[MELISSA]: The Bomb Mom Podcast is part of the Practice of The Practice Podcast Network, a family of podcasts that are making the world better. You’ll also probably like the Imperfect Thriving podcast, Beta Male Revolution and Empowered and Unapologetic podcast, check them out at www.practiceofthepractice.com/network. Hey, what’s up everyone, if you’re looking to be inspired, motivated, educated and entertained, you have come to the right place. Welcome to the Bomb Mom podcast, the podcast where we explore your fitness life mindsets and actions that help you become unstoppable. You’re worth it and it’s time to finally make changes in your life that will last you the rest of your life. Welcome back to the Bomb Mom podcast and do we have a unique and special episode for you today? We are talking everything about Botox, fillers, injectables, techniques, and Co2 laser resurfacing. Say what? What is that? Well, you’re gonna find out. Our guests are Dr. Alex Denes and April Turner. Now, let me tell you guys a little bit about their background so you know that they are the top leading practitioners in their field. Dr. Alex Denes was an internal medicine physician. He then transitioned into cosmetic surgery. April came to work with Dr. Denes in 2006, and she was trained as a medical aesthetic Rn. They pursued cosmetic training together and both felt that their passion and futures lay solely in this field. Both Alex and April continued to receive injectables training, and always striving to obtain the highest level of knowledge and skill in their respective fields. Dr. Denes retired from cosmetic surgery in 2017, but he continues to treat patients and perform Co2 laser resurfacing at the Canyon Lake Med Spa. Now he and April co-own the Canyon Lake Med Spa here in Canyon Lake, California. April is considered by many to be at the forefront of injectables and is constantly refining her skills and technique. April has received multiple advanced trainings in injectables, learning and perfecting standard practice of care, off label techniques and soon began training other physicians and practitioners in this art. She has multiple master training credentials and has innovated many techniques on her own. In addition to Botox and fillers, April also provides non-ablative laser treatments such as laser hair removal and medical grade skin rejuvenation treatments. Alex and April are very active in their field by hosting peer-based training sessions and providing internships for the Temescal Valley High School Health Academy students. They both share great passion for contributing their knowledge in this highly dynamic and ever-changing field of medical esthetics. Are you guys ready to hear what they have to say? It is incredible. And we’re asking all the hard questions, everything you want to know, we’re going to ask. Let’s get started. Welcome to the Bomb Mom podcast everyone. We have some incredible guests today. We have Dr. Denes and April Turner say hello you two. [DR. DENES]: Hello, everyone. [APRIL]: Hi everyone. [MELISSA]: Nothing to be nervous about because today’s topic is all about things that make everyone nervous so you guys don’t have to be nervous. This episode on the Bomb Mom podcast is all about our face, our neck, like Botox, fillers, lips, injections, like eyes, like looking younger, feeling good. It’s all about stuff that, you know people get done. I think, before we started recording, April was telling us I think April you said like 80% of people now like, get it done and talk about it? [APRIL]: Well, yeah, back in the day about 14 years ago when I first started in medical esthetics, I’d say only about 50% of patients would admit that they got Botox, but now it’s at least a good 80% and a lot of times now, it’s like, “Wait, what? You don’t get Botox?” You know, it’s changed a lot. [MELISSA]: I think that’s totally true. It’s kind of flipped and people are like, wait, you don’t? Why not? I completely agree. But it’s such a, and I think maybe it’s different here in California, because we’re in California you guys, Dr. Denes and April are literally right across the street from my neighborhood. And they own and operate the Canyon Lake Med Spa. So, if you’re listening and you’re local, you’re going what I’m in Canyon Lake, I know that, or it’s in Riverside County so you probably have heard the name. And they do everything right here. So, I’m lucky I have them right out outside my front gate to my neighborhood. But everything that they do, you know, we have access to right at our fingertips, but like so many people go in and out of there and so many people who don’t talk about it, so many people do talk about it. So I wanted to open the door today on this podcast and like, let’s just be real. What do you guys want to know? So I put out different polls and questions and surveys on my Facebook, my Instagram people sent me DMs and we gathered all of your top burning questions for them to answer because let’s just get the truth out there. Right? Like let’s just be real, let’s be honest, let’s debunk some of the myths and find out like what this stuff is all about. I know some of the women listening this are going, yes, okay, tell me. I got to know, I got to know. So, Dr. Denes, tell us just real quickly a little bit about your