The B Word…


No, not “bitch”.  Something far more interesting…


In all my time behind the chair as a stylist, I think I’ve had more conversations about plastic surgery than any other topic, period.  The main thing my clients and I discuss, at length, is always injectables!  Fighting the hands of time is a battle most of us are in, whether its loading up on serums and night creams, or something far more immediate like Botox.  In my opinion, injectables are the ultimate in maintenance.  I began my love affair with Botox when I was just a wee babe at 27 years old.  All it took was seeing an unposed, candid picture of myself at a Holiday Party, and let’s just say I didn’t like what I saw.  It looked like railroad tracks going across my forehead, due to the goofy face I was making.  I had begun to notice a few scowl lines between my eyebrows too.  Nobody likes “resting bitch face”!  I asked a few girlfriends and clients what could be done, and the rest is history.  I’ve been a faithful devotee ever since.   I feel like I know a fair amount about it but I decided to go straight to the source and get the real scoop on Botox and other injectables from the experts.

The Experts:  Whom I trust with my life, and my crow’s feet…

Mischell Christmas, RN  Nurse Injector Charlotte Plastic Surgery

Mandy Bazemore, RN Cosmetic Nurse Injector Just Glo Skin Care Studio and Med Spa

Amanda:  Introduce yourselves, ladies!

Mischell: RN, BSN Aesthetic Manager, Injection and Laser Specialist

Charlotte Plastic Surgery

2215 Randolph Rd.  Charlotte, NC

Mandy: I am a Registered Nurse, but in the Med Spa field we are commonly called “Nurse Injectors”.

Mandy Bazemore, RN

Cosmetic Nurse Injector

Just Glo Skin Care Studio and Med Spa

704-817-9330  I  2727 Selwyn Ave. Suite 201, Charlotte, NC 28209  I

Amanda: What, if anything, should women in their 20’s and early 30’s be doing to prevent wrinkles?

Mandy:  Prevention is KEY!  Every Woman (and Man for that matter) should be protecting their skin from the sun by applying sunscreen daily.  Tanning beds and baking in the sun without SPF is an absolute no-no.  Not only can tanning cause skin cancer, it can cause premature aging (wrinkles, loss of elasticity of the skin, etc.)

I am also a big fan of starting eye creams in your 20’s.  Eye creams can help keep the sensitive, thin skin under the eyes looking youthful.  This is one of the first areas women notice aging.  It’s important not to wait until the problem is already noticeable.

If you have a family history of deep frown lines, horizontal lines across the forehead and/or lines around the eyes OR are already noticing these lines while your face is at rest, it may be time to start Botox treatments.  Botox can help create a more youthful look and prevent those fine lines and wrinkles from getting worse.

Amanda:  When should you start getting injectables? I’m thinking yesterday!

Mischell:   You can start getting Botox as early as your 20’s.  How we express is a learned behavior.  think about it, as a newborn your parents are in your face making expressions.  So often my patients will say “I have this line between my brows just like my Mom”  It’s not genetic, just learned behavior.  they see they are developing these expression lines and want to prevent them from getting more pronounced.

You should start when you are ready but quite honestly you should start before the lines become static as then they are much harder to erase or even soften.  Static lines are those that are there whether or not you are expressing – frowning, smiling, raising your eyebrows.  Hyperdynamic lines are those that only occur when you are expressing but at rest are not visible

Amanda:  What are the latest trends in injectables?

Mischell:  I’ve found that over the past 6 years my patients have gotten younger – to prevent the lines that their parents have and my male population of clients has increased in an effort to look more youthful in a competitive job market.

Mandy:  This is the fun part about my job.  It is constantly changing.

There are a lot of new (and not so new) trends out that clients may not have heard of.

–       Strutting:  At Just Glo, we call this “Lip Rescue”.  This is a new technique in which the lips are injected vertically with fine “struts” of filler.  The result is natural, soft, full lips. It’s a major difference from the overstated “duck lips” that were so common in years past.

