Everything you wanted to know about Botox

What is Botox?

Botox is a specific brand name for botulinum toxin. The toxin is derived from the bacteria clostridium botulinum. The toxin itself causes paralysis of muscles and in high doses can be fatal. However, the cosmetic industry has figured out a way to purify this toxin and give it in very small doses so it can have cosmetic benefits without systemic risk. There are currently 3 FDA-approved brands of botulinum toxin on the United States market currently (Botox, Dysport, and Xeomin), each is slightly different and from competing manufacturers. There are more brands that will also be hitting the market. Botox is the most well recognized brand since it was the first to be approved and has been used the longest. Much like “Xerox” and “Q-tip”, Botox has become synonymous with all botulinum toxin, so when people say “Botox”, they are not necessary referring to the specific brand. They are describing the class of toxins. Even healthcare professionals mistakenly use the term Botox when referring to other brands.



How does Botulinum Toxin work?

Botulinum Toxin is a neurotoxin. This means that it directly acts on nerves. Specifically, the toxin blocks the connection between motor nerves and muscles. The neve is unable to communicate with the muscle, and the muscle stops working. The result is relaxation of the muscle through partial paralysis. It is only temporary and the nerve function will return after about a few months as these connections heal themselves.

What is the purpose of Botulinum Toxin?

Botulinum Toxin injection are used to improve your looks by reducing the appearance of fine lines and wrinkles that are the result of muscle movements. By relaxing the target muscles, the lines and wrinkles disappear. Take a look in the mirror and scrunch your face.  Do you have lines that appear? Well, those are the lines that are targeted by Botulinum toxin injections.

Botulinum Toxin is commonly used throughout the face and neck to reduce the appearance of:

  • Frown lines (the “elevens”)
  • Forehead lines
  • Bunny Lines on the nose
  • Crow’s feet around the eyes
  • Lip lines (“smoker’s lines”)
  • Dimpling of the chin
  • Neck bands

Who is a Candidate?

Basically, anyone with lines or wrinkles that they want reduced can be a candidate for botulinum toxin injections. You should be in good health and without and systemic neuromuscular disease. You should also not have any active skin diseases in the area that is to be injected and have no history of prior adverse reaction to botulinum toxin injections.

You will be evaluated prior to your injections, so your injector will help determine if botulinum toxin injections will produce the result you desire. Sometimes, other treatments like fillers, lasers, or chemical peels may be more appropriate.  Botulinum toxin should not be given to pregnant or breastfeeding women.

How is Botulinum Toxin given?

The toxin comes in a liquid form and is injected directly into the areas being treated. This means that you will get a needle. We use the smallest needles available and you will get multiple small injections to the area, so that the toxin is injected directly into the muscle. This will help ensure a smooth relaxation of the muscle. These injections are very well tolerated and most people feel very little discomfort.  After the injections, you can go back to your normal daily activities.

What is the recovery time?

There is essentially no recovery time after your botulinum toxin injections. Because it is administered with needles, there can be some pain or bruising at the injection site. This is temporary. You can resume normal activities right away, but we do recommend no heavy exercise for a day or two, in order to prevent worsening bruising and swelling.

Will I see it working right away?

No. Botulinum Toxin takes time to work. There is some variation among different brands, but in general it takes a few days to a week for the muscles to be relaxed. Many people do report that Dysport brand toxin kicks in faster, with most people seeing results in about 2-3 days. Some people respond differently so the time to onset may vary.

How long will it last?

In general, the effects of Botulinum Toxin last 3-4 months. But this can vary based on the anatomic location of the injections and the brand of toxin used. There is also some variation between people. Some people are more sensitive to the toxin and require smaller doses, and some require higher doses. Additionally, there is a very small percentage of people who are resistant to botulinum toxin and it just doesn’t work on them.

Can Botox be combined with other treatments?

Of course. It is very common for botulinum toxin to be given together with other treatments. This is because many people require more than one treatment to correct what they are complaining about. Commonly, patients get botox to reduce lines and wrinkles, but also get fillers (like Juvéderm or Restylane) to fill deep folds or deep lines. Most of these different treatments can be performed at the same time.



Are there other uses for Botox?

While botulinum toxin is most commonly used to treat lines and wrinkles of the face, there are some other, less common uses.  These include:


  • Jawline reduction
  • Treatment of migraine headaches
  • Reducing appearance of a gummy smile
  • Treating temporomandibular joint (TMJ) disorder
  • Stopping excessive sweating

How does Botox treat sweating?