background. [DR. DENES]: Sure. Well, I’m a physician, and I started my professional life in internal medicine. I had an internal medicine practice in Hemet for 37/38 years. And about 15 years ago I started transitioning into cosmetics, starting small with Botox and fillers, and back then those were fairly primitive procedures and got retrained and went into cosmetic surgery which I’ve done for the past 11 years or so. At this point, I’ve given up my surgery center, I had a surgery center right next door to April’s Med Spa, or our Med Spa, but I closed that a few years ago and now just work with April and I do a lot of the CO2 resurfacing procedures at the Med Spa. [MELISSA]: Which we will definitely get into you guys. If you guys don’t know what a CO2 is, ooo you’re missing out. We are, we are definitely going to get into that. And April… tell us who you are. What do you do? [APRIL]: I’m a medical aesthetic Rn. Alex, actually back in the day was my medical aesthetic provider before I even started working in medical esthetics. And one day, he was doing a treatment on me and my boys were young, and I said, “You know what? When I go back to work, I’m going to come work for you.” And he’s so sweet and he’s like, “Yeah, sure. Why not?” Of course, thinking to himself. Yeah, right. Like that’s ever going to happen. Well, sure enough, about a year later, I actually did start working for him. He trained me in medical esthetics and I took to it like a duck to water and never looked back. It’s been my passion ever since. [MELISSA]: And how many years now? [APRIL]: 14 years full time non stop. This is all I do is medical esthetics. [MELISSA]: Oh my gosh, I love it. And your husband works with you now too, correct? [APRIL]: He does. You know he worked with Alex for quite a few years in his surgical practice and then we transitioned him over into the medical aesthetic portion of the practice. My husband’s a practitioner. Very well rounded, the boy works ICU, Urgent Care, pre-op, post-op, and medical esthetics. He actually took to it like a duck to water as well. We trained him right out the gate on cannulas, not needles, old school, damaging, traumatizing needles. And he took to the cannulas really well, took to treatments really well. Patients love him because he’s a sweetheart, so yeah, he works with us as well. [MELISSA]: Nice. Okay, we have to talk about cannulas because everyone’s going, “Wait, what do you mean cannulas and not damaging needles? What?” OK, so let’s start with that. Let’s start with cannulas. I’m so glad you brought that up because people are going, “What’s a cannula?” So, what is this, like, non-needle procedure you speak of? [APRIL]: Well, you know with needles, it’s non-discerning. Once you inject it or insert it into the patient’s tissue, it slices and dice. If there’s a blood vessel there, and you know, anatomy, human anatomy varies patient to patient, you know, ever so slightly, it still varies, and it’s just going to slice and dice right through that tissue, blood vessels. With the cannula, it’s a blunt tip or rounded tip that has the ability to, as long as you’re gentle, it’ll go around or over or even move blood vessels out of the way instead of going through them. And, of course, bruises are from blood, you know, leaking into the skin from sliced blood vessels and you don’t get that with cannulas 99% of the time, as long as you’re gentle, which we are. And so you make a little teeny pilot hole just to be able to insert and begin the insertion of the cannula into the tissue. And it’s almost a Botox sized needle to make that little hole instead of the larger bore needles that are used for injecting fillers, say with a needle. And when you become really advanced with the cannula, you can do even more just from one little poke, one little hole instead of having to poke a patient all over the face to get the filler where you want it to go. [MELISSA]: So it’s like a tube, you poke a little hole, you have a skinny little tube. Don’t you feel it moving through? I mean, let’s just use lips as an example because when you’re talking about this, all I can envision is like all the stories on Instagram of women getting fillers and the needle is just poke poke poke all around her lips. You stick a tube up and around in there. [APRIL]: Well, it’s no larger than a needle that’s used to do the lips, it’s just longer. And so you glide it in gently. And in the lips, we have a lot of nerve endings and blood vessels, so it’ll work its way around those without slicing and dicing through them like a needle would. And then as you inject, you pull out and inject on retrograde, and you have a very smooth appearance with the cannulas. I don’t care how good you are with the needle, you’re still gonna get a smoother treatment with a cannula. [DR. DENES]: Let me just add here, if you don’t mind, just so that your listeners can visualize this a little bit better. A cannula, it has a blunt tip just like April said, but along the barrel, it has small perforations and much of the product, especially filler is actually delivered through these small perforations. So, it gives us a much smoother delivery system, if you will. [MELISSA]: I had no idea. That’s like, shocking, but I’m just trying to envision the tube, and I’m sure everyone else