The term “20 units” is a frequent way to refer to an amount of BOTOX, but it doesn’t mean that you’ll get 20 different pokes with a needle.

Twenty units of BOTOX is just enough for five or six injections of the precious youth-enhancing fluid. Three to four units of BOTOX are injected into the skin at each point, explains Dr. Nicolette Picerno, double-board certified facial plastic surgeon.

It’s not unusual for a patient to need more than 20 units of BOTOX at one sitting.  Because this usually is just enough for the frown lines and more would be needed for browlifting, crow’s feet, forehead or bunny lines. 

BOTOX renders nerves nonfunctional so that the face is unable to wrinkle in precise areas for three to five months. The former wrinkles smooth out in time—taking about two weeks for the BOTOX to show its full effect. And because BOTOX makes it impossible for those portions of the face to crease, the skin looks smooth and youthful on the surface. Repeated injections prolong youthfulness and prevent further aging.

Dr. Picerno uses BOTOX in many areas.  The most common include:: between the eyebrows, on the forehead and in the crow’s feet around the eyes. Highly specific injections of BOTOX in the brow area can recreate the natural arch of the eyebrow which has a “lift” effect, making the eyes look brighter.�
Other less common area for botox injections are the upper and lower lip wrinkles, bunny lines, chin dimpling, neck bands, neck lines and jaw muscles.

Her expert injections mean that the treatment takes only minutes and has very little discomfort if any at all.

For patients with profuse sweating, Dr. Picerno recommends BOTOX injections in the underarms. The quantity of BOTOX used means the procedure costs about $1,000, but for those patients who suffer from heavy sweating, it’s a small price to pay. Underarm BOTOX treatments only have to be done every nine to twelve months versus some facial injections that require re-treatment every to five three months, the Doctor says.

Besides the underarms, BOTOX injections can also be used to stop sweating on the feet and the palms of the hands—both areas that can cause extreme embarrassment to a person suffering from sweat glands that work overtime.

Every Monday and Tuesday at Dr. Picerno’s offices, BOTOX injections are only $12/unit, down from the regular price of $15.50/unit. Appointments are necessary, so call Dr. Nicolette Picerno’s office at 303-744-2300 to make an appointment.

Q: Like most people, I’m short on time. And every day that passes, reinforces that fact that time is moving on—it’s evident from the way my skin has aged overnight. What can I do to look younger that doesn’t take time away from my over-booked life? Help!

A: Fillers are the latest innovation in facial rejuvenation. Juvederm is one product that Dr. Nicolette Picerno recommends for its longer-lasting quality plus its ability to mold smoothly and readily into facial folds. One of the places on your face that shows your age most are the “marionette” lines around your mouth. Starting at the nose, these lines run vertically downward and deepen as time goes on. A filler like Juvederm can be injected into the area of the line to smooth away the crease. Interestingly, it can make your smile appear to turn upward as a result. Have you ever noticed older women with a lip line that seems to be upside down as if it’s a frown? This injectable treatment that takes no downtime and shows immediate results will eliminate that unhappy expression.

Q: What about my jowl line? It seems to be lower every time I look in the mirror. When I use two fingers to “lift” my lower half of my face, even I can see the difference in the mirror.

A: A “lift” that is surgical is not something that can be done without incurring some downtime, even though today’s procedures are less restrictive than lifts of yesterday. Dr. Nicolette Picerno recommends that patients with a slightly falling jowl line opt for fillers in the facial area, below the check line. The fillers used can range from injectables like Juvederm to fat transfers, using fat from another part of your body to plump up your cheek area. Part of the aging “look” you’re noticing on your own face is a result of the area under the cheekbone losing volume, or fat, as it takes on a hollow appearance. That happens because as we age, the collagen in our faces doesn’t reproduce like it once did. Once this area of the face is restored to the healthy, plumper look each of us has when we’re younger, you’ll also notice that your jowls are lifted and years are removed from your face.

Q: What about the hollows under my eyes? Can they be corrected with fillers too?

A: Absolutely. Injectables like Juvederm are ideal for this area. And the results are immediate. One thing to note is that the under-eye area is tender, so you may be one who experiences slight bruising around the injection site. You can cover any bruises with make-up and you’re not prohibited from participating in any of your routine activities. But, you may want to schedule a family photo session for your holiday greeting cards for the week following, so that any bruising has passed. And once your relatives get your greeting card, you can be sure they’ll be calling to say you look younger than ever!

Q: I understand that some procedures are not for the lower face, like BOTOX. What areas of the face benefit most by different treatments?

A: BOTOX is used from the forehead to the under-eye area. The purpose of BOTOX injections is to “paralyze” the muscle tissue just below the skin’s surface so that it disallows your regular facial expressions from creating creases and wrinkles that “age” your face. When used properly, BOTOX can give your eyebrows a lift. Dr. Nicolette Picerno has treated patients with BOTOX injections in the eyebrow area so that the arch of the eyebrow stays higher which visually “lifts” the overall look of your face. Injectables, on the other hand, are most effective from the brow area downward. That’s because as we age, our face loses volume. Injectables restore that volume to the facial areas in which volume has been depleted, restoring a plumper, more youthful look to your face. And one benefit of plumping up in this way is that the jowl line is lifted slightly too, enough so that your friends will be asking you what you “did.”

Q. I have heard about a new injectable cosmetic filler, Perlane®. What specific issues does this new filler tackle?

A. Dr. Nicolette Picerno uses this new product, Perlane, used to correct a multitude of facial problems. It is most commonly used to soften wrinkles and for facial contouring but has many other uses such as lip and chin augmentation, filling the hollows under the eyes, softening the appearance of jowls and is even used as a temporary brow lift. Perlane is also used in patients who have experienced a loss of facial volume, something that happens to us over the course of time. Perlane is injected into the areas where they most need it to give them a refreshed, healthy appearance. 

Q. I heard that the same company that makes Restylane®, also makes Perlane. What is the difference between Perlane and Restylane?

A. You’re right, the same company manufactures Perlane and Restylane, but there are significant differences between the two. Dr. Nicolette Picerno explains that Perlane has much bigger hyaluronic acid particles than Restylane. Because the particles are bigger, they reach the deeper layers of the skin and last longer than Restylane, sometimes up to a year. Perlane also has much smoother results than other fillers.

Q. I want fuller lips. Is Perlane an option for me?

A. In a word, yes. Unlike collagen, which is extracted from bovine, the hyaluronic acid in Perlane is a natural substance that is found in the human body. Over time, the natural levels of hyaluronic acid in the body are depleted and wrinkles form. Since Perlane is already naturally produced in your body, there is no chance of experiencing an allergic reaction and a skin test is not needed.

Q. I want to make my wrinkles disappear but I also don’t want to lose all facial expressions. Does Perlane work like Botox or is it different?

A. The two, BOTOX® and Perlane, have entirely different applications. BOTOX paralyzes the facial muscles at points on your face that tend to contract creating wrinkles, crow’s feet, frown lines on the surface of your skin. BOTOX injections stop the muscle from contracting and thereby eliminate the opportunity for your wrinkles to “work.” Perlane is an injectable filler that plumps up the area it is injected into, filling in frown lines and wrinkles that have become creases if you will on your face.

The two treatments are often used in companion to achieve a younger, more refreshed facial appearance. And don’t worry, Dr. Nicolette Picerno, is very attentive to the fact that no one wants to look overdone like they’ve had major plastic surgery that has gone too far. Instead, Dr. Picerno has mastered making patients appear to be natural and younger looking using a variety of injectables and maybe a little BOTOX too.