–        “Airbrushing” which involves diluting hylauronic acid fillers such as Restylane and/or Juvederm with Saline and injecting it into finer lines around the mouth and eyes.

–       Cheek Filler:  The aging face begins loosing volume from the temples down.  When a client comes in for a consultation and is looking to get rid of the “parenthesis” around the mouth (aka nasolabial folds) it’s important to first address any volume loss in the mid-section of the face.  Sometimes a small amount of filler needs to be added to the cheeks to lift on the sagging skin and replace the volume that has been lost.  This doesn’t mean the client doesn’t still get the lines around their mouth filled, it just means that we are balancing the face more appropriately.

–       As for Botox, there really aren’t a lot of NEW trends.  Some areas a lot of clients don’t know they can have Botox injected are the upper lip, lower lip and chin area.  I commonly inject a very low dose of Botox over the upper lip to soften the “smoker’s lines”.  I also use Botox around the borders of the lips (top and bottom) to help turn out the lip giving it a fuller appearance without having to inject filler.  Botox in the chin can decrease the “dimpling” or the “orange peel” look of the skin.

Amanda:  How much is this gonna set you back, cost wise?

Mischell:  The average cost varies.  Typically the more experienced and credentialed professionals do not do Groupons and Living Social specials.  It’s fine to get your car detailed or a mani pedi or lunch from Groupon.  I can’t tell you how many patients I see who come in from having a disastrous result from a botox party or an inexperienced provider that I then have to try to undo – which you can do with filler faux pauxs but little can be done for bad botox.  So now they have wasted money on bad results, they have to pay to have it undone, and then pay again to have the results they wanted in the first place.  The adage is true – you get what you pay for.  That being said, Allergan, the makers of Botox have a rewards program that is unparalled.  Every time you have a Botox or Juvederm injection or purchase SkinMedica products – the best in the industry you earn points which convert to coupons off your purchase.  You should expect to pay between $350-$550 depending on how many areas are injected.

Mandy: Average Cost:  I usually tell my clients to budget around $200/area (frown, forehead and crows).  Chin, nose and mouth areas are normally much cheaper ($50-100)

Amanda: What are the major DON’Ts of Botox?

Mandy:  Don’t get Botox without a thorough consultation.  It is so important that you express your concerns and needs with your Injector prior to having anything done. A few things I like to discuss in consultation is previous Botox experiences and what the client liked and didn’t like, medical history, the “look” you are going for and budget.  It’s important to be honest with your Injector so he/she can make sure you are getting exactly what you want.

Mischell:  Neurotoxins, you cannot undo.  And trust me, every week I’m explaining this to someone who bought a Groupon or a Living Social special or who went to a Botox party at a friend’s house to save a few dollars.

Groupon’s are great for lunch or car detailing.  Not something you want to gamble on with your face.

Amanda:  Is there anything you should avoid the day you get a treatment?

Mischell:  I generally tell my patients to work out prior to coming in for their injections as I’m going to instruct them not to work out afterwards, no laying down for 4 hours immediately afterwards and please, don’t play with the injected areas.  I’ve placed the product where I want it and I need you to leave it alone.  All of these rules apply the day of treatment.  The following day you are free to do as you will.

Amanda:   What are the different products available?

Mischell:  There are three FDA approved neurotoxins in the United States.

Botox, Dysport and Xeomin

Amanda:  What is the most common misconception about Botox?

Mandy:   There are so many!  The one I hear all the time is “I don’t want to look plastic or fake”.  Our media/celebrities, I believe, have misled us a bit.  I find it comical to watch an actress who has obviously had surgery tell the person interviewing them, “I’ve just had a little Botox”.

It is possible to look natural after having Botox.

Mischell:  It is interesting that my patients new to neurotoxins and cosmetic fillers are more   afraid of fillers than Botox.  I can erase any hyaluronic acid filler with a simple injection as soon as 24 hours after being injected and the product is gone.