Excessive sweating, or hyperhidrosis, is a very debilitating condition. Hyperhidrosis can occur on the hands, feet, underarms, and scalp – basically anywhere that there are sweat glands. It can cause significant social anxiety, not to mention damage clothes.  Botulinum toxin has been very effective in treated excess sweating and is FDA-approved for the treatment of hyperhidrosis.

The Botox is injected into the areas being treated. The toxin actually paralyzes the tiny muscles that surround each sweat gland. Most people see significant reduction in sweating within a week and the results can last 6-12 months. Higher doses of toxin are required when treating hyperhidrosis.

If you are concerned about the appearance of your lines and wrinkles, Botulinum Toxin may be right for you. You should be evaluated by a Board-Certified Plastic Surgeon or Board Certified Dermatologist. They will be able to tell you if Botox, Xeomin, or Dysport is best for you. They will also be able to discuss other treatments that may be better to help your areas of concern. To see an experienced injector in New York City, you can contact Board Certified Plastic Surgeon Dr. Matthew Schulman.


Body Mass Index (BMI) and your surgery

What is Body Mass Index (BMI)?

Body Mass Index, or BMI, is a number that is calculated based on your height and your weight. It is a measure of obesity. There are dozens of free BMI calculators that you can easily find on the internet. When you plug in your height and your weight, you will get a number, and this number characterizes your degree of obesity:


  • Less than 18.5 = underweight
  • 5 – 24.9 = normal
  • 25 – 29.9 = overweight
  • 30 – 34.9 = obese
  • over 35 = extremely obese

Why Does Body Mass Index (BMI) Matter?

The importance of BMI is that is reflects your risk of obesity-related health problems such as diabetes, high blood pressure, and heart disease, among other conditions. This is why you should be aware of your own Body Mass Index and modify your diet and activity level if needed.

BMI is also very important in the surgical world since it also reflects surgical risk. It is extremely important when evaluating someone for an elective procedure like cosmetic surgery. This is because the level of obesity is related to the risk for complications during and after surgery, as well as predicting your body’s ability to heal from surgery. The data shows that people with a BMI above 30 are at increased risk for having a surgical complication.  These complications may include a negative reaction to anesthesia, breathing problems, heart attack, stroke, and blood clots. These can be serious and even fatal.  Additionally, we know that people with BMI over 30 are at increased risk for healing problems. This means that incisions may be slower to heal, there can be infections, and there can be an overall poorer cosmetic result. This is extremely important with procedures requiring long incisions such as tummy tucks and breast reductions.



What are the Body Mass Index (BMI) Recommendations for Surgery?

Based on this data, Board Certified Plastic Surgeons generally require that their patients have a BMI of 30 or below before proceeding with elective cosmetic surgery. This means that they are likely to decline to perform surgery on you if your Body Mass Index is above 30. This makes sense, since we certainly would never want to place you at risk, especially for an elective cosmetic procedure. Of course, if you needed life-saving surgery, the surgeon will perform the procedure no matter what your BMI is, and you would accept the added risk. But plastic surgery is different since it is not medically necessary and we try to minimize all risks as much as possible.

Criticism of Body Mass Index (BMI)

The criticism with Body Mass Index calculations is that it is imprecise and doesn’t always accurately reflect someone’s actual level of obesity. Critics argue that since it is so imprecise, it is not a good indicator for surgical risk level. This is definitely true.  A simple calculation using your height and weight does not take everything into consideration. BMI does not consider things like:

  • gender differences
  • bone mass
  • muscle mass
  • excess skin
  • fat distribution.

Men tend to have a higher BMI and this doesn’t necessarily mean that they are more obese. A muscular man may have minimal fat but a very high BMI. For example, NBA superstar Shaquille O’Neal stands 7’1” tall and 324 pounds. This makes his BMI 31.5 and in the obese range, but no one would consider this elite athlete to be too obese for surgery.  Also, patients who have lost a lot of weight will usually still carry significant excess skin. A person who has successfully lost 100 pounds and has no fat left on their body, may be carrying 20+ pounds of extra skin. Using a simple BMI calculator, they may have a BMI over 30 only because of the extra skin they are carrying around.  There is no Board Plastic Surgeon that would deny skin removal surgery in this case, even though the BMI is above the accepted limit of 30.

Also, the location of the excess fat is very important, and not considered in the BMI calculations. There is a difference between peripheral and central fat. Peripheral fat is excess fat in the extremities, like thighs and legs. Central fat is found in the abdomen, flanks, and back. Central fat is more dangerous since it has a higher correlation to obesity-related illnesses. Peripheral fat, however, is not as directly related to obesity risks. Basically, an apple shape is more dangerous than a pear shape. These are some of the things that must be considered when analyzing someone’s BMI and whether they are a safe surgical candidate.  A surgeon will probably be more willing to operate on someone with elevated BMI, if their excess fat is found in the legs.  However, if the excess fat is located in the core, such as the abdomen, the surgeon is likely to deny elective cosmetic surgery.

