Baby Botox, Trap Tox & Weird Uses for Botox - Get Off My Lawn Part 1

Announcer (00:02):
You are listening to Alabama the Beautiful with cosmetic surgeon, Dr. James Kohler and Kirstin Jarvis.

Kirstin (00:10):
Hey, Dr. Koehler.

Dr. Koehler (00:11):
Hey, Kirstin.

Kirstin (00:14):
Do you want to know what we're doing today?

Dr. Koehler (00:17):
No, please tell me.

Kirstin (00:18):
It' something different.

Dr. Koehler (00:19):
Something different?

Kirstin (00:21):
Since you seem to have so many hot takes about what's happening in aesthetics, you are totally in your element when you rant about them. We figured we'd do a little more of that today.

Dr. Koehler (00:33):
I don't want to be the angry old guy, sorry.

Kirstin (00:37):
Well, we trust your judgment and we really want to know what you think. So we're going to talk about a few different trending aesthetic procedures as seen on TikTok and Instagram. And I'm going to ask you, is it a "get off my lawn" or "Come on, yeah, we're good with this"?

Dr. Koehler (00:55):
Get off my lawn. You have to explain that to me. I don't even know what you mean by that.

Kirstin (00:59):
Because grumpy old men say, get off my lawn.

Dr. Koehler (01:02):
Yeah, no, I'm not going to, nothing's going to get off my lawn. I'm not going to be. I'm not going to be that guy. I told you.

Kirstin (01:07):
Okay. All right. So let's start with toxins and neuromodulators.

Dr. Koehler (01:13):
Yes, love them.

Kirstin (01:14):
Do you have a brief, quick, basic history about Botox?

Dr. Koehler (01:18):
Dr. Jean Carruthers and Alistair Carruthers were the ones that kind of really brought it to the cosmetic world. I don't remember exactly what year in the, it was the eighties. It was being used for things like blepharospasm, and they just so happened to notice that when they were treating this spasming around the eyes that, Hey, by the way, the lines around the crow's feet area got better. And they started playing with it and realized that this is great for getting rid of lines and wrinkles, and sort of was the beginnings of the Allergan cosmetic Botox. I mean, Botox has been around for a long time, but really the cosmetic use, really, those two doctors were the ones that really, and they're in Vancouver, Canada, ophthalmologist and dermatologist. It was really what sort of brought this to light in terms of the cosmetic world, and it's been nobody looking back since. So obviously it's one of the most popular cosmetic treatments that non-surgical treatments that's out there. I don't think it's going away. And yeah.

Kirstin (02:28):
Now they got lots of competitors.

Dr. Koehler (02:30):
Yeah. Well, it's good. Competition's good. So yeah, there are competitors. I mean, some of them a little better, I wouldn't say better than others. There's some differences between them, but realistically, all kind of do the same thing. Some they come on a little quicker, some last a little longer, that kind of thing. But really, they're all pretty good.

Kirstin (02:50):
Okay. All right. Well, let's talk about baby Botox. The trend, people start getting Botox when they're babies, when they're in their early twenties. They get just like a few units here and there as a preventative.

Dr. Koehler (03:08):
Yeah, get off my lawn.

Kirstin (03:11):
Okay. So we don't like the baby Botox.

Dr. Koehler (03:14):
Well.

Kirstin (03:14):
When should you start then?

Dr. Koehler (03:16):
Well see, these are these difficult questions that it's just really hard to answer. It's like, well, when should you get a facelift? I mean, I don't know. There's not an age. There is a time, and it's different for every person, but let's just get back to the point of prevention. Okay. Well, I suppose if we paralyzed your face from your twenties through to your seventies, you would not maybe have any wrinkles. So I guess. We haven't done that study, but maybe we could do it a prospective study, follow these 20 year olds all the way to 70 and make sure they get Botox every three months or three to four months and see if they develop more wrinkles. Anyhow, I guess I'm a little bit of against it because I feel like it is different for every person. I see people that are doing their first Botox maybe in their late thirties or forties, and their skin is actually pretty smooth and they don't have a whole lot of lines.

