BOTOX

[Intro] Hey, everyone. Welcome back to Facially Conscious, with myself, Trina Renea, esthetician, Dr. Vicki Rapaport, dermatologist, and our fabulous overly-educated consumer Julie Falls. 

We are gathered here together with you to talk about this crazy world of aesthetics. It's confusing out there in this big, wide world. That's why we're here to help explain it to you all, subject by subject. We will be your go-to girls. And from our perspective, without giving medical advice, we will keep things facially conscious. 

Let's get started.

00:56 Trina Renea: Good morning, ladies. How are you? Welcome back to Facially Conscious. How are you?

01:01 Dr. Vicki Rapaport: I'm so excited today. We're going to talk about Botox.

01:04 Trina Renea: Botox. 

01:05 Dr. Vicki Rapaport: Botox. 

01:06 Trina Renea: Well, you know, there's a lot of people out there that really don't know what Botox is. So I think this episode is very important for the mass. We're going to refer to Dr. Vicki on this episode for all of our questions. And, what? 

01:27 Julie Falls: I said masses. 

01:29 Trina Renea: Oh, the masses. 

01:30 Julie Falls: There you go. 

01:32 Trina Renea: Sorry, my English isn't so good. 

01:32 Julie Falls: I love you. 

01:34 Trina Renea: I'm from a small town in San Diego.

01:40 Dr. Vicki Rapaport: But you know a lot about skin and that’s all that matters.

01:42 Julie Falls: You really, really do. We just need a few little grammar lessons.

01:46 Dr. Vicki Rapaport: That’s okay. We got that. 

01:47 Trina Renea: I'm turning red. 

01:47 Julie Falls: She's perfect. She's really perfect. 

01:50 Trina Renea: All right, Dr. Vicki, so can you please tell us what Botox is? Because I feel like there's a lot of confusion around it. People think it's fillers. People think it's all kinds of things. So what is Botox? 

02:02 Dr. Vicki Rapaport: I think the first thing people should understand about Botox is that it looks like water. So when you think Botox, think water. It's literally a clear fluid. It is not filler. Botox is a highly sterile, purified protein from the bacteria that causes botulinum toxin. It's from a bacteria. It's a protein. We are not injecting the bacteria. We are not injecting the toxin. We are injecting a protein that relaxes muscles that was derived from the bacteria that causes botulinum toxin. 

Think about antibiotics. A lot of antibiotics, a lot of cardiac medications, they're from bacteria and fungi and they're from things you would never consider safe and effective, but they're safe and effective. They've been around forever. 

Same with Botox. Botox was FDA approved in, ready? 1989.

03:01 Trina Renea: It's been around that long? 

03:03 Dr. Vicki Rapaport: It was approved for two eye disorders in 1989, two eye disorders called strabismus and blepharospasm. Then a couple years after that, there was an ophthalmologist in Canada who was testing it or doing studies on strabismus and blepharospasm, eyelid twitching. She was injecting it in a patient and she noticed that the crow's feet went away. That is when they realized, oh, this could be an actual treatment for wrinkles. Because what it really does is it just relaxes the muscles. 

It is safe and effective, and it is one of the tools in dermatology that we love because it's so safe, it's so effective. It's almost dummy proof. It's really for people who want to relax muscles. It is not filler. It is not volumizing the face. It's just relaxing muscles. 

03:54 Trina Renea: So it relaxes muscles that, if there's a wrinkle that you're seeing there and you put a little Botox in it, it'll just relax the muscle to release the wrinkle so that it just kind of disappears. 

04:07 Dr. Vicki Rapaport: Right. So when you relax the muscle… and the beauty of Botox made us all learn the anatomy really, really, really well. Because when we're in medical school, we learn the anatomy, but then if you're not a surgeon, you don't really remember the anatomy as well as you did when you were a medical student. But when we had to remember which muscles were in which areas to cause which wrinkles, when we strategically inject Botox in the exact muscles that we need to improve your wrinkle, we know what we're doing. We're only injecting in those certain muscles. The skin above those muscles doesn't keep smushing and smushing and smushing all day long, and then the skin lays nice and flat. It basically works every single time. 

Remember, Botox is also FDA approved for many other diseases. 