is, going up and around the lip. So it’s like numbing it first and then? [APRIL]: Well, no, you don’t need any numbing. Back in the old days, before there was lidocaine in the filler, we used to do dental blocks. And then, now there’s the lidocaine that’s actually in the filler, and because we’re not slicing and dicing, poke, poke poke, like you said, with a needle, we glide the cannula into a little teeny pilot hole at the corner of the mouth, not even in your lip, slide the cannula in and then as we inject, we’re injecting that filler which has the lidocaine in ,the numbing agent in it. So, as we inject we’re numbing at the same time It’s markedly less painful. [MELISSA]: So, why aren’t more people doing this? Because, all I see is needles. And the other women I’ve talked to, all I’ve seen is needles. [APRIL]: Well, you know, it is an advanced technique. And it’s one heck of a learning curve, especially if you’ve been doing needles for quite a few years. That’s why we started Michael right out the gate on cannulas. He doesn’t even know any better. [MELISSA]: Your husband, Michael? [APRIL]: Yes, sorry. Um, but for me, I trained and practiced on victims for about a year. Yes, my friends, Alex, for about a year before I would even use it on a paying patient. I wanted to make sure I had it down to a science. So, it is one heck of a learning curve. So that’s why I think a lot of providers, you know, just go with the old school needles but I would say that most advanced practitioners that do medical esthetics, and they’re advanced and in their field, they do use cannulas. [MELISSA]: Yeah. Okay. And you can do this technique because women don’t just get their lips filled, right? People are doing under their eyes, like those laugh lines that are like, you know, come down by your nose like down and around. I’m probably describing the face terribly. You guys are like, have a name for it. I’m like, you know, those lines that come down your face by your nose. [APRIL]: Actually, we can do it everywhere. And you know, one of the main, oh, I’m so grateful, the two highest risk areas for bruising are the lips and under the eyes. And under the eyes, over by your cheekbone, we make a little teeny poke, we glide gently the cannula in, inject the filler as we’re pulling out on retrograde and boom, it’s done. There’s no bruising, you know, a lot of women, you can see online, you know, pictures of women having full on black eyes from getting fillers under their eyes. And also, it’s very dangerous to use a needle under the eye. We have the infraorbital artery, which is under the eye, that if you get product in a blood vessel, it can cause occlusions and cause you know, decreased blood supply to surrounding tissue and necrosis, death of that tissue. So cannula, I just, I can’t speak highly enough of the cannulus. [MELISSA]: Yeah, like, it just seems like a no brainer to me. Well, since we’re talking about fillers, I know everyone wants to know too like, how safe are they? You know, are there different types of fillers? Is there like a cheap one and an expensive one? I’m sorry, I just asked like five different questions. Take your pick of whatever you would like to answer. [APRIL]: There are different types of fillers. You have, say Radiesse, it’s basically calcium hydroxyapatite and it doesn’t break down with hyaluronidase. We only use, well number one, we only use Allergan products, the makers of Botox. Also we only use hyaluronic fillers because it is the safest, that if you were to ever, and thank goodness knock wood, 14 years we’ve never had an occlusion of a blood vessel. But if you were to ever get an occlusion of a blood vessel, you would be able to use what’s called hyaluronidase also known as vitrace, and inject that to break down hyaluronic fillers. But, if you use a type of filler that is not hyaluronic or hyaluronic base, then it will not work at breaking that down so it’s not as safe to use other types of fillers. Also, there’s like your Sculptra, which is very unpredictable, and I’m kind of a control freak. When you use the Sculptra, it’s based on your own body’s ability to stimulate and produce collagen around the liquid that’s been injected. And I’ve seen many patients where they’ve had that done and where one side of their face will be more stimulated than the other, so they’re quite asymmetrical. So I’m, again, I want to be able to have control and I want to be able to have that safety measure, being able to break down a filler if it gets in an area that we don’t want or if it’s too much, or God forbid, into a blood vessel. Fortunately, again, we always have, it’s a part of an injectors crash cart, we always have hyaluronidase, but in 14 years, I’ve never had to use it for any reason. Wow, that’s pretty impressive. And I’m going to have to say that probably has to do with the person that is applying it. Well, when we do our trainings, and we train other providers, we, you know, always encourage very slow injection technique, always keeping the cannula (back in the day needle) moving, and it increases your safety factor. And, obviously, to know your facial anatomy and be aware that individual patients vary slightly from each other in their facial anatomy. [MELISSA]: Yeah. There’s so much behind it that it’s scary because I feel