I did write about this topic, albeit tangentially, in this silly article when Kylie Jenner was rumored to be pregnant with her first child!

Botox in pregnancy

While no doctor will encourage you to get botox injections for cosmetic reasons while pregnant, it doesn’t mean you can’t or you shouldn’t. Simply put, there isn’t a large randomized controlled study comparing women getting botox while pregnant vs women not getting botox while pregnant.

Yes, a large study of this type would answer the question of whether botox was safe in pregnancy. But it will never happen. For obvious reasons, no one would conduct or fund a study that could potentially affect a baby. So we’re left to extrapolate from this retrospective study (studying patients after the fact), animal studies or personal stories of patients that have gotten botox during pregnancy.

As a plastic surgeon, I have injected patients with BOTOX® or XEOMIN® when they didn’t realize they were pregnant. And the patient and their baby turned out fine. So while there’s no evidence of a problem in being injected with these products while pregnant, it’s impossible to say they’re safe beyond a doubt. But there’s no evidence of birth defects associated with cosmetic botox injections that exceeds the risk in the general population. It’s a calculated risk similar to the risks we take walking across the street, not wearing a mask outside or speeding on the highway.

Botox while breastfeeding

This one is a little easier. Based on the LactMed database that evaluates medications and their presence in breast milk or their affect on the child, the evidence is quite clear:

“No data exist on the medical use of onabotulinumtoxinA [BOTOX®] during breastfeeding. However, it is not detectable systemically after intramuscular use, thus excretion into breast milk is considered unlikely. Breastfeeding appears to protect infants against botulism.”

In other words, botox isn’t detectable in breast milk. To further drive home the point, even in a patient that became ill after ingesting botulinum from tainted food (not cosmetic botox injections), she didn’t pass the toxin along to her fetus. So even if it’s present in high concentrations systemically during an active infection and still doesn’t reach the breast milk, then it’s even less likely to reach breast milk when present in lower concentrations associated with cosmetic, localized injections.

As an aside, botulism from tainted food is the same reason you don’t feed honey to a baby before the age of one because of the presence of the botulinum bacteria. After age one, children are better equipped to ward off the infection.

There you have it. The data. And now you can make an informed decision based on that.

Click here to check pricing from Dr. Kaplan!

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyHealth.

The post Botox, Xeomin or Jeuveau during pregnancy and breast feeding first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

The major categories include reconstructive plastic surgery, pediatric craniofacial surgery and cosmetic plastic surgery. Cosmetics is further divided into surgical and non-surgical cosmetic plastic surgery. So while Botox is within the field of plastic surgery, it is part of the non-surgical aspect of cosmetic plastic surgery, also known as cosmetic medicine.

Is Botox plastic surgery?

Any treatment that affects the functionality or appearance of the body is generally within the field of plastic surgery. Botox has an affect on the function and appearance of the body by its interaction with the receptors on muscles and sweat glands.

For example, Botox can minimize movement of muscles that cause wrinkles. That’s why a Botox injection around the 11’s in between the eyebrows or the forehead and reduce those lines. Giving someone a more youthful appearance.

The same receptors that cause muscle movement can also cause sweat production from sweat glands. And through the same interaction with receptors on sweat glands, Botox can minimize sweating from the armpits or palms.

Botox is a very versatile treatment and lasts for 3-6 months. It’s starts to work within 1-3 days and hits its maximum effect at 1 week.

There’s a great deal of misunderstanding around Botox. For example, many patients are told they can’t work out or bend over after treatment. There’s an unwarranted fear that the Botox could diffuse to another area when exercising or laying down, resulting in an unintended affect on other muscles of the face. Potentially causing an eyelid droop.

As I tell all of my patients this doesn’t happen from diffusion or movement of the Botox after injection. It’s not like sauce in a saucepan. It’s doesn’t slosh around. If someone has an eyelid droop or unintended effect after Botox, it’s because too much or too little Botox was injected in an area adjacent to the planned injection point.

To check pricing on Botox from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Is Botox plastic surgery? first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Botox LIVE Event!