04:52 Julie Falls: Was it like MS or was it dystrophy?

04:54 Dr. Vicki Rapaport: No. It's approved for blepharospasm and strabismus, which are eye disorders. It's approved for bladder incontinence, so people who, unfortunately, urinate because the bladder is not doing its job. 

What is the bladder? The bladder is a muscle. You relax the muscle of the bladder and people don't pee on themselves. It's a miracle. It saves people's lives. 

Cervical dystonia, which is a crooked neck or a neck spasm, you inject it in the muscles that are making the person's neck crooked, and guess what? They get their life back. 

Hyperhidrosis, which is hyper sweating on the palm, soles, wherever. You inject Botox, it works beautifully. It is literally the most fascinating medication out there, and people should not be afraid of Botox. Remember, it looks like water. 

05:39 Trina Renea: And it also works on TMJ, right? 

05:42 Dr. Vicki Rapaport: Well, right, because TMJ is caused by three different muscles that are either cramping or being overused, or if people clench their teeth in the middle of the night without realizing. We inject it into those muscles, it relaxes the muscles, the TMJ goes away.

05:58 Julie Falls: I heard something that it was used for either muscular dystrophy or MS or something.

06:04 Dr. Vicki Rapaport: Cerebral palsy. So kids with cerebral palsy who get terrible muscle spasms. For instance, like in the thighs, these kids with cerebral palsy might get 1,000 units of Botox, the average cosmetic patient gets 64 units of Botox. So it's safe, safe, safe, safe. Even these kids who have cerebral palsy who have other medical issues, they're getting 1,000 units. 

Yes, it has actually been detected in some of those children in their blood, but hasn't necessarily caused any trouble. It has not ever been detected if people are doing it for a cosmetic indication, it has never been detected in the blood. It really is quite safe. 

06:40 Julie Falls: So safe. 

06:43 Trina Renea: Is it covered by insurance for medical situations like that? 

06:47 Dr. Vicki Rapaport: It is actually. If people have a neurological disorder and they're getting injections for muscle spasms. Remember, it's also FDA approved for migraines. I forgot to mention that. 

06:59 Trina Renea: That's a big one. 

07:01 Dr. Vicki Rapaport: It's a big one. Migraines can be gone for six months when people get migraine injections with Botox. It can be covered. 

Unfortunately, the problem is there are a lot of neurologists that do it but they don't bill insurance, because insurance, unfortunately, doesn't even reimburse them the cost of the vial. A lot of times, it is out of pocket. Until the pharmaceutical company really decreases the price, it's probably going to be mostly out of pocket, even when it's for these medical indications. 

And the price can be up there, you know. For a wrinkle in between the eyebrows, it can be anywhere from $200 to $400, depending on how much you do. Pan face Botox, it can be up to…

07:40 Trina Renea: Can you explain what “pan face” means?

07:42 Dr. Vicki Rapaport: Yes, all over your face. 

07:44 Trina Renea: People do Botox all over their face? 

07:46 Dr. Vicki Rapaport: Yes. It's only FDA approved for three different areas. The glabella, which is in between your eyebrows, the frontalis, which is your forehead, and the orbicularis oculi, which is around your eyes. Those are the only four true facial cosmetic indications, but we inject it off-label all the time. When I say off-label, it's legal for us to inject it off-label, we just have to educate the patient because... 

08:10 Trina Renea: Where else would you put it?

08:12 Dr. Vicki Rapaport: Oh, I can't wait to tell you all the places that we would put it. This is crazy. So, the lines around the mouth. The orbicularis oculi is your eyes. Orbicularis oris is your mouth. It's an orifice. It's a sphincter muscle. You can inject it around the mouth for those little smoker's lines. It smooths them out beautifully. 

You can inject it in the DAO, which is the depressor anguli oris, which brings the corners of the mouth down and makes people look like they're frowning. You inject like two, three units on each side. Boom. The sides of the mouth go up. 

You can inject it on the chin for a dimpley chin, for the mentalis muscle. It's amazing. 

And the beauty of Botox is that it really is safe. It's safe. If you have an adverse event, adverse event means you don't like it, you're a little asymmetric, we can usually fix the asymmetry. Because sometimes it just gets taken up on one side but not on the other, so we can usually do touchups and fix it. 

