Botox Myths We Wish Would Go Away

Dr. Chang (00:00):
Okay, Jackie, welcome to the podcast.

Jackie (00:03):
Thanks for having me.

Dr. Chang (00:04):
Great to have you. Jackie's my co-host for today. So as an introduction, why don't you tell the listeners what you do here at the practice?

Jackie (00:16):
All right. So I am the clinical director of our operating room. So we have our own surgery center here on the third floor. Our clinic is located on the second floor. So Dr. Chang and I got together and I helped him put this surgery center together and we've been open since October of 2023. And so now I kind of manage the day-to-day of our surgery center, the staffing, ordering all of our supplies, making sure the day goes smoothly.

Dr. Chang (00:49):
And you do some direct patient care too?

Jackie (00:51):
Yep. I was going to say, yep. I call all of our patients. I help in the OR. I help with pre-op, PACU, all the things.

Dr. Chang (00:59):
You're a Jackie of all trades.

Jackie (01:00):
Yes. Yes.

Dr. Chang (01:01):
Can you tell everyone what your education and training background is like that got you to that point?

Jackie (01:08):
Sure. Yeah. So I started my nursing career at George Mason University. I graduated in 2013 with my bachelor's in nursing. And then I started at Georgetown University Hospital. They had a really good OR program. So I joined their OR residency program where we trained in all the different specialties and I ultimately chose plastic surgery as the specialty that I joined. And then after that I left. I worked at Reston Hospital for a while. And then I became a manager of trauma surgery, plastic surgery, vascular surgery, general surgery. So I did that for a few years. Then I worked at a little surgery center here and really enjoyed the outpatient setting. And then we met through Laura, our nurse anesthetist, kind of joined Dr. Chang and I together. And when he was building this place, we got in touch and the rest is history.

Dr. Chang (02:07):
The rest is history. It's been awesome, right? I can't believe 2023 . Time flies.

Jackie (02:16):
I know. I was thinking that.

Dr. Chang (02:17):
It seems like we were just doing drawings pretty recently, just kind of saying, okay, well, would this be big enough? Will we have the airflow going the right way? Where are we going to put the suction machine in the wear house?

Jackie (02:28):
Yeah. Yeah. Where are we going to put everything? How are we going to fit all of our supplies? It's so crazy.

Dr. Chang (02:34):
So quite a journey, but you love the OR.

Jackie (02:37):
Love.

Dr. Chang (02:37):
Clearly.

Jackie (02:38):
Yes.

Dr. Chang (02:38):
And so do I. So that makes us a good team.

Jackie (02:41):
Yeah.

Dr. Chang (02:41):
So super glad to have you here. And so the structure of our podcast, we're going to talk a little bit about things that are off the record, secrets or things that people don't really talk about too much in aesthetic medicine, cosmetic procedures. And then we'll kind of dive into the truth behind them and demystify things for listeners or people who are just stopping into the practice.

Jackie (03:07):
Love it.

Dr. Chang (03:07):
So our first question to you, what is something that people would never know that you've done?

Jackie (03:14):
Botox is one of them. I started getting Botox probably five years ago. I was like, let me just try it out. And then now I'm a firm believer and a lover. And my boyfriend, one of his friend's girlfriends asked him the other day, "Does Jackie get Botox? And if so, how much does she get? " Right. And he was like, "I honestly don't even know if she does or not. " And I was like, "Whoa, good answer."

Dr. Chang (03:44):
Yeah. Well, that's interesting because I think that years ago people would've thought Botox was for older patients, older men and women who were trying to fight aging. But obviously you're not an old lady and you're up with beauty and fashion trends and things like that. And so you were in your early 30s or late 20s even when you first had your first?

Jackie (04:09):
Yeah, late 20s.

Dr. Chang (04:11):
Yeah. And I think in the practice, it's very common is to have patients in their 20s actually trying it out.

Jackie (04:17):
Yeah.

Dr. Chang (04:18):
What motivated you to try it for the first time?

Jackie (04:20):
Well, it's funny, when I was working at Georgetown years ago, I had just graduated college and all the residents would get, they had free Botox. And I remember being like, "Well, I want to get it just to try." And they were like, "No, you're young. You really don't need this. We're not wasting our good free Botox on you. " And I was like, "All right, fine." So I waited and then I was like, "I finally want to try it. I just want to know, does it hurt? Is it really super obvious that people are going to be like, you can't move your face at all. You look crazy." So I started out, what are they calling it on Instagram like Baby Botox?

