Botox beyond wrinkles: Leslie Fletcher talks lesser-known uses

Botox injections may be best known for smoothing the face, but some providers are using it for so much more. Most of us know it can soften frown lines, forehead lines, and crow's feet, but there are lesser-known uses. They go way beyond wrinkles here, and many are considered off-label. So here to explain what's established and what's still being studied is our plus-one-of-the-day, board-certified nurse practitioner, Leslie Fletcher. Welcome. Thanks for having me. You're incredible. You really are. thank you thank you we really are and we don't know the half of it in terms of what botox is used for everyone says okay it's used for wrinkles but there's so many more ways that you're using botox or you're teaching people to use botox as well so let's go through some of these and the ways they're being used so what does off label mean in terms of the way it's being used okay so off label are basically any area that the pharmaceutical companies haven't gotten FDA approved for that specific indication yet and I think we have a graphic coming up of all the different off-label and investigatable uses and some that are they own patents for but for cosmetic use there's four areas on label which is the frown which we're used to seeing right the forehead lines the horizontal lines and the crow's feet or lateral canthal lines and then the newest one is the neck the platysma the neck bands and that is the first time any country has approved a lower face cosmetic use but you're seeing this graphic as you were mentioning look at all the areas on the body that you can use Botox so this came out in 2017 2014 actually I've just updated it with some of the newer indications and studied areas but all of this therapeutic use I mean those are pretty impressive so if there's anyone out there that's still a little nervous about putting it in the localized frown line look at all the areas they're using it there. Right, you're talking about migraine, tennis elbow, joint pain, plantar fasciitis, excessive sweating, and a lot of those we do in conjunction with our cosmetic indications as well. And you said neck injections or injections right here are the newest. That makes a big difference. So how does that help? Yeah, so two ways. So the one that's on label is the vertical neckline, so those little bands that kind of come from the chin. Go like this. Yeah, like the E, you can all see them do it sandra oh okay you must have gotten your neck injected i haven't i need to but look at these photos what a difference yeah so you can smooth that out um using so the muscle is called the platysma basically the job of it is to pull the face down so when you relax the face the lower pole it allows some of the elevators to lift so there's this almost a paradoxical lifting effect that we get after we relax the depressors so it's really amazing but then you can even take it further you can wrap it around here for like the little waddle area which i think you saw that kind of smoothed out the double chin but you can even take it further and inject it more superficially and this is how i love to do it this is kind of one of my specialized things i trademarked microtox to do it really superficial it helps tighten the skin by reducing some pore size oil some secretions some over inflammation and that pull down that you're getting with all that fluid that we don't even know is there the inflammation will actually allow the face to lift up and you can even smooth out some of the the glands like the parotid gland the submandibular gland and you're actually just smoothing out the inflammation above it but it shows up like volume in the neck so it does help tighten and make that neck look nice and lean are you seeing more men or women come in for that specifically so the women the neck belongs to the women it really does i think when we get our men in it's traditionally going to be kind of that frown that angry look they want to keep up with their wives we're hearing that a lot the wives are looking younger and the men are just kind of aging like because now that gap is getting a little bit greater right so oftentimes we'll get men in for that but i mean there have been some that are concerned about the neck and the volume in their neck too as well especially that that parotid gland slimming is really nice on a man because it will really chisel out that jawline it makes it little bit tighter yeah but you know you can you can kind of mess up the neck a little bit too if you go to D yeah so because there have been cases yeah I've I've had trouble swallowing after I've gotten yes so really so like you weren't hospitalized with like a feeding tube no like a main line no it was it was literally just like so tight yeah you can feel a little constriction but that is depth dependent right and mostly in the anterior the front part if you're out here on the sides you don't necessarily get that at all but the depth is key you have to keep it very superficial so I mean that's why training is so crucial to me because these outcomes that you can see or hear about can make or break it where someone is too afraid to try it because they hear oh I might have difficulty that's right yeah yeah and are you seeing more and more people turn to Botox for so many of these treatments yeah I mean Botox is the gold standard right I mean it's it's been around since 2002 there are different types of ones now with different pharmaceutical companies that have come out with different ones but it is kind of the entry-level drug we call it the gateway i know it's an internal term it's kind of a gateway into all the services that we offer but i definitely think that sometimes there are people who are afraid to go like the filler route or with the ha fillers and so this is a really great way to try it like the lip flip that always looks that's a nice way to kind of see how you would look with a little bit of volumization in the lip because the the muscle around the mouth is like a little tightening so it can tighten tighten and roll in that lip and as you relax it it allows it to kind of roll out and gives you just a little the name of it freaks me out lip flip yeah i just didn't just like well that's freaky that's what i'm imagining yeah good to know yeah see i live in the world i've been in this 26 years so i live in the world where all these terms