Keep Calm & Get Botox

Botox – everyone’s getting it (even if they don’t tell you) – but for anyone who hasn’t taken the plunge yet, let us answer some lingering questions you may have  … What is it? How does it work? What can it do? How does it feel to get injected? How long does it last? And most importantly – how do you avoid looking like you got Botox®?


First, a little science — Botox ® Cosmetic is one member of a small family of medications made from the bacterial neurotoxin Botulinum toxin. Botox® (onabotulinumtoxinA), Dysport® (abobotulinumtoxinA), and Xeomin ® (incobotulinumtoxinA), are all “toxins” in this family and work in the same manner by preventing nerve cells in the muscle from firing and thus preventing muscle contraction. Since certain wrinkles on our faces are caused by muscular actions, this means we can treat (and prevent!) some of the signs of aging.

So where does it get injected? The FDA has approved Botox ® Cosmetic for frown lines – those #11 lines between your eyebrows – and for crows feet around your lateral eyes. Additionally, there are many other “off label” uses including forehead lines, bunny lines on the sides of your nose, and vertical neck bands.   Toxins can also be used to improve the shape of your brow, and to elevate the corners of your mouth (which tend to start to turn down as we age).

During a consultation, your face is examined to determine your natural muscular strengths and weakness, your eyebrow position, and the presnon-surgical-facelifts-botoxence of wrinkles. Based on this, we can come up with a plan for what you would like to achieve and which areas we want to treat with Botox®. You will get a quick alcohol pad wipe-down, some marks with a removable pen, and then you are ready for your injections. There are no numbing creams or numbing shots required because the needle for Botox® is so tiny they aren’t necessary. The medication burns a little bit, but the whole process takes about 10 minutes and is in general very well tolerated by even the biggest needle-phobes. Botox ® injections don’t usually cause bruising, but you can have some little red marks like mini bee-stings for 30 minutes to an hour after the injections. Botox® takes about 4 days to start working, with maximum effect evident at a week post-injection. It lasts for 3-4 months and gradually wears off.

Any toxin dosage is calculated by number of units, and so it can be completely customized. The goal is not to freeze your face in an unnatural expression!  Many people are worried about having an overly “Botoxed” look — the best way to avoid this is to go lightly at your initial appointment and to choose a well-trained injector who understands the muscular anatomy of the face. It is so much easier to add a few units in touch up a week after your first injections than to feel like you used too much up front.


Botox® is no longer a dirty little secret – it can really help to not only improve wrinkles you might already have, but also to prevent more from forming. Call us to discuss more, and keep a look out for our open houses and other events where we do special pricing.  If you have a group of girlfriends (or man-friends — “Brotox” is a real thing!) who are interested, let us know and we can organize an evening with skin care, botox, bubbly (or brews), and appetizers.  No better excuse for a little party than turning back the clock ….



Anti-Aging Skin Care Essentials


One of my biggest beauty concerns is having healthy clear skin – it’s the first thing other people notice about you, and one of the hardest things to fake. There is so much information and marketing of skin care products, and so many opportunities to try out new things at the department store or even CVS, how do you know what is actually effective?   While this topic is an expansive one and I think I could write forever about skin care, below is a brief overview of the most critical steps that anyone wanting to slow down & reverse the aging process should know about. Some of the recommendations below are not “feel good”products – they can sting and burn (or “stingle”) and make you a bit red with some flaky skin when you first start to use them. Do not be afraid! You do not get younger looking skin by using expensive moisturizers that smell good (which is too bad).  For all of us who struggle with fine lines, wrinkles, uneven pigmentation, blemishes or any other problem, read on!


This step is fairly basic, and since most people already wash their face, there is not a lot to add. Wash you face twice a day, and do not go to sleep with makeup on. Do not use soap that you would use on your body – your face deserves a mild cleanser, which can be gel based or foam based. We like ZO’s Normacleanse and Revision Brightening Face Wash but really you can use anything you like.


This is one of the most important daily steps that not everyone does. As our skin ages, the rate of cell turnover decreases. Cells are born in the stratum basale and move through several layers before joining the stratum corneum as the top layer of our skin. Too much buildup in the stratum corneum leads to a dull appearance, rough texture, and places emphasis on fine lines.

zosh-offects-exfolliating-polishThere are two main ways to exfoliate – mechanical and chemical. Mechanical exfoliation is when you use a scrub (we LOVE LOVE LOVE ZO Exfoliating Polish which has a fine texture and leaves you soft and glowing) to rub off the top layer. An adjunctive step to daily exfoliation is some form of a light acid agent such as glycolic or lactic acid. While both can be used as traditional “peels”, a weaker formulation such as ZO’s Gycogent can be applied daily to encourage cell turnover.


Many people have heard of Retin-A (generic: tretinoin). This is a form of vitamin A that works to reverse aging changes to the skin. A point of confusion: tretinoin/Retin-A are NOT the same as “retinol”, which is a much weaker vitamin A derivative. Retinols or pro-retinols are found in over the counter “wrinkle” medications and are much less effective (sorry Olay).

Tretinoin is the most well-studied and well-proven anti-aging skin medication. It helps to re-build collagen, reverse pre-malignant lesions, clear out pores, and improve uneven pigmentation. It’s an amazing drug! It is UV sensitive, so goes on at night after washing, and definitely cause sun sensitivity so needs to be used in conjunction with a good sunscreen (see below). You may need to build up to daily used with this one – start every other night or even every 3rd night until your skin gets used to it.



Another well-studied and well-proven anti-aging drug, vitamin C (ascorbic acid) is an antioxidant that protects against further UV damage when applied daily. It comes in many forms so it depends on personal preference a little when it comes to which you use. We love Revision Vitamin C 30% because it is one of the strongest concentrations of vitamin C available, and it’s a smooth cream. Vitamin C also acts to boost collagen production and fade brown spots.


The most important part of the equation! All of the rest of this post is obsolete if you aren’t protecting against on-going free radical and UV damage (which destroy collagen…and cause wrinkles). The best sunscreens are physical barrier sunscreens, meaning they use titanium dioxide or zinc oxide as the particles to block UV radiation rather than chemical agents (oxybenzone, avobenzone etc). These come tinted so you can wear them instead of makeup, or just plain old white sunscreen.

Clearly there are many skin products not listed here – more antioxidants, more “daily defense” type products, eye creams, and neck creams to name a few. While those do have a role and I love some of them, what I listed above are really the bare-bones of an anti-aging daily regimen. The products listed above are ones we use at Duggal Plastic Surgery, but there are others with similar formulations in each category. So to wrap it all up: in the morning — wash, exfoliate, apply vitamin C, apply light glycolic acid, and apply sunscreen. In the evening — wash and apply tretinoin. Call with questions!



Disclaimer: The information presented on Dr. Claire Duggal’s blog, and any related links, is provided for general interest, educational and informational purposes only and are the opinions of Dr. Claire Duggal. Dr. Duggal is not paid by any skin care, implant, laser, or other company to write favorable reviews. Any advice in this blog is not to be considered as a patient consultation. Please call Duggal Plastic Surgery for any questions and for individual medical care.