Dr. Gabrielle Davis on the Do's and Don'ts of Botox in This Mask-Wearing Era

The world, as we know it, stands to see face masks in our future for who knows how long so what better time than the present to indulge in your curiosity about Botox and fillers. With an abundance of information out there of Botox do’s and don’ts, we spoke with an expert in the field, Plastic Surgeon Dr. Gabrielle Davis, to dispel any rumors we’d heard (Ummm, is it okay to start Botox as early as your 20’s as a preventative measure?), why it pays to find a qualified and appropriately trained doctor to treat you and one fail-safe anti-aging skincare product she recommends that might already be found in your cabinet. And to note, now that her Beverly Hills clinic is back up and running from lockdown, they strictly follow COVID safety protocols such as body temp checks, installing plexiglass in places that are necessary, access to plenty of hand sanitizer, face masks, and gloves.

You have an extensive background in Biochemistry. What inspired you to want to move into the field of plastic surgery?
Dr. Gabrielle Davis: I think that what most people do not realize is that plastic surgeons are scientists. There are a lot of plastic surgeons that have their own research labs and investigating different topics such as tissue engineering, wound healing, in addition to processes involved with aging and how to mitigate the effects of aging on the skin. Research is very pertinent to what we do because understanding the fundamentals of what is causing different pathology is the best way to be able to know how to treat it.

When I was in my surgical residency, I received a competitive fellowship award from the California Institute of Regenerative Medicine to conduct research.  I was in the research lab for three years and obtained my Masters in Biochemistry and Molecular Biology during this time to understand all of the advances that have occurred over the last several years in science.  I researched the effects of radiation on the skin, and how this relates to plastic surgery is that we often treat wounds, very complex wounds, related to radiation therapy after cancer treatment. I was investigating the process behind it and how we can use cell therapy, particularly stem cells derived from fat to treat it. It is very tied together even though it seems like it is two separate fields. I think by understanding the process, the disease, the pathology - is the best way to find a solution, in my opinion.

Plastic surgery is so glamorized these days and I think we take for granted that you actually have to have a lot of knowledge behind what you’re doing.
DGD: Absolutely! Plastic Surgeons not only do aesthetic medicine, which is all the cosmetic procedures and surgeries that you see, but also reconstruction. Reconstruction is a big part of plastic surgery as well. We reconstruct areas after cancer treatments, after injury through trauma, in addition, we do other types of surgery such as hand surgery, facial fractures, etc.  There is a lot that goes into plastic surgery that I do not think that people realize, and all plastic surgeons are trained in both – the reconstructive aspect as well as the cosmetic aspect. A lot of surgeons choose to apply both of them in some capacity in their practice.

For people that are new to Botox, what are some of the things you speak to your client about before the treatment?
DGD: It is really important to understand their concerns and what are they trying to treat. Is it more of a volume issue? Meaning that the changes are related to loss of volume in certain areas of the face or is it related to dynamic, static lines, or wrinkles. We typically address volume loss by fillers and dynamic lines and wrinkles with Botox. In some cases, fat grafting can also be utilized for volume loss.

And those are permanent?
DGD: Botox, as well as fillers, are typically temporary fixes, in which you have to go in every couple of months for additional treatment.  However, one thing that is nice with fillers, is that not only does it add volume, but it also stimulates collagen production. Therefore, a lot of women will realize over time that they may not need the filler as often or as much filler because they are building up their own collagen in the treated area. Fat Grafting is longer lasting, but fat is sometimes unpredictable. Patients that opt for fat grafting, should go to someone who is trained in fat grafting because once the fat is placed, it is very difficult to adjust or to even remove.

Some people say they get Botox done even in their early 20’s as a preventative measure. Is this true?
DGD: Yes! Some people start early. Most patients I see start in their early 30s as a preventative measure.  Wrinkles are caused by repeated contraction of certain musculature in the face. Over time this can lead to the formation of permanent lines. Therefore, if you blunt the muscle contractions early on, then in theory, you can prevent the development of those fine lines and wrinkles long term.

What kind of “before” tips can you give to ensure a good application?
DGD: I think the most important thing is to find someone that has ample experience and is well-trained in the technique.  There is very much an art to performing Botox as well as filler treatment. There are certain areas in which we commonly treat and there is a certain amount of Botox that is recommended per each area. There are also certain danger areas in which we as practitioners need to avoid to prevent adverse reactions such as an eyebrow or eyelid droop.

After the person is injected with Botox, sometimes it’s puffy or sore, so we shouldn’t touch those areas?
DGD: Yes, I usually advise my patients that for the first 4 hours after treatment, not to lay down and minimize bending forward to ensure the medication does not migrate from the areas that we treated. In addition, we also advise patients, no strenuous physical activity 24 hours after the treatment, for the same reason as well as to minimize any swelling or bruising in the treatment area, if they were to occur.

For those that are a little more fearful of a needle, what other non-medical procedures do you offer at your clinic?
DGD:  I think the use of radiofrequency energy is a good modality to tighten the skin and minimize skin laxity. People use it for skin tightening in areas that sometimes are very difficult to treat like the knees (for women), or the neck and the jawline in patients that are not quite ready for a facelift.

Also, one thing that I advise all patients is the early application of retinol. Retinol has been proven to minimize fine lines and wrinkles. It is also great to even out the complexion of the skin. However, patients that do start retinol treatment, should be aware of photosensitivity with the medication.  Therefore, we advise applying the medication at night then washing it off in the morning before you are out in the sun.  In addition, you should wear sunblock during the day or a hat, and avoid being in the sun for long periods of time.