Dr. Chang (04:56):
Yeah, right.

Jackie (04:57):
Yeah. I think that's what I initially asked for. Let me just try baby Botox. And then I liked the way it looked. I also noticed I'm an oily girl and I noticed that I feel like my makeup stayed on better throughout the day. And I just, I don't know, I was noticing all these other benefits and I was like, "Oh, okay, I really like this. " And then now I love it and I'm no longer getting baby Botox. Freeze me.

Dr. Chang (05:27):
Yeah. Well, it's interesting how you describe being so gung-ho and adventurous and trying something. I think as we've gotten to know each other, I think you are a person who's always open to the idea of something new and interested in saying, "Well, maybe I'll try that".

Jackie (05:44):
Yeah.

Dr. Chang (05:45):
I think there's another subset of people or patients that are less adventurous. You may have friends like that. I mean, what do you tell people that are nervous about Botox?

Jackie (05:56):
Some of my friends are all obsessed. And then I also have another set that haven't gotten there. They're like, "Oh, maybe when I'm a little older," I tell them, one, I think one of the biggest things is people are scared that it's going to be painful. So I always tell them, "It's really not that bad. I promise you, just a quick little pokes." And then people are scared of just looking crazy. And I tell them, "That's why you start out conservatively, wait a couple weeks until it sets in. " And then if you're like, "Oh, I'm starting to notice the effects, but now I want more." I'm like, "You can always get more, just start with a small amount." And then one of the reasons why I was open to trying it and what I tell other people, I'm like, "It doesn't last forever. So if you get it done and you hate the way it looks, it's eventually going to run out." So it's not like you're making this permanent choice to change your face forever.

Dr. Chang (06:54):
Right. I agree with you 100%. I think Botox is an incredible treatment, incredible medication. For all the reasons you just said, you can titrate the amount if you're nervous. If you're the kind of person who wants to put the toe in the tub before you jump in because it might be too hot or too cold, it's perfect. You can just put a little start with a baby Botox dose, try it. If you're worried it's going to be too little, you can add more. If you worry too much, you can start less. If you're worried it's not for you, it's going to wear off. It's perfect. There's no commitment really. And yes, there is an injection, but we use the smallest ... I don't know if I've found a smaller needle. If the needle is any smaller, it would get dull on your skin. It wouldn't be able to penetrate. It's super small.

Jackie (07:44):
It's so tiny. It's so tiny.

Dr. Chang (07:46):
Yeah. And it's fast. You don't have to sit there all day and numb. So it's an awesome treatment, I think. And all of the neurotoxins, Botox brand, of course, is the most well known, but they all work pretty similarly. And I think they're all within the same class in efficacy and things like that. But I think that what I hear sometimes, and this people who are on the other spectrum, they get fancy with their Botox. They want all sorts of stuff. Can you lift my mouth? Can you give me a brow lift?

Jackie (08:22):
The brow lift. Yes.

Dr. Chang (08:24):
I mean, in terms of the questions that we get, sometimes the Botox brow lift, it kind of drives me crazy because I just think sometimes these things are totally exaggerated. Botox, of course, stops muscles from squeezing, right? And when you're not squeezing your muscles, you're not crimpling or folding the skin on top. And that's how I think the skin gets smoother and relaxes. But you also need your muscles to lift your brows, right? If you're lifting your brows, we're not tightening the muscles really like a brow lift would lift the muscles or lift the skin. So Botox brow lift is more relaxing the muscles that pull your face down and you get an opposite effect. And I think that it's a little bit of a misnomer or marketing.

Jackie (09:14):
Right, right. Yeah. Another thing off the record, I got the Botox in my platysmal bands, which I ended up loving, but I don't exactly even understand what that was doing. It just sounded good. I was like, why not? Let's try it.