we just throw them around like tip dip and lip flip and all these things. What's a tip dip? The tip dip is where we can actually inject some Botox in the tip of your nose. There's a muscle there that pulls the nose down. So you can relax that muscle and it lifts the nose up. Why would you want to tip dip it? You would want to flip it actually. So we're doing the tip dip so that it gives a little flip and gives an upturn. So there's a lot of things we can do to the nose too. So as you age obviously collagen is a big, big issue. So many women take supplements and all of that. But Botox also can change collagen levels yeah there are lots of studies on this that actually shows an increase in pro collagen type 1 which is that collagen that we need to kind of sustain the armature of the skin it can actually regulate even a enzyme that breaks down collagen it can slow that down so can actually slow down collagen and you're seeing here some pictures of a case report of twins where one twin didn't get Botox for 15 years think it was and the other one did this one is actually a patient of mine who has been getting Botox consistently for 12 years and both of those pictures are without toxins so her skin is better and in better condition 12 years later just from the Botox so it definitely is a brighter too I mean look at the shine the reflection there so that's her raising without any Botox before we started anything and And then we have her 12 years later and six months between her Botox raising there. So we see it in our clinical photography every day where a patient's skin actually looks better. And then partially when we're injecting superficially, we can tighten that skin, you know, regulate those overactive oil glands. And so that everything like the makeup just goes on smoother and it does help build that collagen. And when you're injecting superficially, it lasts just about as long as it does for regular Botox. The duration is strictly related to the dose. So that happens everywhere, whether you're intramuscular or whether you're intradermal. The duration is dose dependent. So if you're one of those patients that just wants to get a little bit, don't expect it to last a long time. We want this to last about three to four months. We call it a seasonal drug so that you just get it on the season. So three times a year, it's pretty doable for most people if you get proper dosing. and I think that's part of the problem there are a lot of practitioners out there that want to look cheaper so then they under dose and then there are a lot of patients that are afraid to get the optimal dosing so they like want to start slow but then they're not impressed with those results because they're not getting the full benefits of it yeah okay I think we're gonna keep you around if you're around i'm around okay we'll take a break and then we'll uh we'll continue we might never let you go we have a lot of questions i got stuff in my bag you do we want to see i love it before and after yeah hi there we're back talking about all things Botox but predominantly the stuff that people don't know about how Botox is being used of course with Leslie Fletcher here the expert so tell us about how Botox is used for scars because that's really helpful for people who may need that yeah so it's used in two ways so a scar prevention is the first way and that's that's the ideal because then you want to get that in like within five days of the injury or the surgery so that when that wound closes it's closing with less tension oh so yeah here we have some before and afters of some scars um so that's the ideal if you can get on it early but like some of these are we treated even after the fact years later so because of what we were talking about earlier with that pro-collagen uptick and also the relaxation of like there's a keloid scar coming in here so sometimes too much collagen is actually not good right it's unorganized and too much of it so it regulates either way whether you have too little and there's a depression or too much and now there's an elevation as in the keloid scar gotta get that sweet spot yeah what about like uh things on your skin like redness oil dark patches yes same same pathway so that's an inflammatory pathway so you've got rosacea and melasma those are both inflammatory diseases so if we can bring the inflammation down by calming down those exocrine glands which is the oil you've got the sweat you've got you know some of those inflammation that's going on in there that is actually going to help with flushing and we can see even the pores this is our pore counter on the left so those pores are looking less prominent and there's less there's a less of them it's yeah it shrinks them because they're always going to be there but if they're filled with oil right they're going to be expanded but if if you can get that oil released and relaxed then those aren't going to show up as much and then the same with the flushing you're not like getting rid of the vessels but you're quieting the hyperactivity of them and what a lot of people don't know is that women go through a lot of these changes because of pregnancy because of motherhood all of them yeah yeah so i think i have a melasma before and after there too botox can be used for molasses yeah wow it is actually we're just talking about that incredible yeah melasma specifically yes because it's inflammatory so it brings down those inflammatory markers which really helps with the pigmentation yeah it's a tyrosinase inhibitor so there are a lot of things that we take or put on topically that inhibit tyrosinase this is actually a chemical version of it so we're injecting it and the duration does last the same as uh botox like the four months or so with the scars though sandra this is interesting the scars is actually um like i want to say curative almost like it actually controls that collagen you don't have to keep repeating it with the scars but the melasma and the rosacea because it's an ongoing oh there's stop right yeah it takes years i feel I've tried lasering, I've tried all of it, like bleaching creams, all of it. Yes. I mean, the bleaching cream is the gold standard, but this is, we actually, the photo I have is I have her before and then after Botox and then after hydroquinone. And the bigger change was actually between the Botox before and after and the hydroquinone. So yeah. But lasers are tough