like there’s places everywhere that you can get it done. You know, I feel like everyone has a folding table in a back room. It’s scary. You know, and you get invited to like these filler parties and these Botox parties, and I’m like who’s doing it you know, so there’s a lot to it. [APRIL]: There is and you know, I know about these Botox parties and, mercy, filler parties, but this is fun as it is and how it makes you know, just feel a little uplifted, maybe a little better, you know, being tired but still being able to look like you’re not tired, things like that. But, it’s still medical and people, this isn’t like going to a hair salon or getting your nails done, this is still a medical procedure and it needs to be treated as such. I’ve been asked many times if I would host you know, or do a Botox party and I don’t. I need to see my patients one on one and treat them individually. [MELISSA]: It just makes sense. It completely makes sense. It’d be like me having like a training party. Like you know, like can we all just come over and work out? Well, sure, there can kind of be like a class but like, them still wanting like individual, you know, results, but as like a whole, like it doesn’t work that way. [APRIL]: No, because, like I’m sure with you doing your training, everybody is different, their metabolism is different, how they bulk up is different. [MELISSA]: Absolutely. Now what can make your filler last longer? And what can make it go away faster? I’m sure our body metabolizes it different in everyone, you know. [APRIL]: Yeah, it does. And I’ve seen so many different cases. I always refer back to one in particular… I have twin sisters, that they break down their filler in their lips in about two months. It’s just gone. But when I do say their cheeks, or their nasal labial folds, they actually hold on to it for a good six months, depending on the filler, up to a year, no problem. Everybody is so different and the mechanisms as to why our fillers break down can be due to manipulation. You know, with our lips, we do a lot of talking, eating, kissing. And then with you know, more less dynamic movement areas like the cheeks, it’s just kind of sitting under the cheek. And also placement of the fillers is very important as well. We don’t have any bones in our lips but our cheeks, if we go down to the lower level under the malar fat pad, the cheek fat pad, on or near the bone, there’s actually less hyaluronidase, which our own body makes, our own body makes hyaluronic and hyaluronidase which builds up/breaks down constantly. There is actually less enzymes near the bone to break down the filler than in the mid dermis, so placement is a big factor as well. [MELISSA]: Interesting. You’re so smart April. [APRIL]: I don’t know about that. I’ve just been doing this a long time. I love what I do. And I’m always hungry, hungry to learn. [MELISSA]: Yeah, and I love that like, because it makes me not want to trust, and I don’t trust my face with anyone else. It gets scary because you could really jack up your face going to the wrong person, you know, or your lips… [APRIL]: It is difficult, you know, it, if I take a moment to think about it, it amazes me how I’ll see patients that have gone to 3/4/5 different providers, and I think to myself, you know, don’t you get comfortable with one and that’s where you stay, where you feel safe? You know, but everyone’s different. [MELISSA]: And I think price too. I’ve talked to a lot of my friends and just other, even clients. It gets brought up during training sessions, and they’ll go to someone just based on price. [APRIL]: Yes, and that’s understandable. I understand that, because they can be very expensive but sometimes the price will actually go along with the experience… [MELISSA]: Totally agree. [APRIL]: …and the outcome you’ll achieve. [MELISSA]: Yep. I absolutely agree. Is there anything else you want to say about filler that I didn’t ask? Because I know, next, people want to get into Botox, but I don’t want to, if there’s something you’re dying to say about filler, say it right now. Speak now or forever hold your peace. What else do we need to know? Is there anything else? [APRIL]: You know, I think one really important aspect is the right filler for the right treatment in the right location. I’ve seen some pretty, pretty horrific stories, especially under the eyes. I implore everyone, don’t let anyone do the heavier fillers under your eyes, you’ll end up with what a lot of people refer to as the worm, or with severe swelling. You know, some fillers have more of a hydrophilic effect, meaning it draws water into the filler, like Juvederm Ultra XC, you would never want to use that under the eyes. I always play it safe, you know safe, sane, reasonable treatments always. So I always use Volbella under the eyes. It is a filler that is least hydrophilic in drawing water, and it’s the softest filler, and that’s what we use under the eyes. So be careful. [MELISSA]: Yeah, for sure. Because your face is your moneymaker. [APRIL]: And ask your providers when you go in, ask them a lot of questions. And also another thing that really surprises me… so many patients I’ve seen that they’ve had a lot of work done and they come see me, and then they tell me, “Wow, I never knew all of that.” And to me, it’s