(04:10):
So starting at that point is just fine. But there definitely are people that I see that have pretty heavy animation in their twenties or early thirties, and maybe genetically their skin does not have the same kind of elasticity. And you can already start to see the formation of permanent creases in the skin. So yeah, I think in those people, starting it earlier is better, but it's not an across the board thing. It's not like, oh, yes, at 25 you should start Botox. There's lots of people that don't do this till later in life, and some people don't do it even at all, and they don't have heavy lines and wrinkles. So it's just not an easy question to answer. And I just don't think we should be telling 20 year olds that you need to be spending your money on Botox to prevent lines when you're 60.

Kirstin (04:57):
So long and short.

Dr. Koehler (04:59):
Yeah, sorry.

Kirstin (04:59):
Get off my lawn.

Dr. Koehler (05:00):
Get off my lawn. Yeah.

Kirstin (05:01):
Okay. All right. The next one is trap tox or Barbie Botox

Dr. Koehler (05:11):
Trap tox?

Kirstin (05:11):
Yep.

Dr. Koehler (05:11):
Yeah, I saw that. I mean, I've never done it. I've never done it for a patient. I would never do it. I mean, no.

Kirstin (05:22):
Botox in your traps to, what is the goal, to make your traps smaller, to seem more feminine?

Dr. Koehler (05:29):
I guess, to make your neck look slender, more slender or whatever? I don't know. But here's the deal. Okay. Alright. Get off my lawn. You are making me a grumpy old man.

Kirstin (05:40):
I love when you start, okay, here's the deal. Let's talk about it.

Dr. Koehler (05:43):
Okay, well, here is the deal. Let's just talk about Botox. And we don't want to get into all the doses in the units, but with these little tiny muscles, tiny, teeny, tiny muscles right here. And we're going to inject 20 sometimes 30 units and sometimes more for some of my male patients. But anyhow, let's just say 20 units though, for this little teeny tiny muscle right here. I've seen your traps. They're pretty big. I mean, but it's a large muscle group. Okay. It's a large muscle group. And so basically what the theory, I guess would be is that if you weaken the muscle, again, muscle dysfunction, if the muscle's not working, it atrophies, it shrinks. And so it's going to look, maybe it might give you a more slender look. I don't know. But that muscle's big and the doses that people would need to do to really make it weaker.

(06:42):
I mean, you're probably looking at least a hundred units per side, but I know they do a lot lower doses than that, but they're still probably putting, I don't know, at least 50 units aside. And I don't even know that it's really, it's not going to paralyze it completely. Obviously you wouldn't want to do that anyhow, but still to weaken it significantly, I mean, I still think you're going to be needing at least 50 units per side to do this. And to me, just, first of all, it doesn't even make sense. I just don't know that people go around looking at people's necks going, God, you see how thick their neck looks? I mean, and

Kirstin (07:17):
Their neck muscles are huge.

Dr. Koehler (07:19):
Yeah, the neck muscles, I mean, I think people are way more concerned about what sagging on their necks than what the side of their traps are looking like.

Kirstin (07:28):
If you're talking about that many units of Botox, that's like thousands of dollars every month.

Dr. Koehler (07:32):
Well, it gets expensive.

Kirstin (07:33):
It's still every three months.

Dr. Koehler (07:35):
And so there are medical uses for putting Botox in large groups of, large muscle groups. It's for things like kids with cerebral palsy, with spastic muscle contractures and things like that where they're trying to relax these spastic muscles so they're not all contracted. And to do that does take very high doses of Botox to get those things to relax. And anyhow, but that's for a medical purpose. I mean, just to make your neck look, I dunno, to me, I hate to be this way because I like to be an open-minded person. We can both disagree on what we think looks good or looks beautiful, and that's okay. But to me, that's just not a, I don't have people coming into my office asking for that typically. Maybe it's I'm grumpy old man, I don't know. But the also thing is, so it's not requested, and I'm certainly not going to be asking people, have you looked at your neck lately? Do you think it's a little thicker than it should be? So it's not something like, we're in there,

Kirstin (08:37):
It's kind of comical, especially when you put it that way, just because you have a thick neck, we want to, yeah, I'm with you.