Dr. Kaplan will be on hand to give a short presentation on Botox and fillers. Greg, the host of 99.7Now Big Bay Mornings will be the emcee for the evening. He’ll be taking questions for Dr. Kaplan from the audience. And after your questions are answered, Dr. Kaplan will perform live injections on one of his patients (sorry, attendees, you won’t be getting treated that night)!

However, attendees will receive $50 towards treatment of Xeomin (competitor to Botox) when you come into the office to smooth away lines on the forehead, the “11’s” or crow’s feet.

Space is very limited so RSVP by texting or calling us at 415-923-3005 or DM us @realdrbae on IG.

We hope to see you there!

The post Botox LIVE demo with Dr. Kaplan, Caviar Co and 99.7! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Join the Bae Club (aka Club Kaplan)!

For those of you not aware by now, Dr. Kaplan goes by Dr. Bae on social media! As silly as it sounds, this online persona has taken on a life of its own. He’s still the same person regardless, but being Dr. Bae in the Bay Area just made sense on Snapchat and Instagram. Spelling it B-a-e rather than B-a-y is simply a play on words.

And now Pacific Heights Plastic Surgery and Dr. Kaplan are launching the Bae Club! The Bae Club is an additional way to provide our patients with a high end, VIP experience.

When you join the Bae Club, you’ll enter a world of special offers just for you and the ability to treat yourself year round. Check out either the Membership or Package below and see which fits your needs best:

The Bae Club Injectables and SkinCare Membership:

• Up to 20% off Botox/Xeomin, fillers, Latisse and Obagi skin care products.
• Get treated, or purchase, as much and as often as you like and always get up to 20% off.
• All you do is pay a low monthly membership fee (automatically charged to a card on file).
• Purchase must be made online by clicking the button below. Can not purchase in office.

Purchase your Membership HERE!

The Bae Club Wrinkle Reducer Package: 

• Come in the office every three months, get 20 units of Botox/Xeomin and walk right out of the office!
• Instead of paying a lump fee for treatments at each appointment, you pay a little each month with an automated charge to your card on file.
• You’re getting the treatments anyway but instead of paying the full amount every three months, you pay a monthly fee that covers your cost for the year – but at a 15% discount!
• Purchase must be made online by clicking the button below. Can not purchase in office.

Purchase this Package HERE!

We know something new like this can be confusing so please don’t hesitate to call with any questions. Dr. Kaplan (aka Dr. Bae) and his team are always available! Call or TEXT us at 415-923-3005.

The post Introducing the Bae Club! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

This recent Wall Street Journal article highlights the increasing competition in the neuromodulator market. A neuromodulator is the fancy term for a chemical used to relax facial muscles, thereby reducing wrinkles, ie Botox! In most industries, when you have more competition, that benefits the consumer by forcing lower prices. Will these competitive forces cause Botox to lower its price? Don’t bet on it!

Why more competitors won’t force Botox to lower it’s price

It is a natural assumption that with more options for a particular product, prices will go down. That’s why competition is good. But Botox is different. We’re most familiar with Botox for relaxing the wrinkles in between the eyebrows. Or treating a gummy smile. Or narrowing the jawline. But it has other uses that are less cosmetic.

Botox (and it’s competitors Dysport and Xeomin) are also great for medically necessary problems. Babies that have problems with bowel movements can get Botox to relax the anal sphincter. It can help with hoarseness. It’s an appropriate treatment for torticollis – a severe spasm of the neck muscles that causes the head to tilt. Medicare and other insurance companies will cover the cost of Botox for these medically necessary issues.

But because Botox has an agreed upon cost with the Federal government (Medicare) and other insurers, they have to be consistent with their financial practices. For example, if Medicare or an insurance company agrees to a certain cost for Botox, the makers of Botox can’t charge doctors a different rate. Said another way, if they charge the doctors less that are using Botox for cosmetic purposes, then the government or insurers won’t agree to pay a higher amount. Or at least it will bring up the uncomfortable conversation of why they’re charging one group one amount and more (or less) to a different group.

So they can either charge everyone (doctors, Medicare and private insurers) less, or charge everyone a higher rate to obtain a higher profit margin. Because the makers of Botox generate a lot of revenue from the medically necessary side of business, they don’t want to take a hit by lowering the cost to be more competitive with the cosmetic side of their business. Make sense? If not, comment below.