Dr. Chang (09:34):
Yeah. So of course everybody always talks about their neck, right? Whether you're young person or an old person, the neck thing, everybody wants to have a very sharp jaw and neck. If you have fullness here, people say, "Oh, I look fat or overweight." Or if you have sagging here, it's like, "I'm loose and I need a facelift or neck lift." But the platysma muscle is something we'll probably talk about more in future episodes, but it's a sheet. It covers your whole neck and chin and jawline area. And even though you have all these angles, when it contracts, it shortens and you can get these bands if you're lifting weights or straining or things like that. And so if you Botox that area, it reduces that bow stringing. And it's a really cool treatment. It was just FDA approved, I think over the past year for the Botox brand neurotoxin, which is really great. And I think more people are just learning about the uses of it.

Jackie (10:35):
Right. I thought that was really cool. I was like, I didn't even know about this on my neck. I just thought it was, I always noticed it, but I didn't know that I could even really do anything about it.

Dr. Chang (10:46):
Yeah.

Jackie (10:47):
So that was cool.

Dr. Chang (10:48):
Yeah. It's very cool. I mean, yours wasn't bad, but I know other people that are really strong there who really benefited that. And the other thing that is a little sort of secret that we hear about a lot is Botox in the masseter and the jaw muscles. Have you ever had that?

Jackie (11:06):
I haven't.

Dr. Chang (11:07):
I have a lot of patients that come for that. I think it started a lot with Asian patients that wanted jaw slimming and jaw narrowing, and the idea of cutting the jaw bone was too scary. I mean, cutting the bones, it's scary.

Jackie (11:27):
Yeah.

Dr. Chang (11:28):
So these muscles that are on the jaw that really clench hard and cause a lot of bulk there can be injected. And the Botox really relaxes the muscles, reduces the tension in the face, but also can shrink the muscle and slenderize the face just slightly. So I think that cosmetically can provide a benefit if that's your goal.

Jackie (11:52):
You're selling me.

Dr. Chang (11:54):
And now, well, you're an easy sell. You can sell ice to an Eskimo. It's like I'm not that good. But for those people that ... I've had a lot of people with clenching, just headaches, TMJ pain.

Jackie (12:10):
Yeah, I was going to say TMJ, right?

Dr. Chang (12:12):
Night grinding. And I have patients that say it is just life changing.

Jackie (12:17):
Grinding in their sleep.

Dr. Chang (12:20):
I don't get it that much, actually. I have had my dentist sometimes say, "Oh, it looks like you have some areas of wear, but I don't really have that grinding."

Jackie (12:29):
Yeah, mine asked me one time and I was like, "I don't think so. "

Dr. Chang (12:34):
Yeah, I don't know. Are they fishing?

Jackie (12:35):
Yeah, right. Yeah. Let me

Dr. Chang (12:36):
Give you a $3,000 nightguard.

Jackie (12:37):
You just want me to wear a nightguard?

Dr. Chang (12:39):
Yeah.

Jackie (12:39):
i was like, I think I would know because people that do get the master Botox, because of that, they say they notice a huge difference. So I'm like, I feel like I would have side effects if I was grinding at night.

Dr. Chang (12:50):
It's also real sexy. I'm sure your boyfriend would love that nightguard.

Jackie (12:53):
The nightguard, yes.

Dr. Chang (12:55):
Hey, honey, hold on. Yeah. I love that.

Jackie (12:58):
No, thank you.

Dr. Chang (13:01):
But I have had TMJ pain from grinding, particularly, I remember when I wasn't getting much sleep or doing a lot of work or stress or something like that. And I can remember one Christmas holiday when I was taking care of all the kids, sleeping in my in- law's house on a terrible mattress and my wife was working. So I was just exhausted and I definitely had headaches for a couple of days and could feel that pressure. So if that was your norm, I'd be miserable too.

Jackie (13:30):
Yeah, for sure.

Dr. Chang (13:33):
But Botox has tons of cool applications beyond cosmetic stuff, but it's really a great treatment, I think. So I would never have guessed. You're so young and have no pain and all that sort of stuff.

Jackie (13:46):
Well, thanks.

Dr. Chang (13:48):
Good secret for the day. But all right, onto the next. So on this podcast, we're going to kind of give a look into our world and our perspective, I think would be cool on things that are going on in the community. And one good way is now that social media has so many things like on TikTok or Reddit or things like that, or people emailing in questions, we could kind of address those things on the show. So this one's from Reddit. It's super, it's super good.

Jackie (14:22):
We love Reddit. We love Reddit.

Dr. Chang (14:24):
I can't stop. Reddit is so addictive.

Jackie (14:26):
It's so good.