The worst case scenario that happens with Botox is ptosis, which is an eyelid droop. Of course, it's horrible if it happens, but it does usually go away within two to three weeks. If it doesn't go away in two or three months, it will go away in three to four months, which is about how long the Botox lasts. It is very rare to have a severe adverse event with Botox.

09:31 Trina Renea: Okay. I know that there's some people who Botox doesn't work on or it only lasts for like a very short period of time. And I know there's a couple other options out there that now act like Botox, other brands.

09:46 Dr. Vicki Rapaport: Yes. 

09:47 Trina Renea: What are those? 

09:49 Dr. Vicki Rapaport: So botulinum toxin, I believe it's A through G. There's botulin toxin A, B, C, D, E, and G. All the things that are FDA approved right now for human consumption or human injection are all botulinum toxin A. 

There's four of them. There's Botox, Dysport, Xeomin, and Jeuveau. They're all originally from that mother molecule, which is botulinum toxin A. Remember, it's a purified protein. It's not a toxin. Then it's just they kind of trademark the way that they filter that mother molecule down to what they can trademark and make billions of dollars on. 

They're all variations. Some of them have more proteins to bind and keep them from reacting. Some of them have less proteins to bind and keep them from reacting. Some of them have very subtle differences. They all do about the same thing. 

But, you're right. If somebody is a non-responder from, say, for Botox, or they've been using Botox for so long that it's just not working as well anymore, you can try Dysport, you can try Jeuveau, you can try Xeomin. But generally speaking, if an injector put whatever they wanted to put in your face that they thought was appropriate for you, you probably would not know the difference. 

11:03 Trina Renea: So, when we were at our podcast launch some time ago, we had a sponsor there who came out with a new one that's not going to be so new when this episode comes out, but what is that one called? 

11:15 Dr. Vicki Rapaport: That one is Jeuveau. It's great. 

11:16 Julie Falls: Jeuveau.

11:18 Trina Renea: Oh, Jeuveau. Okay. 

11:18 Dr. Vicki Rapaport: I really like all of them and I use all of them. I think that the key to the newer products is sometimes they come on the market a little less expensive. I think that's a really good selling point for patients, because it really can get up there in price. 

Jeuveau came on the market a little less expensive, so we're able to offer that price point, decreased price point for the patients. I feel like Jeuveau works beautifully. I love it. 

I guess my only problem with all these neuromodulators, is what we call them, is that they only last about three to four months. And when you say they don't last as long, so one of the big things in Allergan, who owns Botox, is really trying to help educate doctors and patients that you really need the dose amount that was FDA approved, which is 64 units if you're going to do those three.

12:08 Trina Renea: 64 units per area or 64 units in total? 

12:10 Dr. Vicki Rapaport: No, 64 units in those three areas.

12:14 Trina Renea: In total.

12:15 Dr. Vicki Rapaport: 64 units, so 20, 20, 24. 20 in between the eyebrows, 20 on the forehead, 24 around the eyes. 64 total. 

12:21 Trina Renea: But what if somebody has a really big middle line and they don't need the other places and they don't want around the eyes or the forehead? Can you put 64 units in that one area? 

12:30 Dr. Vicki Rapaport: No, you wouldn't put 64 in that one area, but you can just do one area. If somebody just wants one area, yes. You want to do the dose amount, which is 20 units. If you underdose, which people do all the time, we call it baby Botox. It's either because they definitely want a little bit of movement or they absolutely cannot pay the amount for 20 units. We will underdose them. 

And Allergan’s big thing is the patient will be unhappy. It won't last as long. It won't be as nice and firm and tight. 

But we've been doing it for 20 years. People know that. They're like, “I don't care. I only want six, eight, ten, twelve units in there. I don't want the 20 that's FDA approved and I will come back every six weeks,” because it really doesn't last the full three to four months if you underdose them. 

It's like telling you, “Hey, I'm going to give this birth control to you, but, you know, just take it whenever you feel like taking it. It's okay. Just take it once a week.” You're not going to do that. The dose is dosed because that is how that birth control was FDA approved to give you the whatever 95%, or hopefully 98% efficacy so that you won't get pregnant. 