just basic patient education. And it surprises me that they hadn’t received that from other providers. So, you know, be proactive. The best patient advocate is the patient. Ask a lot of questions. [MELISSA]: Absolutely. I completely agree. And I think unfortunately, a lot of women just trust. They just go in and they’re like uh [APRIL]: Okay, go ahead, go for it. No, ask questions. [MELISSA]: Lots of questions. Because, just based on this conversation alone, I’m learning a ton but you could really get jacked up. I’m sure there’s a way better medical way to say that but you know, this is me. [APRIL]: And you know, I don’t want to, obviously we used straight needles for years before they got the cannulas right. I waited until they got them right, the first ones were too rigid, the second they were too flexible. Now they got it, you know, kind of just right, but I don’t want to put down anybody that’s using straight needles. But, after all these years of now using cannulas versus straight needles, my preference would be to seek a provider that uses cannulas. [MELISSA]: Yeah, absolutely. And I completely agree with that. Especially, you’ve had experience with both, you’ve seen, you can compare. Whereas, someone who only uses the straight needle, like they can’t compare. [APRIL]: And also, that’s kind of another thing that can lead you to the right providers. It is an advanced filler technique using cannulas so, if they’re able to do that, then you know that they have had advanced training. [MELISSA]: Right, absolutely. Hey, this is a good time to take a quick break and remind you that if you like this episode, please rate and review. It is just so helpful to me. I can’t tell you enough how much I appreciate it when you guys leave a review and rate. Also, if you want to connect a little bit more with me and learn a little bit more about how to be a Bomb Mom, make sure you sign up for my free, yes free, email course. You can find it in the show notes and you can also go to www.melissavogelfitness.com/course. And it’s not an insane, long email course or anything like that you guys, you’re going to get little golden nuggets from me just dripped on you in your email that’s going to help you open your eyes to what’s going on around you with your health, your wellness, your fitness, what you’re being exposed to in the grocery store lines, and the magazines, and everything. You’re going to want to receive this free course. And then also, in the course, you’re going to get a free 30 day at home workout program that you can follow. This was a program that I had kind of created to hit every muscle group and it was something that was progressively going to get harder for me after I had that third baby and getting back into shape, and you guys get it for free. So you can start on day 1, work your way to day 30, and it’s going to help you start taking the right steps to become that Bomb Mom. Alright, let’s get back to the show. Let’s go into Botox because I know everyone’s dying to know about Botox. Because girls, everyone’s getting it done, whether you know it or not. [APRIL]: Right? [MELISSA]: So the first thing… like explained to us, you know, like Botox for dummies, what is Botox and what does it do? [APRIL]: Well, Botox is actually a neural modulator where it decreases muscle movement. And it’s kind of like if you take your hand, look at your hand and slowly open and close it. On your palm, you’ll see your lines develop as you close your hand. And what that is is manipulation of the collagen out of the way per your muscles moving that hand. When you do Botox, it paralyzes the muscles, so you’re no longer able, now don’t flex your hand, you’re no longer able to move or manipulate that collagen out of the way, but in many cases, you’ll still see lines. Now, once that’s paralyzed, Botox has done its job. Now it’s up to your own collagen to be able to flow through, without getting manipulated, and to fill in those lines. Now of course our younger patients, you know, they have the movement but they still have a lot of collagen, elastin fiber, a lot of volume in their epidermis and dermis that helps, even when they frown it goes back to fullness, filling in the lines. But, as a neuromodulator, it can also be a muscle modulator where say they frown, when you inject the Botox it’s actually going to allow lift of those muscles, and it opens the eyes a little bit, or even lateral of the eye treatments. So, that’s basically how Botox works. A lot of patients will come in and they don’t know about Botox, they don’t know exactly how it works and they’re pointing to lines on their cheeks or their nasal labial fold and say I want to get Botox there, and that’s not what it does, it paralyzes muscle. That’s it. Then it allows your own collagen to flow through, fill in the lines because you’re no longer able to manipulate that muscle. [MELISSA]: So, areas for Botox. We all know eyes, right? Crow’s feet? [APRIL]: Yes, well, there’s actually a lot you can do with Botox. You know, we have Botox Cosmetic, which is meant for the face and even down the platysmal bands, and then there’s Botox period, and that’s used for medical necessities like bladder spasms and cervical dystonia, things like that. So Botox Cosmetic – mainly for the face, can be used in