Dr. Chang (14:27):
People ask all sorts of wild stuff. So this comes from the subreddit AITAH or Am I the asshole? Am I the asshole for divorcing my wife over Botox/fillers? My wife is beautiful. She always has been one to turn heads and draw attention with her natural looks. I love her face, her expressions, smile, lines, all of it. I explained to her that I thought the treatments changed her face in a negative way. The puffiness, shiny and paralyzed forehead and overall fake look are a major turnoff for me. She agreed, promised, and swore she wouldn't do it anymore. Fast forward six months, and I noticed the change in her forehead again and confronted her. She instantly got defensive and I can't tell her what to do, et cetera. I let things cool down. We had another long discussion about it in which she said she saw my point and would stop. Four months later, I get the big F you and she initially tries to say a mask tightened her skin, which I knew was BS.

(15:30):
Then came the defensiveness again. told her I was done. She absolutely can do whatever she wants her face, but I don't have to watch it. I'm filing for divorce tomorrow, but I'm being made to feel like I'm petty, like my feelings are not justified. Yes, I can tell when it's done and I hate it, but the behavior behind it is even more concerning with the secrecy and lying. I feel like in marriage we should consider each other's feelings in our actions. If she came to me with such a concern, I would stop just because I value her opinion most. Lot to unpack in that one.

Jackie (16:06):
That is insane.

Dr. Chang (16:10):
All right. Let's start with the beginning. I mean, what do you think?

Jackie (16:16):
Well, I think it's a little sad. I would love to see her face.

Dr. Chang (16:21):
Yeah, that's true.

Jackie (16:21):
You know what I mean? Because is she just getting ... Does she look like a normal person? I mean, he described her forehead a lot and that makes me think that she probably is normal. He wasn't like, " Oh, her cheeks are huge. "I mean, he mentioned puffy face, I guess. But I do wonder, is it a normal amount or is she overdoing it? To divorce her is crazy.

Dr. Chang (16:50):
Right.

Jackie (16:51):
I think that's crazy. However, one of my favorite TikTok trends that I see is girls talking to the camera and they're like, " My husband always tells me, I hate when other girls get Botox and fillers. You don't need them. You're so naturally beautiful. "And then they look at the camera and they're like, " I get Botox and fillers. "Yeah. I think a lot of people get it and hide it from their significant others, honestly.

Dr. Chang (17:21):
Oh, I mean, now that I am exposed to women in beauty a hundred percent of the time, there's a couple things people don't know. First of all, women do so much in terms of upkeep in beauty that men have no idea about.

Jackie (17:39):
Absolutely.

Dr. Chang (17:40):
Hair straightening, hair coloring, hair cuts, hair styling, blowing it out, dry ... I mean, that's just the hair. Eyelash and eyebrows, tinting, threading, shaping, whatever you ... I mean, crazy. And then tanning and other things like that and waxing and tweezing and lasering. There's so much men have no idea that ... Nails ... You guys are talking about get your nails done every two weeks in the operating room. You guys were talking about

Jackie (18:12):
Mine are naked right now. I feel like a different person.

Dr. Chang (18:15):
What's the next nail technology, gel, color?

Jackie (18:19):
Cat eye. Yeah.

Dr. Chang (18:21):
And then you guys get bored of it and do it all over again. So I think overall, it's eye-opening to me to see men appreciate a lot of these things. They may not overtly say it, but they don't realize that they like it and they don't realize what's going on behind the scenes.

Jackie (18:37):
That was another thing I was going to say. It's kind of like, " Oh, babe, you don't need to wear makeup.You're naturally beautiful. "But then they'll point at, say, a famous person and be like, or someone in an ad and they'll be like, " See, I love that. "And then you realize to get that natural no makeup look takes a lot of makeup. You're just doing it in a subtle way kind of like with Botox and stuff like, " Oh, you don't need Botox? No, I'm just doing it in a good way that highlights all my attributes so you don't think that I look all frozen and crazy. "It's like, " No, it's helping me look better. You just don't know. "

Dr. Chang (19:17):
Right. They don't really know the work that goes into that stuff, the work, the effort, the financial aspect of it, the number of products, they have no idea.

Jackie (19:26):
Right. And this Reddit guy seems like super observant for a man. I feel like so many men, you can get even a haircut, change your hair color and it'll take them days to notice.

