When it Comes to Botox, I’m Proud to be ‘Old School’

Doing Botox the right way with Dr Michael Prager
Doing Botox the right way with Dr Michael Prager

Roll up! Roll up! Get your recycled, upcycled, brand-spanking-always-been-done, boho-cosmetic procedures here! Brotox, Haytox, Microtox, Handtox, Twintox, or Baby Botox, there’s nothing we can’t ‘tox’ and if you’re really hip there’s the Lip Flip and Nefertiti Tip.

It’s all Botox, people! We’ve just given it a shiny new name. So, step this way and prepare to be amazed by the top spin on your toxin!

The Can’t Do, Won’t Do Generation

There’s seems to be a commonly held belief that Botox isn’t a wellness treatment. This is nonsense because if you actually do Botox properly, or you use it on a patient who has the right indication, it will treat teeth clenching, headaches, migraines, oral tension and, in some cases, depression.

More annoying, however, is not the misconception, but the ignorance infecting the industry.

One of my clients came to me recently to confess she’d had work done elsewhere. Not a crime in itself – I was busy and she wanted something done – but the practitioner who treated her wasn’t correct in what she said.

When my client revealed that I injected her lower face, she was told, “Oh, no. Dr Prager is old school. We don’t do that anymore.”

I found that quite interesting because:

  • My client has a very clear problem with teeth clenching, so the lower face is definitely an indication that makes sense on many levels, but mainly preventative and cosmetic;
  • It shows how removed Botox has become from a genuine medical treatment to a High Street consumable;
  • It further reveals that those now practicing are so professionally young they have little or no knowledge of the development of Botox. They see the money and they simply pander to the demands of the looks-matter generation.

Now, I’m not about to tell you that looks don’t matter, but there is a very distinct difference between allowing your looks to take up 90% of a life that is largely played out on screen, and actually living your life in a more fulfilled, happier or simply healthier way.

The bottom line is, we are dealing with a different mindset and different agendas, and many of today’s practitioners don’t know how to inject the lower face because some time ago a certain Botox supplier stopped training people how to do it.

The Case of the Disappearing Skillset

In 2010, pharmaceutical company Allergan was accused of promoting Botox for uses not approved by the U.S. Food and Drug Administration (FDA), such as treating headaches, pain, and spasticity. Allergan faced a fine of $600 million for these marketing practices. At this time, Botox was FDA-approved for certain cosmetic and medical uses, but the company was accused of encouraging its use for unapproved purposes. Allergen was slapped with a $600 million fine for alleged violations of marketing regulations.

When I started out in 2000/2001, we were educated about every area of the face imaginable. So, when the latest generation Botox practitioners get excited about a hot new trend – such as the lip flip – they have no idea this procedure was done and dusted by 1995. In fact, after ‘95 I don’t think there was one area of the face that hadn’t been looked at, and the person who has to take most of the credit for that is Freddie Brandt.

The Baron of Botox

Dr Fredric Brandt was a prominent dermatologist and pioneer in the field of cosmetic dermatology, and he played a significant role in popularising the use of Botox for aesthetic purposes.

Dr Brandt passed away in 2015, but his impact on the industry remains noteworthy. He was renowned for his expertise in facial rejuvenation and was often referred to as the ‘Baron of Botox.’

Dr Brandt authored a number of academic papers looking at Botox, and his influence is evident in the numerous studies and publications that followed exploring the cosmetic applications of botulinum toxin. His clinical insights and innovative approaches to injectable treatments continue to influence the broader medical community.

Some key aspects of his methodologies include:

·       Natural-Looking Results. Dr Brandt emphasised subtle enhancements that preserved the natural features of the face, steering away from an overdone or artificial appearance;

·       Customisation. Recognising that each patient is unique, Dr Brandt tailored his procedures to address individual concerns and enhance facial features based on each patient’s anatomy and desired outcomes;

·       Combination Therapies. Dr Brandt often employed a combination of treatments to achieve optimal results. This might involve using Botox in conjunction with dermal fillers or other non-invasive procedures to comprehensively address different aspects of facial ageing;

·       Patient Education. Dr Brandt believed in empowering patients with information about their treatments, ensuring they had a clear understanding of the procedures, expected outcomes, and potential side effects;

·       Innovative Techniques. Dr Brandt was known for adopting and sometimes pioneering innovative techniques. His commitment to staying abreast of the latest advancements in cosmetic dermatology contributed to the refinement of injection methods.

In short, Freddie Brandt was a genius. Before he came along, nobody had done what he set out to do and he had to really think about what was involved. He had to look at the muscles, think about what the products could do and would do, know how muscle groups worked together and how their work might be compromised, or how Botox might affect the lift and angles of the mouth, for example. That kind of understanding, at that kind of level, requires a lot of talent, a lot of intelligence and Freddie Brandt was a one-in-a-million practitioner. He did the groundwork. After that, it was done. There was nothing left to ‘discover’ and that was back in 1995.

Latest Trends are Not Pioneering Breakthroughs

Dr Philly Levy is widely credited with introducing the Nefertiti Lift to the world, but it wasn’t something that added anything new to the Botox portfolio. To suggest otherwise is pure fiction. This was a masterpiece in marketing, not medical science.

The Nefertiti Lift is a non-surgical cosmetic procedure designed to rejuvenate the neck and jawline. Apparently inspired by the graceful contours of Egyptian Queen Nefertiti, rather than a marketing gimmick, this technique involves injecting Botox along the jawline and neck muscles to redefine and tighten the skin. By targeting specific muscles in these areas, it creates a lifting effect, enhancing the jawline and neck without surgery.

Practitioners like myself learned our craft and honed our skills by devouring the studies of the real pioneers. We then worked on that knowledge and refined it. In contrast, today’s practitioners attend a one or two-day course, where they might even inject someone, but that’s it. There is nothing new to add. They are not going to burst onto the scene offering something that’s not been done before, because that’s virtually impossible.

Some 20 years ago, we also tried Botox on the upper lip and we realised, some six weeks later, that there was nothing left to show for the work done there. We had attempted Botox because fillers at that time weren’t up to the job.

The Future is Bright, The Future is Wellness

Currently, we live in a world where people buy into the latest fashion because it’s affordable, not because it’s necessarily good for them.

Technically speaking, well-practiced medicine is anti-ageing medicine because anything that you do that maintains, prevents or cures disease will make you live longer, better, and healthier.

Unfortunately, I would say 90% of the Botox doctors nowadays are not interested in anti-ageing medicine, they are high street salesmen.

Botox doctors these days don’t differ greatly from anybody else who’s not medical. So, maybe what we are actually witnessing is the end of an era. Once I’m gone, I don’t see anybody else who has been there from ‘day one.’

With any luck, the tide will one day turn and everyone will grow tired of the Love Island look and Botox will shift from being a commercial transaction. The financial crisis might even end up inadvertently regulating the market again.

But what I would really like to see, is not this constant need to rehash old ideas that didn’t work especially well in the first place, but instead return to the valiant pursuit of wellness. The future isn’t just anti-ageing, it’s anti-ageing medicine.