BellaSugar: What is Botox exactly, anyway?
Dr. Anthony Youn: When we talk about Botox, what we're actually talking about is botulinum toxin, which is a very powerful paralytic that we only use in minute doses. When you inject Botox, what it essentially does is paralyze specific sets of muscles so that wrinkles don't form there.
BellaSugar: Will people likely be able to use topical Botox all over, or will its use be more limited?
AY: For years, the problem with a topical botulinum has been this: how can you develop a cream that will be effectively absorbed through the skin and penetrate all the way down to the muscle? Because it's been so difficult to develop a cream that will actually absorb to the muscle, I doubt that a topical botulinum would be as powerful. The applications they're looking at seriously now are crow's feet and sweating. The skin is thinner in these areas, so the absorption ability would be greater.
BellaSugar: How do you know how much Botox is too much?
AY: As a consumer it's hard to know. Typically, most doctors won't inject more than 20 to 25 units in a given area.
BellaSugar: We hear so many horror stories about "bargain" Botox gone wrong. Is there a way to protect yourself?
AY: Unfortunately, botulinum is sometimes watered down at spas, and as a patient, there's no way for you to know. Someone could literally be injecting pure saline, and you couldn't tell. Botulinum is clear, and you mix a minuscule amount with saline, so only the practitioner really knows what they're injecting. The best way to ensure you have a good outcome is to make sure you have your Botox injected at doctor's office — not strictly by a doctor, because it can also be pretty much fine with a trained nurse or physician's assistant who's under doctor supervision doing the injections. Spas with Botox have a medical director to sign off on things, but what they don't tell you is that they could be any doctor; their medical director could be a pediatrician whose actual office is miles away. Another issue is that spas usually close. Doctor's offices are almost always available 24 hours a day. I have an answering service, so I'm there if you have a problem or complication at 3:00 in the morning. Because of a spa's operating hours, that's usually not the case.
BellaSugar: What's the biggest misconception people have about plastic surgery?
AY: The biggest misconception is that people believe all doctors are created equal. Often, people will go with the doctor who has the most billboards up around town, because they think the doctors with the biggest ads are the best doctors. Technically, quite often, the inverse is true — the size of the ad is usually inverse to the quality of the doctor. Most of the best surgeons get work by word of mouth and hardly advertise at all.
BellaSugar: You're famous for turning some patients down because of your ethical standards. Is there any kind of red flag that tells you right off not to accept someone as a patient?
AY: Unrealistic expectations; someone wants something you just can't give them. For example, a morbidly obese person who wants to "fix" themselves with liposuction, or somebody with a tiny bit of excess skin who wants a tummy tuck.