Dr. Chang (19:40):
Right. He does seem quite sensitive to the look describing the puffiness and shiny and paralyzed forehead and fake look. I think some men believe that the treatment will automatically make you look super artificial just because of the type of product that it is. And I think that's a huge myth that we have to bust is that there's so many people that you think you know what they've done because they look totally outrageous, but you don't notice the 10 other people surrounding them that had it done appropriately, subtly, or reasonably that didn't have it, didn't have too much done, that also had the treatments.

Jackie (20:25):
Right. Maybe this lady just needed a new injector.

Dr. Chang (20:30):
Maybe. He doesn't talk about money at all.

Jackie (20:32):
No.

Dr. Chang (20:33):
Does he see the credit card? Is he upset with the money or ... It's a strange thing to get divorced over beauty treatments, I think. There may be something else going on in their marriage.

Jackie (20:46):
Right. And I'm like, was this something that was laid out before they got married? You can never get these treatments done.

Dr. Chang (20:53):
He must feel guilty though. I mean, to some degree to be posting this online, maybe he must be thinking, am I being unreasonable to be in this?

Jackie (21:03):
I would hope everyone in his life is telling him he's being unreasonable.

Dr. Chang (21:08):
Well, hopefully they work it out. I didn't dig too far into the comments, but it's just a crazy scenario. But we do see a lot of people that sort of sugarcoat it or hide it from their spouse. There are people that'll come in and they'll pay

Jackie (21:22):
Yeah, the secret credit card.

Dr. Chang (21:24):
On the credit card, quarter of it on a debit card and then the rest on a Visa gift card or something.

Jackie (21:30):
Yeah. They're like, " Oh, my husband thinks it's like a hundred bucks to get this done. "

Dr. Chang (21:35):
Yeah. Fellas, you're in the dark. They're-

Jackie (21:38):
So far in the dark.

Dr. Chang (21:39):
They're just trying to protect you from yourself.

Jackie (21:41):
So far in the dark.

Dr. Chang (21:41):
And all the judgment. All right. I got one more for you.

Jackie (21:46):
All right.

Dr. Chang (21:47):
This is a woman that posted her 10 day results from Botox. It says 10 day Botox results. My eyes are heavy and hooded with a ton of extra skin. My peripheral vision is off. This was my first time getting Botox. I got 41 units in the forehead and glabella. I went to an NP, not a med spa. Is this treatable or am I stuck like this until the Botox wears off? And there you go. You take a look at that.

Jackie (22:14):
Yeah, let's see.

Dr. Chang (22:17):
I think that when we see a patient for anything, the most important thing is kind of talking to them about expectations. You know what I mean? I think this lady was not set up well in terms of her expectations, or maybe she's particularly nervous and needed a little more handholding and preparing for what would happen.

Jackie (22:45):
Yes.

Dr. Chang (22:45):
But if for 41 units in the forehead for a first timer personally, I think it's a little strong. It might scare some people their first time, but the real problem I find is that once you scared somebody, then they're going to be like, " Oh, this is a terrible treatment. "And she might be like, " Okay, I'm never doing Botox again because of-

Jackie (23:07):
And telling all of her friends, "This is what happens when you get Botox." I had a friend like that too, that she got it once and dropped and got the hooded eyes and she was like, "Oh, Botox isn't for me. " I'm like, "Well, give it another try."

Dr. Chang (23:27):
Yeah, you have to sort of see, I think it does take a little bit of a sophisticated injector. And also you have to read the person in front of you. It's not just, "Oh, my hands are so good," or, "My product is so good," or whatever. You have to sort of see, "Well, you're nervous. Let's just give you a sprinkle and let's see how you do. " We can always add more. If you came back to me and said it didn't work or it wasn't enough, that's a lot less scary to you as the nervous patient, I think.

Jackie (23:56):
Yeah, absolutely.

Dr. Chang (24:00):
Thanks for listening to Secret Services, the podcast where we see everything and say nothing except right here. I'm Dr. Christopher Chang, double board certified plastic surgeon located in Tysons, Virginia. Follow us on TikTok @CongressionalPsurgery or on Instagram @congressionalplasticsurgery. To send us a classified message or to hear more episodes, go to secretservicespodcast.com. Links to everything we talked about on today's show are available in the show notes. Oops, patient's here. We got to go.