Amanda:     Are there any common side effects?

Mandy:  Yes.  The most common side effects are redness, slight swelling and/or bruising at the injection site.  Two other common side effects are headaches which are very mild and usually last only a few days and less commonly the client will experience flu like symptoms

Amanda:  Is anyone not a candidate?

Mandy:   The best candidates for Botox are healthy without a history of neuromuscular disease and over the age of 18. Women who are pregnant or breastfeeding are also not candidates.  A few other reasons a client may not be a good candidate for Botox would be if they have an existing weakness in the targeted muscles, drooping eyelids, marked facial asymmetry and/or skin disorders around the planned injection sites.

Amanda:      Do men get Botox?

Mandy:  Absolutely!  Men are starting to maintain their looks (almost) as well as women and I for one love it.  If you can do something about the wrinkles, why not?!?

Amanda:       What’s the most common area to get injected?

Mandy:  Frown lines between the brows.  This area bothers people more than any other because it makes them appear upset or angry at all times (even when they aren’t).  This can really have an effect on the way other people perceive you and even how you look at your own self.  Having Botox treatments in this area has even recently been proven to improve mood and treat depression.

Check out this article:

Botox is most commonly injected into the frown (area between brows), forehead and crow’s feet (lines around eyes) but can also be used in the nose, chin, platismal bands on neck and around the mouth.

Mischell:  Areas that are “on label” the eleven lines between the brows or the glabellar complex and crow’s feet.

Off label areas include:

Lines on the forehead, “bunny lines”’ those pesky nose lines, gummy smiles, chins that have or will develop Peu D’Orange which is when our chins have a pebbled, orange peel appearance, the muscles responsible for pulling our smiles in that upside down fashion, fine “smoker’s” lines around the lips and strong platysmal bands which are the rope like band of our necks.

Amanda:   Does Botox work for heavy sweating?

Mandy:   Yes.  Botox can be injected under the arms for clients who experience hyperhidrosis (excessive sweating).  It works very well at minimizing if not eliminating this over production of the sweat glands and lasts for about 6 months.

Amanda:  How long does Botox take to kick in?

Mandy:  Once Botox is injected, it usually takes 5-7 days to see results.

Mischell:  I find the onset of Dysport to generally be quicker than Botox – averaging 24-72 hours and Botox to be 3 – 5 days.  Each seem to last about the same amount of time.

Amanda:  How long does Botox Last?

Mischell:   It lasts between 3 – 4 months.

Amanda:  Does it hurt?

Mischell:  The needles used are very fine and have minimal discomfort.

Amanda:  Can you get injections while pregnant or nursing?

Mischell:   Even though Botox stays where it’s injected and is not absorbed by your vascular or nervous system, treating pregnant or nursing women is unethical and not recommended.

Amanda:  Will everyone know I got injected?

Mischell:  My general goal is to have plausible deniability.  Your friends will ask you if you’ve recently gone on vacation or using a new skin care regimen.  You should look like a younger version of yourself but not like one of the “Housewives.”  That’s my work and signature on their face.  I want them to be proud of how they look and I want that look to be natural.

Amanda:  Most importantly, what is the maintenance required?

Mischell:  If you like the desirable affects of neurotoxins it is necessary to maintain your treatments every 3 – 4 months.  I wish there was a magic wand that would erase years of wrinkles or prevent new ones from forming but there isn’t.   I’ve been personally using Botox since 1999 and Dysport since 2007.

I want to say a BIG “thank you” to both of these fabulously talented ladies for taking the time to answer all of my silly questions.  I trust them each implicitly, and knew they would have all the answers!  Aging gracefully sometimes requires a little help, so if you have any other questions you’d like answered regarding this subject, book a consultation with one of these experts.  Until next post, maintenance is a dirty job, but somebody’s gotta blog about it!

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