TRANSCRIPT 🔗
Ravi: So Botox is actually a happy drug, I would say.
Amber Graafland: I listen, I agree. And I think all my friends would agree as well. I don't think you'll have anyone arguing against you there.
Ravi: We're told a lot about beauty, what to inject, what to laser, what to freeze, and what's suddenly out. And apparently how our faces should be looking this week. I'm Amber Grathland, a beauty a fashion journalist with over 20 years of experience and a very healthy scepticism about beauty trends. Together we're asking the questions that nobody else seems to be asking. What actually works? What's clever? Definitely what's not. And what's new? What's next? And what's everyone excited about? We'll talk treatments, technology, trends, ageing, and but we'll focus on beauty culture and all the grey areas in between. Basically everything you talk about with your friends, but through a professional lens. No hype, no judgment. Well, maybe just a little. In this episode, we're going to address the trend about Botox being bad for you, Botox not working anymore, and we're going to address why that could be, is it true, and how to prevent and avoid that. We're also going to ask you a favour about our podcast, and we really would appreciate your input. So before we go any further, please press the subscribe button. It's absolutely free, it doesn't cost you anything, but it makes a massive difference to how many people get to see. our work here. Anyway, let's jump into the episode.
Amber Graafland: Okay, should we discuss the fact that we might be changing the name of the podcast? Do we think that we should get some feedback on that? Hmm.
Ravi: Well, I was thinking, you know, I was just, I was thinking, what do people say in clinic a lot of the time? And, and I listened to quite a few podcasts at the moment and they, tend to have a topic that, a title that's not directly what they're talking about. It's more
Amber Graafland: True.
Ravi: about what the, the message is almost
Amber Graafland: Yeah.
Ravi: something, something a little bit more indirect. And I felt that our title. maybe a bit too brazen or something, a bit too in your face. I was just thinking, I just wondered what you, and I'm happy to talk to you about it. You know, this is a discussion, it's our podcast and I want us all to be happy, but just thinking when... some patients come into my room and they they're trying to point something out to me a line or a wrinkle and I literally cannot see it. Okay.
Amber Graafland: Mm.
Ravi: And because we have a mean this is the treatment room we're in is a beautifully lit daylight room. And they go it's because of your light, it's too good. But in certain light, you can see it.
Amber Graafland: That's brilliant. They yeah.
Ravi: And when I've gone on lectures and talks around the world, and I describe patient consultations, and I mentioned this phrase, how many of your patients, and this is to hundreds of people in the room, how many of your patients say, in certain light? You can see this only in certain lights. And everyone
Amber Graafland: Yeah, that's pretty good.
Ravi: puts that. So I just wondered, from that point of view, that would be good. But also,
Amber Graafland: What the one that comes to my mind, because obviously I'm coming
Ravi: Go on.
Amber Graafland: at it from a very different angle, when get together, if there's a a room full of women, what they all say is thinking of getting anything done. Or what have you had done?
Ravi: Okay.
Amber Graafland: Yeah. Because everyone wants to know if they're missing out on something, if people have got stuff that they know about that no one else knows about. So that's kind of
Ravi: So the name would be thinking about getting something done. What was?
Amber Graafland: Yeah, or yeah. Or what have you had done, you know? Yeah.
Ravi: What have you had done? Okay, that's one. Yeah, what have you had done?
Amber Graafland: Yeah.
Ravi: we're have to think about this.
Amber Graafland: Yeah. I actually catch my like really good friends sometimes if there's like a pause in a conversation which is rare because they talk as much as I do. I can catch them staring at me sometimes. I'm like, why are you staring at me? They say, Mm, just wonder if you've had anything done. Wow. Yeah. Yeah. Yeah.
Ravi: That's good, isn't it? Or what she had done. But yeah, what have you had done? Yeah.
Amber Graafland: We love it. We can't get enough of it. So yeah, it it it's a conversation that crops up rather a lot.
Ravi: Well, maybe we put a vote out to our
Amber Graafland: Yeah.
Ravi: poll out to our listeners and see what they come up with. I'm just going to put Alright, so that's your that's your one your pitch, what have you had done? Yeah. And my pitch is in certain light. Now the
Amber Graafland: Yep. Yep, that's me. Yep.
Ravi: other side angle of certain light is that because we talk a lot about the background of aesthetics and treatments and dispelled myths and stuff. I felt like we're shedding light on
Amber Graafland: Very good.
Ravi: information on shedding light in aesthetics. So you're seeing this in a certain light as well. So from my point of view, your point of view.