your frown, your forehead, around your eyes, their little bunny hop (like when you scrunch your nose up), above the upper lip (in very small amounts because you don’t want to be drooling), the corners of your mouth which pull the muscles, the muscles pull the corners down. When you put a little Botox in there, it relaxes those muscles and will actually lift the corners up a bit so you don’t look like you have those, as deep, marionette or puppet or sad looking mouth. You can also do the chin. You can do the masseter muscle which a lot of women that have large masseter jawline muscles… [MELISSA]: I was gonna say, I don’t know what muscle that is. [APRIL]: I’m sorry. Like, if any, anybody out there listening knows Bethenny Frankel (from Real Housewives of New York and Skinnygirl Margarita). Anyway, she actually had huge masseter muscles very, very square, back jaw line. Well over time, because it takes time to atrophied these muscles to where they get smaller and smaller, because you’re not contracting and moving them, kind of like when we don’t work out – our muscles get smaller. We paralyze it to a certain extent. With Botox, it relaxes the muscle, you keep it in that mode. You keep applying the Botox when you start seeing movement come back. And over time that muscle relaxes, gets smaller, and you lose that square jaw line like she has. She’s night and day now. So Botox can be used in quite a few places. [MELISSA]: Now, the big question I know everyone wants to know. How safe is it? [APRIL]: Well, Botox is actually very safe. There have been 16 deaths in what about 20 years now? And all of those were attributed to mass amounts of injections, a few of those were in children for certain type of muscular disorders, never in an instance of aesthetic treatment, although you can have side effects from Botox. You can actually get flu-like symptoms which are temporary, but that can happen. You can get headaches. Uh, what else Alex? [DR. DENES]: Well, I would mention ,and everything you said I completely agree with April but, I would also mention that some of the Botox deaths, especially early on, have been from rather unscrupulous physicians who try to buy botulinum toxin which is what Botox is, on an industrial basis. You know, Botox is very expensive, we pay a lot of money for it, and the patients pay a fair amount of money for it. And in trying to cut corners, some physicians obtain their toxin elsewhere, besides Allergan, and some of the deaths have been attributed to that because the quality control isn’t there. A Medic One physician I believe in Florida actually killed his wife by injecting Botox that wasn’t dose controlled and he didn’t know how much he was injecting. So, Botox, as April said, is really very, very safe. There have been 10s of millions if not billions of doses given and I mean, really the most common side effect that we see which is easily reversible is maybe a little drooping… you know, you have to remember that for every muscular action, we have a counteraction. We have muscles that raise the corner of the mouth, we have muscles that lower the corner of the mouth. We have muscles that raise the lids and the brows, we have muscles that lower the lids and brows. And Botox as April said, weakens or paralyzes one set of muscles. If we over parallelize levators for instance (our muscles that lift things) and we get too much of an effect we can also Botox the depressors (the counter active muscles) so we get a nice balance. And all of that has to do with skill and experience. You have to know exactly where to put the Botox. You have to know how much to use, and how each person is going to react to that. And that’s something you gain by experience. [MELISSA]: Yeah, I feel like everything goes back to the provider. [DR. DENES]: Correct. I agree, yes. [MELISSA]: I’ve had girlfriends get it done and the next day, their eyes didn’t look the same. And I’m like, wow, are you going back to get that fixed? Because… [DR. DENES]: Yeah, and like April said, you can’t always predict, people’s anatomy is a little bit different. And one of the advantages of seeing the same provider over and over again, is that that provider knows you, knows your anatomy, knows how you’re going to respond to whether it’s Botox or fillers or whatever and can get you the look that you’re after. And remember, not everybody’s after the same look, some people want a very dramatic change, some people just want a subtle change. [MELISSA]: How often does someone need to get Botox? And I’m sure that varies too. [APRIL]: Yes, it does. On average, patients get Botox every three months. Then there’s someone like me that does it about every two and a half months because on average, the peak mode of action for most patients is at two months. After two months, it starts working less, working less. Now, if you want to get technical, the interesting part is that it’s not actually working less, we actually develop and build more muscle fibers, well not really muscle fibers, nerve endings that take over and cause contraction of the muscle again and, on top of that, slowly over time the Botox does dissipate. But, I do mine about every two and a half months. I get to use less Botox than the average patient that does that every three months or so, but I get to