Allergan’s take and these other companies’ take is that is the dose that we saw in the studies work the best and last the longest. So, really, you should be getting what is recommended to you if you want it to last the longest. 

13:48 Trina Renea: Right. 

13:49 Julie Falls: I have a question. When somebody comes in and is not really educated, I'm comparing all the different manufacturers, all the different names, Dysport and Jeuveau, but they haven't really done their homework but they say to you, “I want Botox,” do you just automatically— do you offer them… Like, I see it's like 20 to 30% less money. Do you offer them? Do you say, “Well, there's this now.”?

14:15 Dr. Vicki Rapaport: Such a great question. 

14:15 Julie Falls: Because I know your reps probably come in and say, “Can you sell this now?”

14:20 Dr. Vicki Rapaport: I do like to educate them on, especially if they've never had Botox, I'll educate them on what it is and how it works. Then I will sometimes mention the four that exist and the price difference, if they want to know. Sometimes it's literally like a dollar less per unit, so they're saving $20. Sometimes they're saving a lot because we'll have specials and the companies will have specials. They have these special membership points.

But, yes, if somebody comes in specific asking for a certain product, of course I'll give it to them. Because I really do like them all. And if, for whatever reason, it's not appropriate for them, for whatever reason, yes, I'll maybe explain why I think one would be better for them. But they all work very similarly right now. 

However, I will say there is something coming out. It doesn't have a trade name yet and it's supposed to last six months. So we'll see. We'll see. If it really does last six months and has this same side effect profile and the same efficacy and the same sort of longevity, all the good points that we love about Botox, Dysport, Jeuveau and Xeomin, then I think they will be blowing everybody out of the water. 

I hope that they won't be twice as much. That's the problem, is the longevity. 

15:34 Trina Renea: It will cost the same amount. 

15:36 Dr. Vicki Rapaport: It might cost the same but it will last long. I'm not sure. We'll see what happens. But tune in again because we'll talk about it when it's on the market. And people will hear about it. But it's going to be exciting. 

Honestly, I really do feel like when I educate people about Botox, I tell them to have a healthy respect for Botox. Because if you had bladder incontinence, if you had hyperhidrosis, if you had migraines, you would be begging for Botox. And you would probably have already had Botox and it would have been a miracle medication for you.

16:02 Julie Falls: Yeah. And the TMJ, people are getting such relief with the clenching. 

16:05 Dr. Vicki Rapaport: Yes. I'll tell you one other crazy place I have put it. There's a lot of crazy places that we can put it. Safe, but crazy. 

So, I get this terrible trapezius spasm. And I said, “You know, it's the trapezius. It's a muscle. Let's do it.” 

So I have my PAs inject it in my right trapezius, because probably the way I hold myself at work and my posture…

16:26 Trina Renea: Does it help? 

16:28 Dr. Vicki Rapaport: It's amazing. It takes away my stress headaches, my stress musculature issues for months.

16:35 Julie Falls: Oh, I need to talk to you about that. 

16:37 Dr. Vicki Rapaport: And it also is used cosmetically in that area. So women who want more of like a ballerina like softer neck, longer neck, we actually can do it in the trapezius muscle. It does take a lot of units.

16:47 Julie Falls: Wow. So great.

16:48 Dr. Vicki Rapaport: It's kind of an amazing medication. Like I said, it's safe, safe, safe and it can relax basically any muscle.

16:53 Trina Renea: So if somebody has, like, always constant pain in a muscle, they could do a little Botox to relax that muscle a little bit?

17:03 Dr. Vicki Rapaport: It's not the first line therapy but we always think about it as a possible option, yes.

17:06 Trina Renea: Wow. Okay. Is there anyone who should not ever do Botox? Is there anyone out there like that?

17:14 Dr. Vicki Rapaport: Yes. Anybody who has an allergy to Botox.

17:17 Trina Renea: How do you know? 

17:19 Dr. Vicki Rapaport: That's the silly question, right? You’ll only know until you've had it. And have there been allergies to Botox? I don't believe there have been many. No real, true documentation to Botox. 

17:31 Trina Renea: What would happen to someone if they had an allergy to Botox? 