Amber Graafland: Yeah. Yeah, yeah. Because we are trying to present every single angle and not just give it this sort of marking spin. I like it. Yours has got a bit more mean
Ravi: Yeah, so what we'll do...
Amber Graafland: a bit more depth to it, Ravi, than mine.
Ravi: maybe, maybe not. But I don't I'm not going to decide. think we're gonna play
Amber Graafland: Yeah.
Ravi: people who are listening, please put comment in your in the comments below. What do you prefer in certain light? Or what have you had done as a new potential new name for our podcast? And we'll take it on board. We'll take it
Amber Graafland: Okay. Well, I'm intrigued. Yeah.
Ravi: on board. So apart from that, have we got anything else to talk about this week?
Amber Graafland: Yeah, so this I mean, it's a topic that gets a
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lot of of airtime and there's a reason for it, Botox. But we're not just we've we've have done a podcast on what it can do, what it can't do, and I think we've looked very much at sort of the the the sort of technical side of it. But I think something that I'm increasingly hearing and reading about is people saying that their Botox doesn't work anymore or it doesn't last anymore. And it's and I thought actually Maybe as we do get older, maybe it doesn't work anymore and it doesn't have the same effect. I mean, or I definitely think it works differently. So I thought I was actually going to put this on to you and actually get the the the actual explanation as to what what what changes. It's such a huge industry. I tried to get a stat on how much it's worth. I mean, 10 billion was the figure that I saw last week. So there's a lot of people who are going to be interested in this because there's a lot of people using it and it's a really, really effective treatment to have. But I think if people are thinking that it's not working anymore, why are they thinking that?
Ravi: It's a good point. And people do talk about it a lot in clinic. And they wonder why. And it's, you know, there's many, many, many reasons, starting from what were their expectations? So what does not work in mean, actually, you know, does it mean
Amber Graafland: Yeah.
Ravi: that you're not frozen anymore, and you've started to have some wrinkles starting to come back, which is really the optimal effect of Botox, we don't like
Amber Graafland: Yeah.
Ravi: frozen. And I think for a lot of younger people and their first time they try Botox type treatments, they get this sudden freezing and they love it, especially, know, sub thirties, they love no movement or even sub 35, they love no movement because they don't have any lines on their face. So it looks completely natural to them. But if you give someone who's 45 plus, who've got some signs of aging on their face, and they're frozen, it's going to look unnatural. So I think possibly that's one aspect of it doesn't work anymore. It's not frozen anymore. Okay. And that's one interpretation. The other side is, is big science, big, sorry, lots of noise going on in the industry about do people develop resistance? Do they develop antibodies to the to the botox protein? It's a peptide at the end of the day. And
Amber Graafland: Yeah. I read that and I was quite interested in that.
Ravi: Yeah. And it's a it is a risk. It does happen, but it's exceedingly rare. Okay, exceedingly rare. I have seen one patient in 20 years, who came to me because she has resistance and wanted to try a new type of Botox, which she hasn't tried yet. But I have not seen resistance developing any one of my patients. Okay.
Amber Graafland: Mm.
Ravi: There's reasons for developing antibodies to Botox. too frequent treat have a treatment. not long enough intervals between treatments. So many patients expect to have their treatment and then they have their two week top up, which in their eyes is compulsory. That's part of their treatment, which they paid for. It's not just so you know, it's there as a just in case it needs tweaking. But if it doesn't, we don't treat.
Amber Graafland: Yeah, that's what I always understood. Yeah. It was just to sort of review and to see, you know, that that that you had the effect that you wanted. I didn't think it was a let's get it top
Ravi: Many,
Amber Graafland: up.
Ravi: many patients expect that as part of their treatment to improve the longevity.
Amber Graafland: Mm.
Ravi: And then they come back at the earliest sign of movement. So they may be a three month interval. So anything more frequently than that increases the risk of developing antibodies, which will cause resistance, okay. And given the fact that all of the cosmetic use botoxes are come from the same type of, well, they all have the same protein type in it, you're likely to be resistant to all of the botoxes. So That's when people might think that their Botox is not working. It won't just wear off, it won't just be shorter, it'll probably not work at all.
Amber Graafland: Okay. Yeah, 'cause that's another thing I hear that it people will say to me, it d it doesn't last as long as it used to.
Ravi: Okay, so that when they say it doesn't last as long as it uses that again, that could be to do with dosing, maybe they've gone to another practitioner who uses a lighter dose. Maybe
Amber Graafland: Yeah.
Ravi: you have to use a lighter dose, because if you use the regular dose, they'll start to get complications, like a heavy brow or heavy lids or wrinkles
Amber Graafland: Mm.