maintain the appearance. Then I do, I have over the years have had a handful of patients, they really did last about six months. And I believe them to be reliable sources, but that’s not common. The average per Allergan (the makers of Botox) says every three months. [MELISSA]: Okay. Alright. And, are there any tricks or ways to make it last longer? That was definitely one of our top questions. [APRIL]: You know, there really isn’t. There really isn’t and it’s very patient dependent as to how their body metabolizes the Botox. And the same is for fillers as well, it’s going to last as long as it’s going to last. Now, if you get a patient that… I’ve had a few where I just couldn’t seem to get their glabella under control, and I just learned, as Alex said, being able to treat them over time, that they just happened to be the patients that need more Botox in the glabella than an average patient would. And that helps them to at least achieve 90% paralyzation for at least three months. [DR. DENES]: Yeah, sorry, just to clarify, the glabella are a set of muscles between the brows that cause the elevens or the furrowed brow look. We’re so used to calling it glabella, but maybe some of the listeners don’t know what that is. So, those are the forehead lines between the brows. [MELISSA]: We lay people do not know what that means. [APRIL]: I’m sorry, bad habit. [MELISSA]: I was going to ask so I’m so glad you did, so I didn’t have to look stupid. And another big question, which I feel like you kind of already answered it, but I’ll just lay it out there like what happens when you stop getting it? [APRIL]: Really nothing. You go back to your regular appearance before you had received it. It is funny, over the years, I’ve had a few patients here and there say, “April, my lines are worse now than before I got Botox.” No, trust me, you got a reprieve. Your skin got a reprieve from contraction for a few months, but you got used to the look. That’s why everyone says Botox is very addicting. [MELISSA]: That was the next question, like do you have to continue it once you start? And I feel like it’s you don’t have to but if you want that… [APRIL]: You don’t have to, yes. But you know with fillers, that’s a different story. If you have, and I have seen a couple of cases, not that I had done, but where patients have been overfilled. Like, especially in the lips, and there are some pictures I believe online too where if you have them overfilled… and we’re talking like Botched, the show Botched, for a long period of time and then you allow all the filler to dissipate, it will cause permanent stretch of your skin. So it’s important and that’s not safe either, because there are some anecdotal incidences and schools of thought that you can get compression of blood vessels when you’re overfilled which would decrease the blood flow to your tissue. But that’s always debated. [MELISSA]: And what about too much Botox? Like, can people get over Botoxed? [APRIL]: Well, you know, really, that’s patient dependent, but true. It really is. It’s just what type of look are you going for? Are you looking for 100% abatement of movement? Like me, and most of our patients, we like a little bit of movement in the forehead. And one of the reasons I like that is because over time, if you keep your muscles paralyzed, they can become atrophied, kind of like a bedridden patient, you know, their muscles atrophy and they can’t, you know, move, they’re much weaker, right? Well, with the forehead, when that becomes over atrophied, and the forehead muscles go up – they’re levator, mainly levator. When you paralyze them, they relax down, and they can relax down almost in a permanent fashion if you don’t continue Botox in the frown lines which lift those muscles, the lowered forehead muscles kind of rest on those raised glabella muscles. So, for me, I like a little movement in my forehead. Some patients, they want zero movement and I’m not here to judge. To each their own as long as it’s safe. [MELISSA]: So, do you recommend getting both done? The forehead and… [APRIL]: Oh, it’s highly recommended to never get just your forehead done unless you’re just sprinkling a little very high near the hairline practically. But, you can get your glabella done separately. [MELISSA]: And just do that and not the forehead. [APRIL]: Yes, you can. But it’s never really recommended to just do the forehead because without having the raised glabella muscles to allow the forehead muscles to slightly rest on, you can get some hooding of your eyebrows or on the eyelids. And we don’t want the hooding, everyone wants their eyes open. [MELISSA]: Right, right. Oh take note ladies because… I think a lot of light bulbs just went off for people that their provider is not telling them that or they’re looking for a way to maybe cut back on costs too. Right? Yeah, you don’t want that happening? [APRIL]: Well, you know, when patients come in and they have a bit of a budget, and they’re like, “Look, I can only do a little bit, you know, what do you recommend?” And I look at them and I show them the mirror and I say, “Okay, what bothers you the most.” And usually, usually, it’s the frown – the glabellas, occasionally, it’s around the eyes and I’ll say, “Okay, let’s just treat that area, no problem.” Now, if their