I didn’t try botox until I was 31. And even then I got a BABY BIT amount just for my 11s and crows feet.  I felt I was ready for it for prevention purposes. I continue to research, so I wanted to ask an EXPERT and get some valuable insights on this topic. I’m obsessed with skincare– I just love to know. Everything.

Y’all know I am NUTSO (bat shit crazy) about skincare and wellness. I’ve been wanting to work with the perfect place for all those needs for awhile now. Man oh man did I do hours upon hours upon hours of research. Obsessively. I ended up being the MOST impressed with Pacific Plastic Surgery Group. Like HAD to work with them. Their reviews are outstanding and I’m so dang impressed by their staff and their education and experience. They are the CREAM of the crop.

I’m cocky as heck with skincare lol, I think to myself.. I know a lot already! But even I was able to find an Esthetician who could teach me some things. Alyson has been the skincare Goddess of my dreams lol. (Read THIS about chemical peels! My favorite!)

For this article, I really wanted to interview Dr. Miranda because he gets such rave reviews for his skills with Botox and fillers. It took a month to nail something down with him, but I finally got in! Patience for the things that are worthwhile, you know?

I collected multiple questions from the Violet Fog Nice Girl’s Club Facebook group as well. Enjoy the interview, hopefully you find a lot of value in this if Botox is something you are considering now or down the line!

VF: How long has Botox been around for?

Dr. Miranda: It has been around for about 25 years now, since the late 80s. It was originally created here in San Francisco by an Ophthalmologist.

What is the most common area treated?

The frown lines between the eyebrows (the 11’s) and the crows feet.

What is the easiest place to treat on the face?

That exact combination- the frown lines and crows feet. It has the highest satisfaction rate and lowest pain! Also lowest risk involved.

Pacific Plastic Surgery Group Review 2
Look how tiny the needle is!!!! I pictured it being WAY bigger lol.

How easy is it to treat the forehead? Lots of women are concerned about their forehead wrinkles, not just the 11’s.

I’m very cautious about treating the forehead because those horizontal lines are formed differently. There is a tug of war happening all the time with the forehead. There’s muscles that are being pulled up and above the eye, and gravity pulling it down- a sign of aging. And then you have the frown line muscles activated all the time (the 11s) AND the crow’s feet muscles on the side of the face. So there is a massive tug of war. We can’t get rid of the gravity, but we can relax the muscles. This will make it so the forehead doesn’t have to be so tight and pulled up, which causes the lines. When done right, you can still maintain expression. Some Doctors just treat the wrinkle and inject it, but then you have the risk of losing expression. For 90% of men and women, just doing the 11s and the crow’s feet would make a significant difference in the lines across the forehead. It’ll also subtlety elevate your eyebrows in a good way. Just injecting the wrinkle itself can potentially drop your eyelids and no one wants that. <—takeway: treat the muscles around it first and not JUST the wrinkle. Find someone who understands this!

Women with hooded eyes: if you have botox in your forehead, which relaxes the muscles, do you run the risk of making your eyes even more hooded?

Yes, absolutely. And that’s exactly what I mean by injecting the crows feet and 11s instead of just straight into the forehead. Injecting the crow’s feet area can actually improve hooding of the eyes as well.

Can anyone be allergic to Botox? And when it breaks down over time, how does our body dispose of it?

There have been reported cases of allergic reactions to Botox, but it is EXTREMELY rare. In 17 years of using Botox I personally have never experienced any patients dealing with that. As for how the body disposes of it… when you first inject Botox, it binds to the proteins and the nerves to prevent signaling to the muscles. (So they don’t fire as much.) This degrades over time and is metabolized through the body just like any other protein would. You don’t detect botox over time in your system, it just flushes out. It’s broken down into amino acids.

Is there a way to make your Botox last longer?

Unfortunately there is not really a way to make your botox last longer. In some people, if it’s done regularly, they can increase their length of time in which it lasts. Botox lasts on average about 4 months. Some people do report that their Botox lasts about 6 months- in my experience, those people have been getting botox regularly for years.

If you stop getting Botox after awhile, what happens?

You go back to normal. Exactly how you were pre-botox. That’s the beauty of botox, it’s clean on, clean off. If you don’t like it, it goes away! If you like it… unfortunately it goes away!

What is the most common thing that can go wrong with botox?

That’s a very easy question– the most common thing is a bruise. And when I say bruise, it typically means a tiny little thing typically smaller than the same of a dime that’s easily covered with makeup. We recommend Arnica (an all natural supplement) to help prevent/treat any bruising that may occur after Botox. You can buy oral or topical Arnica at Whole Foods or Mollie Stones or our practice provides it complimentary after treatment.

What about the lines around your mouth? The nasolabial folds also called the “parenthesis.” What are your thoughts on this and Botox?

Most women are not getting Botox for this. Typically it’s filler. Examples of filler include Juvederm or Restylane. Those lines form from loss of volume in the face, loss of fat, loss of bone volume. This plus gravity can mean deeper folds in the skin.

Pacific Plastic Surgery Group Review 3

I want to ask you about your technique, because I’ve seen you administer Botox to patients and I’ve heard that you have “soft hands”… what does that mean?

You have to be gentle, you don’t want to cause trauma. You want to minimize bruising. You want to disperse the Botox evenly, not in lumps and bumps. You want it nice and spread out. You want it sitting in all the areas not just concentrated in one area. The other thing that is important is to take your time.

What is something readers should note when it comes to choosing who they go to to treat botox?