Dr. Koehler (08:45):
I dunno. So anyhow, trap tox, the answer is no,

Kirstin (08:50):
Get off my lawn

Dr. Koehler (08:52):
If you want it, don't come see me. I really not going to be excited about doing it.

Kirstin (08:58):
I do have to say.

Dr. Koehler (08:58):
Oh, so go ahead.

Kirstin (09:01):
I'm the TikTok queen. I watch TikTok every day. And the first time that I saw trap tox, I was like, this is crazy.

Dr. Koehler (09:07):
And just to back up again for things like medical necessities, they do inject sometimes muscles near the back of the neck and we'd inject it in the forehead and other regions for headaches, and neurologists will do this. And so there are some medical indicated uses for doing this. But again, I just think cosmetically in that particular situation just doesn't make sense.

Kirstin (09:32):
Okay. All right. Next one. We're still talking about Botox and injectables: taking zinc before Botox.

Dr. Koehler (09:41):
Do what?

Kirstin (09:43):
People are taking zinc because they're thinking that it's making their Botox last longer?

Dr. Koehler (09:49):
Yeah. I don't know. I've heard this before, but honestly, I mean, I've never seen one clinical study. I've never been to one meeting where there's been a presentation on, oh, the Botox works better. I just feel like if that was a real thing, I've not seen a single publication on that, not one. Now the other thing is, I dunno how many people are walking around that are zinc deficient. My guess is if you're eating semi-decent, it's probably not going to be an issue. But yes, that Botox does require zinc in the whole process of binding to prevent the release of the neuromuscular transmitter. And so yes, zinc is involved in that process, but I really don't believe that, it's not like you can supercharge your levels.

(10:57):
I would say I'm skeptical of that, but at the same time, people take zinc supplements because they don't want get sick. And we had it during covid, you couldn't get zinc during covid. Everybody was getting zinc to try to prevent covid. So it's like until you see the science, it's really just sort of whatever. But taking a little zinc supplement, that's not going to hurt you. If you want to do it and it makes you feel good, go for it. I mean, nobody cares, but I'm not going to be counseling patients to say like, okay, you need to, this many days before surgery, you start taking zinc. And that would also be one of those things that I could just see it now, like somebody like, oh, your Botox didn't work well, you just must not have taken zinc beforehand. It's like, it must be your fault you didn't take zinc. I dunno. Sure. Okay. Do it. But I just don't think that that's necessary. I see people's Botox working just fine, and I know they're not taking zinc.

Kirstin (11:53):
So yes, it sounds like if you already have a sufficient amount of zinc in your body or cells are going to do what they're supposed to do. Is that right?

Dr. Koehler (11:59):
Yeah. I mean, unless you're got a zinc deficiency, I think you're probably pretty good.

Kirstin (12:05):
All right. Get off my lawn.

Dr. Koehler (12:08):
No, you can stay. It's not going to hurt you.

Kirstin (12:12):
Okay, gotcha. There you have it. We'll be back with more hot takes from Dr. Koehler.

Announcer (12:17):
Got a question for Dr. Koehler. Leave us a voicemail at AlabamatheBeautifulpodcast.com. Dr. James Koehler is a cosmetic surgeon practicing in Fairhope, Alabama. To learn more about Dr. Koehler and Eastern Shore Cosmetic Surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, Apple Podcast, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @EasternShoreCosmeticSurgery. Alabama the Beautiful is a production of The Axis, theaxis.io.