rare. So, nobody has injected those amounts. As far as when to start to use Botox, it completely depends. There are some friends of mine, some assistants of mine that started using Botox when they were 26/28 years old and their friends said, “Why are you doing this?” Now those people are 37/38/39 and they have no lines on their faces. Their friends said, “What have you been doing to your face?” Well, I’ve been telling you what I have been doing forever.

So, there is no real time when one should start with this. It depends on when it bothers you and what bothers you. Once you decide that something bothers you, you can to a plastic surgeon aesthetician and they can discuss with you the different possibilities. I suggest that you go to somebody that is board certified to do this just in case there is a partial indication or a possible problem that it could be discovered before the injection.

Host: That’s really good advice. Go to a board-certified plastic surgeon to just get a consultation about what are the different possibilities that you can implement. So, I want to talk about beyond Botox itself. What are some of the other cosmetic procedures that you do that have benefits? What are the benefits that you're seeing?

Dr. Aguillon-Bouche: One of the problems with cosmetic surgery, plastic surgery, is it works. It works very, very, very well. Unfortunately, or fortunately, people get addicted to it. Men and women, we do a lot to try to look good. We go to a hair dresser, we change the color of our hair, we buy clothes, we exercise. We try to stop smoking, we try to diet, and nobody notices. Nobody notices that any of these changes happen. We go to a plastic surgeon and we do a little bit of injection of Botox, some fillers, liposuction, augmentation mammoplasty, an abdominoplasty, and the world notices. Everybody asks what are you doing?

So, this really boosts the personal image. This really enhances how one feels in front of society. I tell my patients on my first visit, unfortunately you will love how you look and the response of other people towards you. So that is the reason that is a little bit addicting, the cosmetic surgery. Because we do a lot to try to look good, nobody notices. We do a small procedure, and the world notices. That’s very addicting. It’s a very nice field to be in.

Host: Yeah. You know it’s so interesting that you say that the biggest issue is that it works. Also, just how people view themselves after getting it done. One of the things I was actually talking to about my wife is about her personal appearance and how she views herself. I, of course, think that she’s perfect and she’s wonderful. But for some people, they might want to fix an eyebrow that they feel is just a little bit too low. They have personal self-image issues that if they just got that fixed for themselves, they would feel better. Do you witness that a lot? That even though you don’t necessarily see something majorly off, that people get this done just to feel better?

Dr. Aguillon-Bouche: Absolutely. That is the reason to go to a certified surgeon and somebody that will be honest with you. The way that I describe this with patients is that first I need to know what bothers you. Second, I need to see if I see what bothers a patient. Third, can I do something about it? And that that we’re gonna do about, is it cost effective? If the patient perceives themselves as droopy eyelids and I don’t see it, I will not do a blepharoplasty on that patient. If the patient comes and says I want done a breast augmentation and they have a D cup, that’s not what the patient needs. A DD, a DDD is not what the best for a very small body.

So be open to discussion. The first time you meet your plastic surgeon is very important. One has to feel very comfortable knowing that the surgeon will understand what the concerns are and can something be done about those concerns and what risks and consequences take to try to improve those concerns. Yes, a lot of times I see patients that tell me, “I have this.” I say yes, you do have it. Yes, I see it. But nobody else sees it. Leave it alone. Ignore it. That is a common discussion with my patients. A lot of patients, of course, get something that is objective and is something I can fix. Of course, those are the patients that we proceed with surgery. So, the first consultation with your plastic surgeon is very important. Hear that the plastic surgeon will be listening really to you about the concerns that one has.

Host: Well I think that’s good advice for everyone. Just that initially conversation with your plastic surgeon is so important. They will tell you. They do cosmetic procedures day in and day out, and they’ll be the ones to say whether it’s something that you need or not. So, Dr. Arturo, I want to thank you for your insights on Botox and these other cosmetic treatments. It’s really been fascinating to learn that they can not only help us look good, but just help us feel good as we talked about today. So, for more information, please visit harrigonhospital.org. Our guest today has been Dr. Arturo, and this is Healthy Takeout from Harrington Healthcare. I’m Prakash Chandran. Thank you so much for listening.