Ravi: elsewhere. It's quite normal for your anatomy to change over time. You know, the muscles thin out, they lose their strength, their tone. So the doses do have to change and the muscles will respond differently to Botox as you get on anyway, naturally.
Amber Graafland: Yeah. You can't assume that what worked ten years ago is gonna have the same effect on your face. That's naive.
Ravi: And many people also say that these, the Botox has caused certain wrinkles, and it's not working as much. And that is likely to happen as part of the aging process, the, you know, the Mr. Spock wrinkles that
Amber Graafland: Mm.
Ravi: happen there. That's because the brows naturally coming down. If you Botox that you're likely to get a brow drop. They weren't there before. That's because you weren't as old as you were now that they've come along, you know, so
Amber Graafland: Well I bet they love it when you say that, Ravi.
Ravi: Do know what, this week I've been a bit too candid, I think to some of my patients. Yes, yeah,
Amber Graafland: Have you? Mm-hmm.
Ravi: I have been a bit too candid. And maybe it's just one of those weeks. I think they will
Amber Graafland: You see.
Ravi: all vouch for me as well and say that that has been the case this week, Dr. Jain
Amber Graafland: Yeah, but peep people need to hear the truth. There's no point sugarcoating this
stuff. I have got a friend who's absolutely brilliant. If you ask her about Botox, she just says, This is the one area we have to be really clear. And apparently she goes in to whoever does her Botox and says, I do not want any movement on my face. Don't go in and say, I'd like to look quite natural. I just want to soften this, if that's not what you want. She doesn't want her face to move. And so that's what she tells the person who's going to administer the Botox. You've got to be very clear about what you want to achieve. There's no point saying all I I don't mind. Just soften it all if you really do want your face to be smooth.
Ravi: But Amber, what often happens that we, I guarantee you 99.9 % of my patients want a natural look. There'll be about 10 % of them that the minute, the minute they start to move a muscle, they'll be in the chair again, saying, I need more. I go, but this is natural movement. This is natural.
Amber Graafland: Yeah. Yeah.
Ravi: Okay, you wanted a natural look. What you and I say to them, let's be honest, what you really want is a frozen look, isn't it? And they go, yeah.
Amber Graafland: Yeah, so I think my there's a lot in what my friend says, and it really made me think you've got to go in and just be really, really honest about what you want. Because going back to you being quite candid, it has to be honest relationship both ways. Otherwise you're not going to leave with what you wanted. another question for you regarding Botox. Do you think, and this is a little bit controversial, that maybe it's just because we all look at ourselves a lot more that we are a bit more critical? Like the whole selfie generation that you know, I I'm not a fan of looking at pictures of myself, but I I I I exclude myself from this 'cause I'm too old to be included in it. But young younger people take a lot of pictures of themselves. Do you think they're just noticing it more?
Ravi: Well, you know, an aesthetic patient generally is more self-critical. Okay,
Amber Graafland: Yeah.
Ravi: or, or maybe that's the wrong word, maybe more self aware of their appearance, you know. And
Amber Graafland: Yeah.
Ravi: once you start a treatment pathway, you naturally check if it's working still, because you spent a bit of money on it, and you want to make sure you get
Amber Graafland: Mm.
Ravi: value. So they perceive Botox as a, as a fixed commodity that you I've spent this much, therefore it will deliver this much.
Amber Graafland: Yeah.
Ravi: But you know, I'm sure there are other treatments or other products out there like, okay, let's look at my electric car. When I charge it up, I'm paying the same amount of money to charge it up to full, but I guarantee you it doesn't deliver the same longevity. Each time I fill it up, it doesn't because it's the way I've driven it, the temperature
Amber Graafland: Yeah.
Ravi: outside what I'm trying to say there's lots of different external factors. So with someone who where they're saying that Botox doesn't work, there's ageing, there's how often have they had the treatment? Have they developed antibodies or not? Have they had different doses? Have they had a different type of Botox? Because the units in Botox aren't the same in all the other different types of Botoxes. You can't just interchange. You can't tell a
Amber Graafland: Wow.
Ravi: practitioner, I had 40 units, so I want 40 units now. 40 units of one Botox might be 120 units of another, and you'll get the same
Amber Graafland: Yeah.
Ravi: effect. know, so there's that. Exercise has actually shown to have a difference. We're not quite sure. Temperature while different botox that has an impact. We know that there's too hot, it can reduce the intensity of the effect when treated. So there are lots of external factors. And of course, know, patients are perfect, you know, they've it's nothing to do with them at all. It's totally to do with the product and the injector But you know, with
Amber Graafland: Yeah, yeah, yeah. Of course. Yeah.