17:34 Dr. Vicki Rapaport: Anaphylaxis. 

17:36 Trina Renea: What is anaphylaxis, for those who don't understand that? 

17:38 Dr. Vicki Rapaport: Anaphylaxis is basically when either your throat— It's a big deal, right? When your throat closes. Somebody gets anaphylactic to bee stings or strawberries. It's legitimately scary. Your throat closes. 

Typically, they do okay, but it's scary. You pass out. You need to open up that throat to get some oxygen to your brain. 

18:01 Trina Renea: In all of your years of practice, how often have you seen that?

18:04 Dr. Vicki Rapaport: Never. It's never been documented.

18:05 Trina Renea: But you’ve heard of it?

18:06 Dr. Vicki Rapaport: No, no, no. It's never been documented. 

18:07 Trina Renea: No, but they say it could happen.

18:10 Dr. Vicki Rapaport: Yeah. So it's just in their literature and their product insert. The only people who really shouldn’t get Botox is people who have an allergy to Botox. That's just what's said with any medication. 

18:21 Trina Renea: Right, right, right. Does it hurt when you get a Botox injection? Do you have to be numb? Do people have to fear pain? Does it feel like a bee sting? What does it feel like? 

18:34 Dr. Vicki Rapaport: Tiny little needles. It doesn't hurt much. Some areas don't hurt at all and some areas feel like a pinch. If people are really, really concerned, yes, we'll put topical numbing on them. And if you topically numb around the eyes, they're completely numb. It's amazing. You don't feel anything at all. It takes about 10 minutes to numb that area. It's just a thin area, thin skin, so it numbs quickly. 

And you can try and numb between your eyebrows and your forehead. It's just harder to numb that area. But if you really want to be numbed, you can. You do not need to be numbed. It is a quick injection. The needles are tiny. It doesn't really hurt at all. 

19:08 Trina Renea: Is there a downtime? 

19:10 Dr. Vicki Rapaport: If you get a bruise, there's a downtime, yes. 

19:13 Trina Renea: How often do people bruise? 

19:15 Dr. Vicki Rapaport: A lot, yeah. Anytime you put a needle in the skin, there's always a chance of bruising. 

19:20 Trina Renea: Is that bad? 

19:21 Dr. Vicki Rapaport: No, it doesn't affect the treatment results at all. It upsets the patient. We try not to bruise people. It happens sometimes and so we just reassure them. It doesn't affect the outcome.

19:31 Julie Falls: Some people just bruise when they have injections. 

19:37 Dr. Vicki Rapaport: I like to reassure people because people get very upset about a bruise, and then they get embarrassed about a bruise. There's not much you can do otherwise other than wait for that bruise to disappear. If you want to take arnica, you want to put on Arnica, it's probably just going away on its own. The placebo effect of the arnica is helping. 

But people just have to know going in that it has absolutely no reflection on the injector. If you want to decrease your chances of bruising, no alcoholic beverages, aspirin, Aleve, Advil, St. John's wort, vitamin E, about a week before. 

20:12 Trina Renea: Okay. So what are the results that someone is going to expect to see, and how long before they see a result? 

20:21 Dr. Vicki Rapaport: It takes three days for it to start to kick in and it takes a full 14 to 21 days for it to get its full maximum effect. 

I just had a patient this week, love her to death. She's had it a million times, but she did a new area. And four days later, so upset. It's not even. What's happening? So I just have to reassure her, “It's only four days. It's barely starting to kick in. You've had it before. I understand you've never had it in this area but, remember, it just takes a little bit of time.”

“I can't wait for 14 days.”

I'm like, “You're just going to have to.” Nobody would go in there and re-inject. Again, it's…

20:57 Trina Renea: It's a new area. It's been like that for a very long time. It's okay to take a little time. 

21:02 Dr. Vicki Rapaport: Right. I think that people just have to trust their injectors and be able to communicate with them. If we're not available for them to reassure them and answer their questions, that's not a person you probably want to go to. I'm happy to reassure her. I'm happy to be there for her, but that's really all I can do is reassure her. I'm not going to do anything other than inject her, other than wait to maybe inject her more in 14 days if she needs it.