My Personal Philosophy

Body Mass Index is an important metric but it is not the end-all, be-all.  BMI is a guide and needs to be used together with other things like a surgeon’s experience and physical evaluation of the patient.  In my practice, I absolutely use Body Mass Index to help me decide if I am going to operate on a patient. When someone calls to schedule a consultation, we always ask for a current height and weight, allowing us to calculate their BMI.  Since I recognize that BMI is not totally accurate, I will allow people to be seen in consultation if their BMI is below 32. I will then evaluate them in person and decide if it is safe to perform elective cosmetic surgery the way they are. This involves evaluating things like bone structure, excess skin, fat distribution, and the desired procedure. I may tell the person that they need to lose a few more pounds, in order to get their BMI below 30, before I will agree to operate on them. I also find that I can offer a better cosmetic result when the BMI is closer to normal.

So, BMI is definitely something you should be aware of, since Board Certified Plastic Surgeons care about it.  You should google a BMI calculator and plug in your numbers to see what your specific BMI is.  This will help you be most prepared for your consultation and give you an idea whether or not you will be required to lose weight prior to your surgery. Your goal should be to have your BMI below 30 and as close to normal as you can. This will minimize your risk of surgical complications and also help to optimize your cosmetic result.



Schedule your Consultation


If you would like to see if you are right for the procedure you want, you can set up a consultation with Matthew Schulman M.D., New York City Board Certified Plastic Surgeon.


Plastic Surgery Trends for 2020

Over the years, various beauty trends have come and gone, but what’s never changed is the desire to look one’s very best. Unsurprisingly, this continues as we enter the 2020s, and in this new decade, men and women are leaning on plastic surgery more than ever to improve their looks.

Here are the biggest plastic surgery trends to look out for in the year (and decade) to come.



  1. Botox for all

Plastic surgeons and dermatologists agree: 2020 will be the year of Botox for all.

Much of this has to do with a younger and younger population wanting to preemptively delay the signs of aging. For a long time, people thought Botox was only for people that already showed showed the signs of aging. This meant that Botox was predominantly used on people in their 40s and 50s who had facial lines and wrinkles. Today, however, people recognize that Botox can prevent the deep lines and wrinkles associated with aging. By treating the face with Botox before the wrinkles formed, it can prevent them from ever occurring. Now, people in their 20s and 30s are interested in botox treatments as a way of preventing the signs of aging. Also, more men are recognizing the power of Botox treatments. So in 2020, expect both men and women in their 20s, 30s, 40s, and 50s to be regular users of Botox. Also, don’t forget that Botox can also be used to reduce sweating of the underarms, palms, and feet. 

Botox is a safe, FDA (Federal Drug Administration)-approved drug that is injected into the skin at strategic points on the face and neck, in order to weaken the underlying muscles by blocking the nerve connections. Relaxation of the muscles helps to smooth line and wrinkles and reverse the signs of aging because the deeper muscles are no longer contracting. The effects of botox lasts about 3-4 months.  


  1. Non-Invasive body contouring

There are essentially two types of body contouring procedures: Invasive or Non-Invasive.

Invasive solutions include tummy tucks and liposuction. Both of these procedures are invasive surgical procedures that require some use of anesthesia and require some amount of healing and recovery. They may be combined with other procedures to help the patient achieve their desired body shape and contour.

There are also non-invasive body-contouring procedures that can help shape the body, without surgery, pain or recovery. These include injectables or energy-based treatments that can reduce fat, enhance muscles, and tighten the skin.  These non-invasive body contouring procedures have increased greatly in popularity, and we expect to see that popularity skyrocket even higher in 2020. While these treatments may not offer the same results as their invasive surgical alternative, they are desirable to people who want a pain-free treatment with no recovery. This is largely because they’re essentially pain-free. 

One of the most popular non-invasive body contouring treatment is TruSculpt iD. This device uses radiofrequency energy to permanently destroy fat. Studies show an average of 24% permanent fat reduction after a single treatment that is painless and takes 15 minutes. TruSculpt iD can be used throughout the body and neck, and is a good option for those who have specific problem areas and are looking for an alternative to liposuction. This has been a very popular choice for men.

