Las Vegas, NV | Botox - Myint Minute | Myint Oculo Facial Plastic Surgery
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Dr. Myint: All right so what I'd like to do today is talk to you a little bit about how to reconstitute the botulinum product. So here I have a 50 unit vial box. In the state of Nevada we have two vials. We have a 50 unit and a 100 unit. And I'm going to do a 50 unit and you can adjust the ratio on the packaging that you get.
Dr. Myint: So we have the bottle of Botox and it's recommended to do the dilution with 0.9% sodium chloride bacteriostatic solution. That's what we're going to use. I have a three cc syringe here, and then I have a TB syringe, which is what I'm going to inject with. So what I've done is I've taken out 1.25 ccs of the bacteriostatic saline solution into this three cc syringe. I've already drawn it up.
Dr. Myint: What this does is gives you a dilution of four units per 0.1 ccs of injection. So that's the dilution. You can mix your own dilution, but what I am showing you is what the FDA approved and which is what I use in my practice, which was four units per 0.1 ccs. If it's a 100 unit vial bottle, you just adjust that accordingly. So let's go inject.
Dr. Myint: All right. So, so let me explain a little bit where these, what these marks mean. What I've done is created five points along the glabellar area, two in the corrugators, one in the procerus. And where I marked these exactly are the boundaries of the corrugator muscle action. Can you from for me? There you go. You can see how strong her corrugators are. And this medial most portion is the lateral most portion of the corrugator. And then I have one just lateral to that, same thing on this side. And then this is where the procerus muscle in the center.
Dr. Myint: I have marked three spots for the frontalis muscle. Now, notice that I put these marks pretty much within the center of the forehead. The reason why is I'm trying to stay within the pupillary axis. If I go beyond that, you're risking some brow ptosis.
Dr. Myint: All right so if you can see there's a 30 gauge needle. I have a TB syringe, and I had mentioned on the reconstitution portion of the video. Every 0.1 cc injection is going to release about four units of botulinum intramuscular. We know that botulinum can diffuse one centimeter. You can put it just subcutaneous and just let it diffuse into the muscle. So we're going to start this first one. So we're going to put about four units in here. So here's the injection point here. Okay? So I'm going in and we're going to push in, that's four units right there. You okay, Jen?
Dr. Myint: We're going to come over here to this corrugator muscle, same thing. We're going to come in and four units I'm coming at about a 45 degree angle. You can do it, some people do come in at 90. I don't see any reason why we need to. I think by 45 degree it's much nicer, more comfortable for the patient and you can deliver this into the muscle. Here's the procerus. So we're going into the procerus muscle. Same thing. I'm at an angle. Here we go. We're going to do another one here. And then one last one here into the corrugator. There. You okay?
Jen: Yeah, I'm fine.
Dr. Myint: And I'm going to inject here again for the frontalis. And here I'm going to put about two units. Two units there and we're going to go about two units here. You okay?
Jen: Yep. I'm fine.
Dr. Myint: And there's the injection. So a centimeter above the rim is critical to avoid the diffusion, allowing ptosis, which we are certainly trying to avoid. Sometimes you can get this Spock appearance and in those instances, it may be necessary to put a small amount of Botox here to avoid that peak.