Hidden beauty of Botox

the secrets most doctors won’t tell you

By Sally Montgomery

“Is there a thing as too much Botox?” I once asked Dr Peeraya Likitkiatikul, my go-to aesthetic doctor from Metro Beauty Centers in Bangkok.

For someone in her early 30s, she answered my question with wisdom. It’s all about presenting the perfect balance of one’s features, personality, and emotions. If one’s face is the window to one’s soul, then cosmetic procedures such as Botox or facial fillers can only be instruments that highlight this reflection of beauty or otherwise. This could explain how some celebrities who have all the money in the world end up looking the way they do after visits to cosmetic doctors.

Since the 1990s, Botox (short for botulinum toxin) has smoothened furrowed brows, crinkled foreheads, and kept crow’s feet from clawing away at the youthfulness of millions the world over. But it’s only a select group of doctors around the world who know how to use the product like how an artist would direct his or her easel, rather than how a labourer would hack at a piece of concrete. The use of Botox, filler or any other cosmetic product should combine a mathematician’s ability to decide exact doses that correspond to each facial part to accentuate that part and the balance of face as a whole. This is where doctors such as Dr. Peeraya are so essential to crafting a face that appreciates in beauty over time. Instead of a face with a chasm-like space between the eyebrows.

Each person’s face is unique. With Botox, it’s not just about erasing wrinkles and making fine lines vanish. It’s also about preserving the unique symmetry of a person’s face with a series of precise doses. For instance, 20 units for crow’s feet could work extremely well for one person, while another person could benefit with 25 or 30 units. But issues could surface if the person who needs 20 units, gets 30 units. The excess Botox could lead to a lopsided smile from Botox migrating from the crow’s feet area or other examples of things going wonky.

In areas such as the forehead, a skilled doctor’s touch is even more important. For a balanced and unlined forehead, it takes an expert’s assessment of what’s needed. Case in point: Dr. Peeraya would suggest two separate treatments of Botox. So instead of going in with a heavy hand, she’d start with a light approach followed by a touch up during the second treatment to ensure an excellent outcome. For those without the luxury of time, Dr. Peeraya has been known to achieve excellent Botox effects with just one treatment. So, the lesson here: if you have a consultation with a doctor and he or she doesn’t discuss dosage prior to the treatment; or if the doctor doesn’t listen to your concerns, then you’d be better holding off on your treatments. There’s one thing that’s worse than wrinkles – results that look unnatural or forced that guarantee getting all the wrong types of looks while on the Skytrain or the Metro.

More than just wrinkle erasers

There are also lesser known and less widely used applications of Botox. Treatments like dermatoxin that comprises diluted Botox injected multiple times on the skin hold the ability to lift, highlight and to a smaller extent, augment facial structures. Dermatoxin is different to normal Botox procedures as with dermatoxin the injector wouldn’t reach into the facial muscles to inhibit movement. For instance, with furrow lines between the eyebrows.

Most doctors wouldn’t suggest dermatoxin for two reasons. The first is that they may lack the skill to do so. Dermatoxin treatments are comparable to using an artist’s instrument to shape and highlight areas such as the jawline or cheeks. So, a doctor to be effective at dermatoxin, he or she would need to possess a thorough understanding of and respect for facial anatomy. The second is that the profit margins from dermatoxin treatments are considerably lesser than cosmetic filler or facial threads treatments. But through the skilled hands of Dr. Peeraya, with dermatoxin treatments, my desired look of angular cheeks and lifted jawline is no longer a dream. A surgeon friend in New York City keeps telling me that his facelift techniques are the perfect antidote to the dreaded ‘pillow face’ caused by too much filler. A facelift procedure with him costs in the region of USD150,000. The effects are stunning, but when I mentioned dermatoxin, this surgeon went quiet. He couldn’t deny dermatoxin’s effectiveness (albeit temporary) to sculpt the face.

Besides facial sculpting, dermatoxin is also known for its pore-minimizing effects. Barbara, one of my many BFFs who I introduced the treatment to, calls it a ‘facial that lasts for two months’. She keeps saying that she no longer spends a lot of money on skincare. “Honey, I’m all set with the right cleanser, some hyaluronic acid gel, vitamin C serum, Skinoren cream, and dermatoxin once every two and a half months,” she keeps telling me about the skincare tips I had shared with her. Okay Barbara honey, you keep being you.

Originally made popular by South Korean doctors, dermatoxin is still an under the radar treatment that not all clinics offer. The treatment’s effectiveness also depends on a person’s skin laxity, so it’s more suited for those in their early 40s. A hard-won lesson in facial rejuvenation: dermatoxin could be a better fit than Hifu or Ulthera treatments if you’re looking to have a more sculpted face, defined jawline, and reduce facial sagging especially around the nasolabial folds. There was once I took a series of Hifu treatments at a different clinic with a disinterested doctor using a substandard Hifu machine. This was during my phase of wanting to look like J.Lo, right after she hooked up with Ben Affleck. What I got instead was loss of facial volume – Hifu can literally dissolve the fat on one’s face – and a lot of sagging. This was a costly lesson. Both in terms of money spent and my confidence level. [Read my other story here.] But we live and learn, all in the journey towards looking, feeling, and being our balanced best.