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By Marc Meisfelt (2010)
No doubt, Botox works.
In a face that is beyond the 20s, it immobilizes facial muscles that, when a person smiles or mimics, make a face look older because of wrinkles.
And in a face that is in the 20s, Botox can prevent wrinkles to develop in later years. If I were in my early 20s, especially if I were a woman, I would start using Botox, regardless of what my environment, and even my physician, would be saying.
A common misconception is that Botox reduces the ability of a person to express emotion, or to show laugh and smile, but this is nonsense. The laughing and smiling face just looks younger. To have a negative impact on showing emotion, much more Botox would be needed than is commonly used (up to 100 units).
It would also have to be injected wrongly.
But the negative impact of wrongly injected Botox would be much less severe than the impact of a cosmetic surgery gone wrong. Botox wears off completely in some three to six month, so that any occurring negative impact anyway would only be temporary.
How is Botox injected correctly, and where is it most effective, based on my own experience?
Well, the spot where it is most effective, and cannot be substituted by anything else, is the glabella fold. That is the fold between the two eyebrows, above where the nose originates. This fold, or permanent deep wrinkle, is caused by the unrelentless contraction of what could be defined as statutory facial muscles.
In anatomy, the term "statutory muscle" refers to those muscles that are contracted almost constantly, at least in the waking stages of a person's life, to maintain body position.
Many neck muscles are "statutory", to keep the head erect above one's shoulder.
Most facial wrinkles are not the result of permanent muscle contraction but of skin fatigue, with the glabella fold is the most striking exception.
Thus, when the glabella fold muscles are constantly relaxed by a sufficiently high dosage of Botox, the vertical fold between the eyebrows disappears completely, resulting in a definitely younger appearance.
While for the glabella fold, Botox injections are the only effective treatment, in most other parts of the face, Botox is an alternative to cosmetic surgery.
Botox can get rid of forehead wrinkles quite nicely, but the effect lasts, as anywhere else with Botox, only three to six months, and some 30 plus units are typically needed. Over the years, this can add up. The cheapest price per unit of Botox is about 5 US dollar (see below).
The alternative to Botox on the forehead would be a forehead lift, with the scar above the hairline. However, a forehead lift will raise the hairline, which definitely is counterproductive to a youthful appearance.
I have a definite opinion on who should undergo forehead lifts, and when. I would consider it only if I were a balding man with a long-term strategy to regain my youthful appearance. And in that case, I would only do it before a scheduled hair transplantation that would later cover the scar.
But when considering the sequence of a forehead lift and a hair transplantation, one should be aware that the hair transplantation cannot follow the forehead lift immediately. The reason is that after a forehead lift, the lifted area has to re-establish its blood supply channels. While the body handles this well for the trauma of the forehead lift, the blood supply would not be sufficient to assure that transplanted hair will not just fall out.
To re-establish normal blood supply takes at least six month, and it is optimal only after some twelve months. One would therefore have to live with a rather visible forehead scar for about a year.
Whether this is bearable will largely depend on the lifestyle of the person considering the procedure.
It may sound funny when one hears or reads the following assessment for the first time, but I actually consider it realistic for the future that the lifestyle of people will be determined by the desire to make optimal use of the benefits one can avail of from cosmetic surgery and related treatments, such as Botox injections.
Optimal benefits from cosmetic surgery and related treatments can only be enjoyed truly by those who are believed to be much younger than they actually are, not by those who are recognized to just look much younger.
To give a practical explanation for the theoretic assessment above: if you are in your mid-50s, but look as if you were in your mid-30s, then you have a small benefit if people know that you are in your mid-50s but look in your mid-30s.
The full benefit of looking in one's mid-30s, even though one is in one's mid-50s can only be enjoyed by those who claim to be in their mid-30s, and are believed to be of that age. And indeed, this can be done. But only for those who are not known to be in their mid-50s.
This is the main reason why I consider any type of fame counterproductive. I was on the path of becoming a well-known journalist, but abandoned this career. I had started training as an actor, and maybe could have been successful, but gave up on it. I was, for some time, politically active, and I still believe that a political career in a Western democracy is easy to manage.
But all of this would have collided with my sexual agenda. Nothing is as satisfying in our limited life span as is feeling on the top of the sexual market value ranking in your environment.