While we’re on the subject, check pricing on Botox and Xeomin from Dr. Kaplan by clicking here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Will more competitors force Botox to lower it’s price? first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Patients often ask me how they can make their Botox last longer. In other words, how can they make their facial wrinkles stay away for more than three to six months. And not just the typical lines treated with Botox like in between the eyebrows. But also the forehead lines and crow’s feet. Well, here’s the answer, sort of. A study was performed with a competitor to BOTOX® Cosmetic, known as Xeomin®, but it provides the same insight.

Making Botox last longer (or Xeomin in this case)

The study looked at what would happen if a doctor gave a patient more Xeomin than usual in a particular area. For example, 20 units to the 11’s or lines in between the eyebrows typically lasts for three months. So what would happen if 37 patients were divided into three groups. One receiving 20 units, one receiving 60 units and one receiving 100 units to the 11’s. How long would the effect last in each of those three groups?

Based on the results, the patient’s 11’s returned after ~4 months if they only received 20 units. But the effect lasted ~7 months in some patients with 60 units and ≥11 months in some patients with 100 units!

By 9 months, 23% of those in the 100 unit group continued to have no wrinkles in between the eyebrows (11’s).

According to the study, safety of Xeomin at higher doses was favorable, with no unexpected safety findings. So next time you’re getting your Botox fix, ask your doctor about getting a higher dose of Xeomin for longer lasting results.

To check pricing from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post How to make Botox last longer? Triple the dose! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Dangers of Botox Injections

So in short, the dangers are extremely minimal, temporary and rare. Botox or Xeomin (and all of the products mentioned above) are injected with a small needle. The most common areas to treat are the lines in between the eyebrows, forehead and crow’s feet. It can also be helpful for TMJ pain, lines around the mouth, a gummy smile and sweaty palms.

“…the dangers are extremely minimal, temporary and rare…”

A physician can treat all of these areas with minimal issues other than bruising, that’s the most common danger. Obviously that’s temporary and won’t affect the final results. Next “up the ladder” of potential dangers is over-treatment that can make you look frozen or make one eyebrow droop more than the other.

The most serious risk that people often cite is difficulty breathing. This is very rare and may occur in situations that are completely NOT cosmetic. Some patients with torticollis, a severe contraction of neck muscles, will use Botox to relax those muscles so they can straighten their head and neck. There’s a nerve that runs along those muscles that controls breathing. So yes, it’s possible to over treat those muscles and affect breathing. But clearly, this is a very rare disorder with a rare complication due to Botox.

In summary, Botox or Xeomin are very safe products to use for reducing wrinkles. And while there are no studies showing that Botox or Xeomin is safe in pregnancy, there are also no studies showing it’s unsafe either.

To check pricing on these services from a doctor near you, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post What are the dangers of Botox injections? first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Don’t forget the under eye wrinkles!

The orbicularis oculi muscles around the eyes are responsible for creating the crow’s feet. Those muscles are always active throughout life. But the crow’s feet start to show as the skin thins with age.

As the orbicularis wraps around the lower aspect of the eye, around the lower lids, this muscle can also cause under eye wrinkles. Often times, your doctor will inject and treat the crow’s feet but forget about the lines under the eyes. The concern is that if treating too much of the muscle with too much Botox/Xeomin, the patient will have trouble closing the eyes.

However, there are ways to relax these under eye wrinkles and avoid those pitfalls at the same time. First, just treat the outermost aspect of the under eye wrinkles. Next, use a very small amount of Botox/Xeomin (less than 5 units) and inject very superficially.

This will smooth out those wrinkles, complementing the smooth wrinkles where the crow’s fee used to be. To check pricing on this treatment from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Botox or Xeomin to the crow’s feet and under eye wrinkles first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

When it comes to fillers, there are a couple drawbacks (but they don’t outweigh the benefits!). Pain and bruising. For those not aware, injecting fillers can be more painful because of the thickness of the material. Compare that to XEOMIN®, which has the consistency of water, and therefore doesn’t hurt “going in.”

But fillers don’t have to hurt with the help of a dental block as I’ve written about here. Aside from pain, there’s also a way to minimize bruising when injecting fillers like Radiesse or Belotero (or Restylane or Juvederm for that matter).