with melasma because that heat can actually activate that inflammatory cascade. So we don't want that. It can work against you, right? Yeah. lot about these like what is it like the lunchtime nose job or whatever people are calling it right a quick fix yeah so you're not actually going in and getting surgery what is that exactly we have a trademark term nasal tox it's basically using your your botulinum toxins or your Botox to inject into areas of the nose and you can see like pores are reduced this is six months apart she's flaring here even some of the little on the talls okay so that's mine yes that is my nose and that's yours yeah so like I have like a little bulbous and well it's not little but I have a bulbous nose but I inject it and I've been doing it since 2003 all around to kind of shrink the oil from there to kind of get rid of that inflammation because there's not a lot of space in the nose so any oil is going to take it and put it out so the best description of what it can do for the nose is it's like putting it in the dryer it makes it smaller smoother less wrinkles it's a shrink wrap effect and you inject yourself when you do when you would do the injections so in 2003 when i did my nose the first time i have to admit i did inject myself nobody wanted to do it it was not a thing back then yeah and i i don't have a problem doing that but um i didn't know to numb back then but now i do okay okay yeah but not only cosmetically there are some benefits also using in the nose for snoring which is huge like a lot of these these things scarring snoring and these are game changers for people right yeah definitely so so the the haytox is kind of how it's colloquially it's called is where you're actually injecting inside the nostril into the lower turbine I think I have a picture up here of a gentleman that we injected um and it was see how it's like red and swollen yeah imagine all that constriction from that inflammation in the airway or the nose passage and then that's the next morning and you can see the redness, congestion is gone. He felt like he could breathe better. We hear a decrease in snoring. We also hear that from slimming of the neck though, because if you have a lot of volume in the parotid and the submandibular glands, as you sleep, that congestion can be here. So we have a couple of ways we can help with snoring. Yeah. And that's for, that's for the patient and their partner. But for the, for the Haytox, it will help. It's so crazy. It will help for a chronic rhinitis so dripping or chronic congestion so if you're like chronically congested it helps it opens up the fast way and then if you were chronically dripping it actually helps turn off that faucet wow okay this was also surprising for me pain yes used for pain relieving pain yes i always feel like my body is broken i know and the older we get You need a full body. Inject me all over. And body talks. It's very true. So theratox is the trademark term that I developed. And another self-experiment, I had plantar fasciitis in the early 2000s. And it's fascia. So a lot of people were telling me, including my podiatrist, that it wouldn't help. But I'm like, it has to help because Botox is like the Windex in my life. It works for everything. It's the right of the toughness. Exactly. And so I did. I injected my plantar fasciitis and so the fascia is inflamed and so at this point now we know that it brings down inflammation so any type of myofascial pain that you have in your body whether it's tennis elbow, plantar fasciitis, Morton's neuroma, golfer's elbow, some shoulder pain, trap pain, TMJ, oh yeah so this is the, we were talking about the The Pilates stance, and so when we inject sort of the anterior area of the shoulder or the pec minor muscle, it's so tight from all of us kind of just doing this all day long especially. Computer the phone. Yeah, exactly. And so that, and it's not even a lot of units, like 30 units, it can just roll that out and give you this open stance and you feel it almost immediately. Better posture. Yeah. You look better. Yes, so it's pretty incredible all the different pathways. This is working on the pain pathways, so something called Substance P and CGRP, which is all documented because it's also FDA approved for migraines, so it works in the same way. It's working on the pain pathway, so it's like the inflammation around the nerve, actually, and so anytime we're doing it in the traps or any of these other areas of pain of the body, it works in that same pathway. Back pain. Well, yeah, because you know, when you get bad migraines, it can, like, sometimes the back of your neck can hurt. Yeah, exactly. And that's part of the paradigm here in the occipital area. It's all connected, yeah. We have so many muscles in our face that you don't even realize it until you actually get Botox. You're like, oh, wow. Yeah, and each one has a corresponding relationship, too, which is really another advanced discussion. It's like when you relax here, you're getting stronger here. So if you want a really nice brow lift, really not putting too much in the forehead is the key. But then you've got to make the patients happy because they don't want the wrinkles there. so we have to just dust it a little bit but then it doesn't last as long there so there's just like a lot of a lot of working parts to making sure that we're we're working on those muscles and their neighboring muscles that actually work stronger so it is it's pretty fascinating and it's not as easy as it looks i think that's something that we're trying to work on as as a field of medicine is that sometimes on instagram or tiktok you just see us quickly you know and it's like oh let's just get a jab here and a jab there but there's so many different things to think about like what's going to happen anticipatory right you have to it's like almost a blind technique you have to think what's going to happen two weeks from now what muscles are going to start working stronger so it's very complicated well you certainly know your stuff you're the expert thank you so much for sharing some of that expertise with us leslie you're amazing of course if you're curious about any of these treatments you can find her on instagram at injectability beauty and on her website injectabilityclinic.com thank you for coming in Thanks for having me. Thank you. Wealth of information. Literally talk to you all.