21:24 Trina Renea: Yeah. Sometimes I feel like, well, a lot of times I hear people say like, “The Botox isn't kicking in. It's not happening.” And I always tell people you have to wait like a week, at least, to be able to see the wrinkles start to soften. 

21:41 Dr. Vicki Rapaport: Good. A good rule of thumb is three to 14 days. And you were asking me about the four different ones. There are some subtle differences. I kind of lumped them all and I said they're all the same. There are some subtle differences. Some kick in a little bit faster. 

So, again, when you go to your injector, if you have a wedding or an event, not your own wedding. Hopefully, you're not doing it three days before your own wedding. But if you have a friend's wedding or an event and you're like, “Oh, shoot, I didn't have time. I have my appointment now, but it's in three days.” There are some that kick in a little bit faster. 

22:11 Trina Renea: Right, but you could also bruise, so be careful. 

22:13 Dr. Vicki Rapaport: There you go. You're right. 

22:15 Trina Renea: Like get it done a month before an event. 

22:17 Dr. Vicki Rapaport: We tell people minimum two weeks before an event, please. Give it a minimum two weeks. Because if you need a touch up, a month before is even better. Because if you need a touch up, which sometimes people do, you have enough time to do all that, and for all the bruising to go away if you bruise. 

But remember, it's water, it's safe, it's effective, it's a miracle medication for seven other indications. We're all big fans of Botox in dermatology. It saves people's lives in terms of certain diseases, but also, of course, it makes them look really good if they want to look good. 

22:50 Trina Renea: So people need to usually redo it every three to four months at this point. And then the average cost per unit is somewhere around…

23:02 Dr. Vicki Rapaport: I've seen it as low as $9 a unit and I've seen it as high in New York as $22 a unit. 

23:07 Trina Renea: And then how many units per area? Like 20-ish? 

23:10 Dr. Vicki Rapaport: Average about 20. So 20 in between glabella, 20 forehead, 24 around the eyes. You do those calculations and it does add up. You're going to your med spa and maybe getting it for $9 a unit, I would really want to watch them pull it out of the vial. How are they charging only $9 a unit when it basically costs not $9 a unit, of course, but it can be up there. The cost is high. 

We are not getting it for $1 a unit. We are getting it $6, $7, $8 a unit is what it costs. They're making $1 per unit? I don't think so. So they're either under-injecting you or they're just getting you in to try and sell you other procedures, which is actually okay. That's fine. If you're getting really good results at $9 a unit, great. But if you're not, there's a reason maybe they're not really injecting as much as they say they're injecting. 

24:00 Trina Renea: Interesting. Okay. Any other questions? Julie? Do you have? 

24:07 Julie Falls: Did we just— It's probably a longer conversation, but do we talk about the difference between Botox and filler? 

24:13 Trina Renea: No. Let's wait on that. Because Botox basically helps to relax a muscle and filler actually fills an area that has loss of fat, basically.

24:26 Dr. Vicki Rapaport: Loss of volume.

24:27 Trina Renea: Loss of volume. So they're two different things. One fills an area on your face and the other just numbs wrinkles, kind of evens out the wrinkles. 

24:35 Dr. Vicki Rapaport: Relaxes the muscles. 

24:36 Trina Renea: Relaxes the muscles. That's Botox. On a future episode coming up soon, we're going to talk about fillers. We're going to talk about non-hyaluronic fillers and hyaluronic fillers. Two different types of fillers, which we'll get into soon and we'll have specific episodes just for those. 

I think we kind of all know what Botox is now. We, of course, talk about Botox in so many episodes, so now you know what it is, in case you didn't know, and that it's safe. It used to be a scary thing years ago. I think people still are a little scared of it but it's not scary. It's been around so long now. We know what it does.

25:23 Dr. Vicki Rapaport: And I want to say one last thing about Botox is that there is one indication for Botox, is for lower limb spasticity. It's FDA approved for two years and up. So lower limb spasticity, usually seen in cerebral palsy and other neurological diseases. Again, it is so safe that if your child has lower limb spasticity, after two years old, they can safely get Botox. 

It is FDA approved for the wrinkles 18 and up, 18 to 65 years old, but of course we give it to 95-year-olds. Remember, we do a lot of things off-label, which is legal. It's just “off label,” but it is so safe that a two-year-old can get it.