Ravi: Thankfully, we are dealing with humans who are alive, dynamic and healthy and want the best out of their treatments. with gentle education, not like I've done this week, they'll understand what's possible and what's not. And when Botox doesn't work or hasn't worked as much as it used to, that's usually an indication that something else is going on with their skin. Okay.
Amber Graafland: Yeah. Yeah.
Ravi: and it's usually a result of sun damage, dehydration and thinning of the skin.
Amber Graafland: Yeah, which unfortunately is is happened to most of us, even as we speak. does it still remain one of the most popular treatments? Yeah.
Ravi: without a doubt. mean, I think I've seen online that they're trying to make Botox a thing not to have these days. And listen, if there's something better, I'm all for it. But currently at the moment, the one treatment that gives the quickest, most effective and most extreme satisfaction is having Botox. The quality of life scores without doubt. are higher when you're on Botox than not on Botox.
Amber Graafland: Yeah. Hmm.
Ravi: You know, in many different parameters, know, self confidence, self esteem, happiness generally. So Botox is actually a happy drug, I would say.
Amber Graafland: I listen, I agree. And I think all my friends would agree as well. I don't think you'll have anyone arguing against you there. But it is interesting that people I think 'cause it's been around for so long, they feel like they they kind of are experts and then you do get this kind of, well, you know, it it didn't do what it used to do or it doesn't last as long. But actually I think
Ravi: But they didn't do what they used to do at the gym either, you know?
Amber Graafland: No, no. No.
Ravi: I mean, I used to lift you know, 160 at the gym. Now I can't go anywhere near a hundred, you know? So, you know, we are changing. I
Amber Graafland: Yeah.
Ravi: mean, it's definitely not going away this industry. The companies are investing tens
of billions of dollars
Amber Graafland: Mm.
Ravi: into this industry. mean, Allergan are bringing out a brand new type of Botox that's worked within an hour or two. It's a whole new strain of Botox. And the downside is it only lasts about two or three weeks. Okay. But they have brought this, they've developed this, they must believe there's a market there
Amber Graafland: Market, yeah.
Ravi: because they wouldn't waste billions on it. So there are, there's whole new types of Botox
Amber Graafland: Yeah, kind of intrigued by that one, but yeah.
Ravi: coming out to reduce the risk of antibodies. And so what we all want is a longer lasting Botox that doesn't have antibodies developing against it and is safe to inject and is reproducible. And that's what the industry is chasing.
Amber Graafland: Am I right? Do I rem I thought that some of this Botox was stronger now. I thought that was a reality.
Ravi: I'd rather say longer lasting and stronger.
Amber Graafland: Yeah.
Ravi: Yes, there are there are two types of botulinum toxin out there right now. One is called Relfydess and the other one is called Daxify. I don't know if Daxify is available in the UK. They both have studies confirming they can reach about six months longevity compared to four or five months. So there's about a 10 to 20 % increase in longevity. I've had experience with one of those, the Relfydess I find it extremely effective. Many of my patients prefer the outcome, the aesthetic appearance
Amber Graafland: Yeah.
Ravi: as well, and they do get longevity. But...
Amber Graafland: Yeah. That's that's a significant increase. So yeah, I can see why patients are loving that. Hmm.
Ravi: Yeah, yeah.
Amber Graafland: Anything else we need to know about Botox? I think we've done pretty good summary there.
Ravi: I think I think I just I think we just really want to address the myths going around online at the moment that, you know, they're trying to say Botox and last as well. And there's conspiracy theories saying, you know, they're deliberately making sure to come back more often. There
Amber Graafland: yeah.
Ravi: are some clinics whose dosing is designed to be three monthly intervals for Botox. And whereas there are other clinics like mine that I want to see the patients as little as possible. So not because I don't like them, but because I want them to be able to get good value
Amber Graafland: Yeah.
Ravi: out of their money.
Amber Graafland: Yeah. Okay. Okay, that was good. What are we gonna
Ravi: Okay.
Amber Graafland: talk about next time?
Ravi: You had a list on your last email to me, you broach?
Amber Graafland: Devices. I s I still think I want to do a dive into the into devices because I think lots of people don't really understand what they do. And I think it would be really useful to explain to people the differences and also the importance of the practitioner and not just the machine. Just because a clinic says it has the latest, greatest doesn't mean that you're going to get the latest, greatest results.
Ravi: Okay, I'm all over that. Let's do that next time. Thank you for listening. Don't forget to like and subscribe. Subscribing really helps us really
Amber Graafland: Perfect. Thank you. in the name. Let us know.
Ravi: helps us. Thank you so much. Okay.
Amber Graafland: Tá.