If you are a man in your early 30s, professionally with a future, though not yet rich, and if you are, apart from that, visibly not married, then your sexual market value is much higher than that of a journalist or actor or politician in his 50s, even though he looks in his 30s (especially when it is known that he owes his youthful looks to cosmetic surgeons and Botox).
In order to enjoy optimal benefits from cosmetic surgery and related treatments, it is essential not to be famous or just known, and beyond that, to be rather mobile, so that one can live in environments where it is not known that one has been around for some time (much longer than one would guess from a person's physical or facial appearance).
If a person's lifestyle is optimal for cosmetic procedures, to be around with a forehead scare for a year or so, is a bearable inconvenience. When asked about the scar, just claim a car accident.
But for those whose lifestyle is not optimized for cosmetic surgery, Botox is the best alternative to a forehead lift, and the results, by and large, are equal.
Apart from the glabella fold and forehead wrinkles, there is one additional part of the face where Botox is efficient: around the eyes.
And not just for crowfeet. And similar to what is the case with the glabella fold, for a certain effect, Botox cannot be substituted.
If we look at the aging eye area of the face, we will notice that two age-related conditions develop that need to be differentiated.
One is the visible tear sacks below and the visible fold of the upper eyelid. These are both best corrected by cosmetic surgery.
The other is that when an aging person smiles, there will be more wrinkles around the eye, including those famous crowfeet, which are permanent traces of the wrinkles that appear every time, a person smiles. To see both, just look in a mirror and grin (don't just look into a mirror with a serious face).
These multiple wrinkles around the eyes, especially when you smile, is what will disappear when you use Botox. The skin around the eyes will just be immobilized.
The glabella, the forehead, and around the eyes, are the three areas that are successfully treated with Botox.
I have tried it for other areas, such as chin wrinkles and wrinkles at the corners of the mouth, but the effect was mi.nimal, and these experiments were a waste of money.
For maximal efficiency, I suggest that a person from an age of 40 years onward uses 100 units of Botox, which is the standard retail bottle. (Please be aware that in spite of my recommendation, you will always need a physician's prescription for the Botox.)
Many dermatologists, in Bangkok and at other places around the world, offer Botox treatment prices by area: 200 US dollar for glabella, 350 US dollar for forehead wrinkles, 200 US dollar per eye for crowfeet.
But to pay for Botox this way is not cost efficient, as there is a clear incentive for the injecting physician to save on the expensive raw material for the treatment.
Much more sensible, it is to buy 100 units (one retail bottle), and let the dermatologist distribute these over the three areas best treated with Botox: the glabella, the forehead, and the areas around each eye.
I myself schedule 100 units of Botox every four months or so. And the past few times, I had the injections handled by Dr. Kanya Techachokwiwat at the Yanhee Hospital in Bangkok. Yanhee Hospital does have the offer of injecting one whole bottle of 100 units at the price of 550 US dollar, though you may have to ask for it, as it is not their most publicized offer (for business reasons, they also prefer to charge per treated area, which will result in much better profit margins).
For those who want to follow in my path: be aware that the dermatological clinic of Dr. Kanya Techachokwiwat is on the second floor of Yanhee Hospital, not on the fourth floor, where the cosmetic surgery department is located.
For most foreigners visiting Bangkok, Yanhee Hospital is not situated as conveniently as is Bumrungrad (just off Sukhumvit Rd). But Yanhee also is not primarily targeting foreigners, which results in lower prices.
Yanhee Hospital is on 454 Charasanitwong Road, on the Thonburi side of Bangkok. Their phone number is 2879-0300. When calling from within Bangkok, the Bangkok area code, 02, has to be dialed before their number.
The following Bangkok city buses stop in front of the hospital: 18, 110, 170, 175, 203
One could take 170 from Victory Monument, but buses run only about every 30 minutes, and Victory Mpharma46721.htmonument is a terribly polluted corner of Bangkok... no pleasure to wait for a bus there, even when one has the time
In my opinion, the most sensible transportation option for a visit to Yanhee is to take the BTS skytrain to the terminal station, Morchit, or the subway to the Chattuchak station, and from there a taxi to the Yanhee Hospital, which, as of December 2007, costs 75 baht.
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Copyright Marc Meisfelt