You need to find someone who will treat not the wrinkle necessarily, but what is causing the wrinkle. Unfortunately, most injectors will go straight for the winkle and then they end up compromising the patient’s expression. So make sure whoever is treating you is treating the cause- the muscle that needs to be relaxed, as opposed to the actual wrinkle. It’s much more natural and subtle that way. Attention to detail on each patient’s face and the expressions they make (and wanting to improve it) is very important. Find someone who will take the time to really evaluate the entire face and not just the wrinkle.

Is there anything that makes botox wear down QUICKER?

Exercising those muscles. If you are actively are trying to move the muscles that were treated, the botox will break down at a quicker rate. Some say sun exposure and increased exercise can make Botox wear down faster as well. Extra exercise = increased metabolism and that wears down the Botox effects.

What about Botox for headaches?

It works really well for certain people. Many headaches (migraine and some tension headaches) occur because there is a muscle compressing a nerve. Most common area is above the eyebrows right around that 11s area. Also the temples and in the back of the neck. By injecting Botox, you weaken that muscle so it’s not pinching the nerve. With proper diagnose you can really reduce the intensity and/or the frequency of those headaches. The red-flag in this is that a lot of Physicians will inject all over- in as many as 20 sites. That kind of shotgun approach will work but then you’re also injecting a lot of areas that don’t need to be injected. You need to figure out exactly where the tension is lying.

THANK YOU TO DR. MIRANDA and Pacific Plastic Surgery!

You can reach them at their website.
View them on Instagram at @PacificPlasticSurgery

Call them at (415) 379-9015. 
And visit them at 77 Van Ness Ave #302, San Francisco, CA 94102

They have multiple treatment plans for Botox and filler, in which you can be on a payment plan for as little as $70/month for your botox instead of paying bigger lump sums. They have added bonuses and gifts in their programs as well. All for saving money and perks wherever I can! I know VFers are the same way…. who isn’t actually? Haha.

Pacific Plastic Surgery group (PPSG) is truly an outstanding practice and y’all- I would recommend them a thousand times over. 

About The Author

Katey Yurko

Katey || INFP || Founder/Director of Violet Fog ||

9 Responses

  1. Avatar
    Leatha Johnson

    Are Botox shots painful when giving for pain in head and face

    Reply
    • Violet Fog
      Violet Fog

      Hi Katherine! I am not sure! Definitely a question to ask your Botox person. 🙂 I would *think* not, but certainly can’t confirm. Thanks for reading VF! x Katey

      Reply
  2. Avatar
    Kay

    Just want to say, for side effects, I had 20units in my 11’s for the first time 2 weeks ago. I don’t know if this is “normal” but I wouldn’t wish the effects it had on me to anyone else. The way it worked on the 11’s is great— but I definitely felt horrible. The pressure in my head, I felt pain in the crown chakra area and tingling/movement all up and down my spine. Way harder for my nervous system to relax, closing my eyes to sleep at night didn’t feel like they were getting the full-on closed feeling so feeling super rested wasn’t as much. I would say it caused anxiety and a bit of nausea, and night sweats (body probably trying to get rid of the toxin?). The mental stress of hoping I didn’t just extremely poison myself forever definitely was difficult, still is a bit but I’m just hoping all the claims that it wears off 100% are accurate. I still have a headache feeling around in my whole skull but definitely is better. Just want to forewarn anyone considering it to be prepared for possible illness, fatigue, and a sort of depression and/or anxiety. It does relieve and I am happy that it worked for the strong reason why I got it— clear the 11’s but I think I realized I’m way more into how I physically feel than how I look to others!! Thank you for this article, it was helpful and asked some key questions I was wondering about like how to make it wear off quicker:-) thanks a bunch, sorry to rant here, just want everyone to know more of the possible side effects and to really consider what you could possibly go through and if you want to take that risk. It’s weird that it seems like not many people experience this but maybe they do and it’s not written about a lot, or I’m just in the few who had an adverse reaction.

    Reply
    • Violet Fog
      Violet Fog

      Sorry you went through that. 🙁 Thank you for sharing and adding to the discussion!

      Reply
    • Avatar
      Nikki

      Hi, Kay!
      How are you feeling?
      I also had Botox a week ago and have most of the same symptoms you have if not worse. Thanks for sharing

      Reply
    • Avatar
      Lexie

      Hi there:

      I also had “bad botox” about 11 days ago.

      How quickly it wears off seems to be largely genetic and based upon your metabolism – faster metabolism, faster restoration of muscle strength.

      No hard proof but some articles mention – high intensity exercise, cold water in the am, vitamin c supplements, massaging impacted muscles with back of electric toothbrush.

      Seems that the impact of Botox hits hardest between 14-30 days in most people.

      Reply
      • Violet Fog
        Violet Fog

        Interesting! I didn’t have “bad botox” but some do! Thank you for sharing your knowledge!

  3. Avatar
    Lexie

    Hi Guys:

    I agree that we should talk more about side effects of Botox – bc they exist!

    I had Botox for the 1st time 11 days ago to correct brow asymmetry (left higher than right). Within 3-4 days, I developed a left brow ptosis which has also created a left lid ptosis confirmed by ophthalmologist. I’ve been in the ER twice with L eye pain, headaches, muscle weakness in the thighs of severe intensity.

    The injecting physician has been completely useless – she pretends there is no ptosis though it’s been confirmed by multiple other docs. The neurologist and ophthalmologist assure me that these issues will resolve with time as the toxin effect weakens. I’m a physician myself and am out on medical leave to allow a bit of time for symptom resolution.

    In short, understand clearly that Botox cannot be reversed in the event of poor outcome. Only “tincture of time”, which is not a luxury most working people have.

    I may have been very unlucky in this particular case. But I’ve gained a wonderful new perspective. I will *never* have botox done again! Facial asymmetry is better than the nonsense I’ve endured over the past week and a half!

    Reply

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