For those with significant amounts of excess skin or fat, non-invasive treatments like TruSculpt, may not offer enough of an improvement and highly effective procedures like the tummy tuck and liposuction may be a better choice.


  1. Contouring of the Chin and Jawline

Chins are in! Dermatologists and plastic surgeons have seen a significant uptick in the number of chin procedures patients want. Amazingly, you can have the ultimate chin you’ve always dreamed of with just some filler to add volume or evenness to specific areas. Alternatively, you can get rid of a double chin if one’s been plaguing you.

For women and men who want to get rid of a double chin, the procedure can vary depending on exactly what the issue is. Most of the time, a double chin is the result of both excess pockets of fat or skin on the neck, combined with a small chin. Fillers can be used to enlarge the chin, which often helps reduce the appearance of a double chin. If significant volume is needed, or a permanent solution is desires, a silicone chin implant can be inserted through a small incision in beneath the chin. Liposuction can be used to remove the excess fat, especially from the neck area directly beneath the chin. Additionally, a neck lift procedure can help create a smoother neckline and jawline if the issue is excess or loose skin. During a neck lift procedure, the skin along and beneath the jaw on the neck is lifted and tightened. The excess skin is then removed through carefully hidden incisions behind the ears.

Men, in particular, are looking to add volume to their chins and strength to the jawline. The strong chin and jawline is a classically masculine look. Many men are looking to give themselves a stronger, wider jawline (think Brad Pitt). Of course, women are also concerned with their jaws — especially the symmetry of this key line that gives a face its overall shape. 

This new fanaticism for the chin and jawlines comes from heightened awareness of the overall shape of the face — its structure — as opposed to what we’ve seen in the past: emphasis on the nose, lips, and brow line. Some plastic surgeons and dermatologists are even saying that jaw perfecting procedures will be the most popular of the year.

In some individuals, an invasive surgery may be necessary to reshape the bones of the chin and jawline. However, in may people, the area can be contoured with simple injections of fillers such as Restylane, Juvederm, or Radiesse.


  1. Fat Transfer

There are many areas of the body that can be reshaped and contoured using your own fat. Your fat is a great alternative to temporary injections and fillers. Fat will last forever, will change as your body changes, and has no risk of a foreign body reaction. Also, since harvesting the fat requires liposuction, you will have the added advantage of reducing fat in some areas that you don’t want it, such as your abdomen, flanks, or thighs. 

Fat can be used to enlarge breasts or correct some pre-existing breast asymmetry. This will allow some people to get enlargement of the breasts without the need for a synthetic implant. This may not be the ideal solution for everyone, since only a small to moderate enlargement is possible with this method.

Fat is also commonly used to enlarge and reshape the buttock and hips. This procedure is commonly referred to as a Brazilian Butt Lift and continues to grow in popularity. The procedure specifically involves liposuction of the abdomen, flanks, back, and legs to harvest the fat. Next the fat is processed and reinjected into the buttock and hips, to give the shape and size you want. 

Your own fat is also a good way to correct asymmetries or contour deformities from prior cosmetic procedures, like liposuction, or for placement in the cheeks as an alternative to temporary fillers.


  1. Impeccable skin with specialized facials and peels

Your skin is what everyone sees, so it is important to treat your skin right. In 2020, women and men understand that treating the skin of the face correctly can help prevent many of the things that people complain of later in life. Good skin care can smooth pores, reduce lines and wrinkles, eliminate uneven pigmentation, and help prevent sagging.  While a good daily skin care routine is important, more specialized treatments such as chemical peels, lasers, and facials are necessary. A plastic surgeon, dermatologist, or licensed esthetician can evaluate your skin and help design a treatment plan. 

One of the most popular treatment for 2020 is the HydraFacial. This treatment combines hydration, exfoliation, extraction, and peels in a single treatment. Having a professional skin treatment, such as HydraFacial or EscarGlow facial, monthly can be a huge benefit to your skin that will supplement the daily skin products that you are already using. Professional skin treatments are also gaining in popularity among men. 



What Are Your Beauty Resolutions for 2020?

With 2020 upon us, it’s time to start making good on those New Year’s resolutions! What are your beauty goals for the upcoming year? For the upcoming decade?

If one of your resolutions was to develop your confidence and self-esteem through an improved aesthetic appearance, plastic surgery in New York City  is an ideal way to realize these goals. Through the use of the latest technologies and with help from an experienced and highly-skilled board-certified surgeon like Dr. Schulman, you can finally have the body and face you’ve always desired.

To schedule your consultation appointment with Dr. Schulman today, or if you have questions or concerns regarding surgery, send our office an email or give us a call! (212) 289-1851

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