main concern is the forehead, then I have to go into heavy patient education mode about how that can cause some hooding of their eyebrows just doing the forehead. So, it’s not recommended. [MELISSA]: Yeah, but at least you’re telling them and you’re being honest, like… [APRIL]: Absolutely, absolutely. [MELISSA]: Can you build up a tolerance to it? [APRIL]: Yes, you can. A study done probably about 15 years ago at least has proven that about 1 in 70,000 may become immune to the neurotoxin treatments. And all of the neurotoxins that are FDA approved for the face right now are a botulism toxin type A. There is a newer neurotoxin, called Myobloc, and it’s a botulism type B. But currently it’s only FDA approved for cervical dystonia, it is not approved for cosmetic use yet. So for those of us that you know have have increased tolerance, we’ve built antibodies that neutralize the Botox at a faster rate or, unfortunately and for some completely, I believe eventually we’ll be able to use the botulism type B for facial aesthetics, but it just takes a long time, usually, to get medication passed through FDA approval. [MELISSA]: So the chances are good you won’t become… [APRIL]: The chances are very good that you won’t become immune. But you know, there’s also other factors where people start to get a little older or maybe they’re getting more sun exposure where they’re damaging the epidermis and they say, “My Botox just doesn’t seem to work as well as it used to.” Well, you know, it’s not just a matter of paralyzing the muscles, and you’re still going to see some lines from aging and decreasing collagen, elastin fibers, you know, sun exposure, increasing crepiness of the epidermis, is on top of it, just you know, keeping your skin looks smooth and decreasing those lines. So a lot of providers, and there’s been a lot of talk actually quite recently about increasing your collagen in your skin on top of using the Botox to keep the muscles paralyzed from manipulating that skin. And increasing that collagen, there’s really two major treatments, and they’re from one extreme to the other… One is simply using Retin-A, which is the only FDA proven topical agent to increase collagen production over a 12 month period. After about 12 months, it’s maintaining that collagen that you produce. And then secondary, on the other end of the spectrum, is getting a CO2 laser and that markedly increases your collagen production, like in a heartbeat. [MELISSA]: Wow. So you guys I’m gonna leave you hanging then because, our listeners not you April, Dr. Dennis, because we are out of time today and this is just going to make you want to come back for part two and we are going to dive into the CO2 laser, because I think we have enough for Botox and fillers for everyone to chew on that for a little bit, absorb it. And if you guys, if you missed any of the names that she said out there, or you like really want to take notes and you’re listening to this in your car, don’t worry everything’s in the show notes so you can go back and read and see everything. Oh my God, thank you so much for coming on today. You guys, we’re going to do a part two so make sure you tune in to the next episode for that because you are not gonna want to miss how to increase collagen in your face. Like, you do not want to miss that at all. April, tell us how we can find you. What is your Instagram and Facebook? [APRIL]: Both of them are Canyon Lake Med Spa. [MELISSA]: Perfect. And you guys, just so you know they do have a backdoor, so if you ever want to go and like not go in the main door, they do have a little backdoor that you could go into. [APRIL]: We actually do have some personalities that do come and see us and they use the two backdoors. [MELISSA]: Personalities, I love that. But yeah, and you guys, if you go in there and you give them a call, tell them that you listen to the Bomb Mom podcast, because April is going to offer you a free… tell ’em April. [APRIL]: Microdermabrasion and chemical peel. [MELISSA]: Just for you. And I’ve had that done and it’s, it’s amazing. And I’m like, “Am I gonna peal?” She’s like, “I don’t know, everyone’s different.” And I peeled in like the craziest spots that like I knew I needed it just from sweating and training. It was like, amazing. She’s gonna give you one for free. So make sure you tell them that you heard it on the Bomb Mom podcast and then you get that. Alright? So Canyon Lake Med Spa, Facebook, Instagram, check them out. Seriously, if you’re anywhere in California, you need to make the drive and go and see them. And if you’re listening and you’re local, they’re right in your backyard. No excuses. So, alright you guys, thank you for being on today with us, we appreciate it. We’re going to continue on with part two so make sure you tune in for the next episode. Until then everyone, stay safe, stay healthy. Goodbye. [APRIL]: Thank you Melissa. [MELISSA]: If you’re ready to become a Bomb Mom join my free course over at www.melissavogelfitness.com/course. This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. This is given with the understanding that neither the host, Practice of the Practice, or the guests, are providing legal, mental health, nutritional, or other professional information. If you need a professional you should find one.