26:05 Trina Renea: Wow. That's good to know. All right. 

Well, we do have a fan question today. It comes from Viv. She was asking us how do we deal with ingrown hairs? Like, how to deal with those? What do you do besides pick them to death? Dr. Vicki, recommendations?

26:28 Dr. Vicki Rapaport: Do you want to ask me, like, maybe where an ingrown hair would be? So bikini? 

26:32 Trina Renea: I would say probably, on a female, she's talking about her bikini line. Probably after waxing, a lot times people get ingrown hairs. 

26:35 Dr. Vicki Rapaport: Okay. Yes. Such a problem.

26:41 Trina Renea: I mean, men get them on their face from their whiskers, but I'm sure— Her name is Viv. 

26:46 Dr. Vicki Rapaport: So Viv, of course, like what I always tell people in the room, I try to educate them on what it is, what is going on. The hair is not able to happily grow right straight through the hair follicle. It pierces the side of the tunnel. And then that piercing, even though it's your normal hair, your body sees it as like a foreign body reaction. 

So your body reacts to it. It gets inflamed. Bacteria, which is very dramatic and brisk down there. That area is full of bacteria. It's a “dirty area.” Lots of normal bacteria live down there. So when your hair pokes the side of the skin, a reaction happens. The bacteria come to the area. It creates basically almost like an acneiform problem. 

You want to clear the path. Think about it, clearing the path of the tunnel so that the hair can happily grow through. Salicylic acid products and then benzoyl peroxide washes to clean the bacteria up.

If it's really obvious, try and get it out, but don't incessantly pick it. If it's really problematic, they usually need oral antibiotics. 

27:47 Trina Renea: Okay. So salicylic, they can find salicylic products over the counter at the pharmacy. Or if you have a doctor esthetician nearby, you could probably go into their office and buy a salicylic product with salicylic acid in it. 

28:04 Dr. Vicki Rapaport: Yeah, a salicylic pad or a salicylic leave-on. Not a wash. You let the salicylic acid really sit there and help unplug that hair. 

28:13 Trina Renea: Okay. And then benzoyl peroxide cleanser that will help get rid of the bacteria, kills the bacteria. 

28:19 Dr. Vicki Rapaport: Got it. 

28:20 Trina Renea: All right. Hope that was helpful, Viv, and everyone else out there who gets ingrown hairs. I imagine men can do the same thing on their face with that? 

28:29 Dr. Vicki Rapaport: Yes. Absolutely. 

28:30 Trina Renea: Pretty much. 

28:30 Dr. Vicki Rapaport: Yes. 

28:33 Trina Renea: Okay. All right. Okay, well, thank you for joining us on this Botox episode. We're going to do takeaways now, and then we'll see you on our next episode. 

Dr. Vicki, takeaway? 

28:42 Dr. Vicki Rapaport: Oh, my goodness. My takeaway would be to have a healthy respect for Botox as a true medical treatment, a true medication. If you had migraines or axillary or palmar hyperhidrosis or cervical dystonia or bladder incontinence or lower limb spasticity or blepharospasm or strabismus, you would already have been treated with Botox and you would have spoken positively about it. 

You should not be afraid if you're interested in Botox for a wrinkle. You absolutely should not be afraid of it. 

29:18 Trina Renea: My takeaway on Botox is that you should go to somebody that is respected in your area that somebody has referred you to. I think there are a lot of doctors who do Botox, including dentists and all kinds of doctors that are doing it. 

And like Dr. Vicki was saying, you need to know the muscles that are causing that wrinkle. So you can't just stick some needles in the head and numb an area. That's when you might get the eyelid droop. I would just be careful and go to somebody who's doing proper injections and who know what they're doing. 

30:00 Julie Falls: My takeaway is from an A1 top-rated dermatologist in Beverly Hills. We've learned that Botox is extremely safe. So if you're interested, do your research and go for it.

[Outro] This podcast is so needed in the world right now. There's so much information out there that it's hard to know who to believe and if it's right for you. We are very excited to be your guides and bring you Facially Conscious. 

If you have something to tell us, share with us, or want to know, please email us at info@faciallyconscious.com.