How to minimize bruising when injecting fillers

The single most effective way to minimize bruising is avoiding what causes bruising. And that’s need sticks. The more needle sticks into the face, the greater the chance of hitting a blood vessel and therefore the greater chance of creating a bruise. Reduce needle sticks, reduce bruising. Makes perfect sense, right?

However, it may not be obvious how to go about providing a full correction to someone’s hollow eyes, under-projecting cheek bones or deep parentheses lines without creating a lot of punctures into the skin. The answer? Good planning and blunt cannulas.

As you can see in the diagram above, you can either treat all three of the aforementioned areas with many needle sticks (image on the left). Or you can use the blunt cannula and inject all of those areas with only two needle sticks (image to the right)! The choice is obvious. The video below shows how a dental block and blunt cannula can also be used for lip fillers, making the experience much better for the patient.

Video using the blunt cannula to plump up the lips

Seek out a practitioner that is competent in using a dental block and blunt cannula. Less bruising and less painful. Unless that doesn’t sound appealing to you!

To check pricing on filler injections from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Injecting fillers with a dental block and blunt cannula to minimize pain and bruising [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Later haters!

In the past, getting botulinum toxin (ie Botox), was considered taboo. Women were embarrassed for friends and family to know they were getting treatments to minimize wrinkles.

Fast forward to today. Not only are women not as concerned if everyone knows they are finding ways to reduce their wrinkles, more men are entering the fray! As this new campaign shows, no one should be embarrassed about feeling better about themselves.

So while most empowerment rhetoric refers to getting involved politically to determine your  own destiny, the Later Haters campaign wants women (and men) to feel comfortable doing what gives them more self confidence.

Follow XEOMIN® on Instagram here. And to check pricing on wrinkle reducing treatments like XEOMIN® from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Later haters! The latest XEOMIN® Campaign first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Gummy smile treatment

There are two typical treatments of a gummy smile. Injection of Botox into the muscles so that excursion, or movement, of the lip is lessened.

The other option is reducing the height of the upper jaw. This is as invasive as it sounds. Reduction of the upper jaw requires the breaking and impaction (shortening) of the upper jaw, to reduce the show of the gums.

In the before and after below, you can see the results of the fairly non-invasive Botox injection for gummy smile treatment. Not only does it reduce the amount of gum show, it also makes the upper lip look fuller. As if the patient has received fillers, but they have not.

To check pricing on the treatment of a gummy smile from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post This Gummy Smile Treatment is Amazing! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

With every new patient I see, whether they’ve had Botox or Xeomin elsewhere or they’re “virgins,” they always reference the same myths about Botox. It’s not their fault. When patients read the same bad info online or hear the same bad info from their friends, it’s not surprising they start to believe it.

Myths about Botox and Xeomin

1) The Botox might move

It doesn’t. I always provide the same analogy when speaking with patients. Botox, after injection, is not like sauce in a saucepan. It doesn’t slosh around and affect other muscles that you didn’t intend.

I guess if you put a horse-dose of Botox just above the eyebrow and massage aggressively it could affect the eyelid. But you would really have to administer Botox incorrectly to approximate this issue.

My favorite is when patients were previously told not to wear a hat with a tight headband (ostensibly it would affect the Botox injection to the forehead). Or don’t lay down and go to sleep too soon after treatment because again, it will spread. I’ve never seen this happen.

Botox, when injected correctly is done with very small aliquots of fluid. And if you’re injecting correctly into the muscle, it’s very difficult to spread in the subcutaneous tissues (under the skin). Is anything possible? Sure. But have I never seen this problem? No.

2) I can’t drink after getting Botox

Drink. I’m not sure what the underlying science is here. Could you bruise more after drinking? Maybe but if you’re gonna bruise, it’s happening whether you drink or not. So drink! L’Chaim!

In 10+ years of practice, I’ve never seen a bad reaction when someone did one of these forbidden things after getting Botox. I’d be interested to hear anyone else’s opinion. Has this happened to you? To one of your patients?

In the meantime, to check pricing on Botox or Xeomin in San Francisco from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Two Myths about Botox and Xeomin first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.