The Artistry of Botox

Advanced Uses

February 22, 2016

discussing the "usual" areas of the face where Botox is commonly used

discussing how Botox can help improve "cobblestoning" on the chin

discussing the muscular bands on the neck and how they can lead to skin laxity

All Images
Taylor Campbell of Seiler Skin

By Buffy York

I told you last week I would be having several new guest bloggers in the coming weeks and months and today I am excited to have Dr. Warren Seiler of Seiler Skin sharing the low-down on the many uses of Botox.  I have recently become a patient at Seiler Skin and the attention to detail paid by him and his staff is unparalleled.  The photographs above were taken after my initial hour long consult and we were discussing how Botox can “lessen the blow” of wrinkles and lax skin delivered by aging.  Dr. Seiler will be appearing monthly on the blog so be sure and check out his video at the bottom of the post and if you have any topics you would like him to cover in the future please let me know.

The Artistry of Botox
Warren B. Seiler III, MD

First of all, I would like to thank Buffy for inviting me to contribute to her great blog. I am excited to educate and share information with all of you.

To introduce myself, my name is Warren B. Seiler III, MD and I am a Board-Certified Cosmetic Laser Surgeon in practice since 2007. After general surgery residency, I completed training in cosmetic laser, injection and aesthetic procedures before starting my solo private practice in Homewood (Birmingham) Alabama. I subsequently received a specialty Board Certification from the American Board of Laser Surgery, the only certifying Board in Laser Medicine and Surgery. I focus my entire practice on laser and injection procedures. Due to my passion for educating practitioners and patients on these procedures, I am a trainer for Lumenis Laser Company and Allergan (manufacturer of Botox, Juvederm, Voluma, Kybella, Latisse and SkinMedica).

In this first blog, I would like to share my knowledge and experience with Botox and it’s multiple common and advanced uses (some techniques are less well-known than others).  Currently, I have performed just over 10,000 Botox procedures.  I have trained multiple physician and nurse (legal in some other states) injectors in the advanced techniques using Botox, Juvederm, and Voluma.

Whether or not you have had Botox, you might not be aware that getting great results with Botox is about the art of injecting, knowing the face and neck anatomy and proportions, and how injecting one area might affect another.  It is also extremely important to comprehensively consult with each patient and take the time to understand their concerns and goals.  The injector must also look at the face/neck as a whole and evaluate many aspects before simply injecting a product into an area.  Some injectors may take a very standardized approach with Botox, simply and quickly injecting the same areas and amount in every patient.  An experienced and specialized injector will individualize Botox treatments to what each different patient needs and can achieve depending on their anatomy.

You may know that Botox can help reduce movement, lines and wrinkles in common areas like the forehead, between the eyebrows, and the crow’s feet.  However, Botox can also be used to lift the brow, reduce nose wrinkles (bunny lines), reduce upper and lower vertical lip lines, reduce mouth/lip frowning, help perk up the lip, soften a strong jawline in women (reduce a masculine look of the jaw), and even give a lower face/jaw and neck lift when injected into the muscular bands of the neck (platysmal bands, popularly called the Nefertiti Lift).  Botox can help with common headaches, migraines, TMJ symptom, and even under arm sweating.

How does all this work?  The injector must really know the proportions and anatomy of the face.  Botox works to soften muscle movement to reduce lines.  Don’t worry, if done correctly, you can have a normal look without heaviness, freezing or crazy brow!  And, you don’t need a ton of Botox in most cases.  My patients are happy to see that I get great and natural results with about half of the typical amount of Botox because I know just where to put it.

It’s not your responsibility to know what is causing your aging look or what areas to inject/treat.  That’s why an injector needs to take a specialized approach and evaluate what you need as an individual to look more youthful.

So what happens as we age and why?  Here is how I look at the entire face and neck.

When I first met with Buffy and started to discuss some of her concerns, I watched her face and neck movement and expressions.  I noticed that she was very active in her facial expressions (movement that can cause the skin to crease and form noticeable lines).  She also moved and flexed her neck muscles.  I told her that in addition to helping her with her upper face lines and movement (typical areas to inject Botox such as the forehead, between the eyes, and crow’s feet), I could help tighten her lower face, jawline, upper neck and decrease her frown with Botox.  She was surprised to hear me mention that.  For example, I showed her in a mirror how she strains her neck muscles (neck banding) and that pulls the skin forward and causes neck skin laxity.  She never even knew that she did that!  I told her that many people make facial expressions with other “less recognized” areas that can cause wrinkles and skin laxity.  This is why the injector must look at the face and neck as a whole, notice “every day movement” that can affect how the skin looks, and understand how to assess all areas.  Sometimes face laxity can be caused by a strong neck muscle that I can relax with Botox which results in a nice lifting to the entire face and neck.

So, what was happening in Buffy’s neck?  With repetitive straining of the frontal neck muscles, the neck skin is constantly stretched and pulled forward.  Eventually, the skin “stops trying to go back to where it should.”  This causes neck laxity and a less well-defined jawline resulting in a more aged appearance.  In the right patient, Botox can be used to soften those neck muscles and the skin will start to retract to its normal tighter position.  This gives the patient a mild to moderate neck lift after several treatments.  Botox in the neck muscle can also help to reduce the neck banding, commonly called the “11s.”

Next, Botox can be injected in the chin to reduce chin “cobblestoning” or wrinkling and can help reduce the muscle that makes the corners of the mouth turn down as a frown.  Don’t worry, if done correctly, this technique results in evening up the corners of the mouth but not making you look like the Joker as some fear!

I would also use Botox in the more common areas to reduce upper face wrinkling, lift the brow, open the eyes, and reduce crow’s feet.

Finally, Kybella can help reduce neck fullness from fat and/or the “double chin.”  Filler, such as Juvederm Voluma, can then be used to lift the mid and upper face and cheeks.  Combining all of these advanced techniques results in a non-surgical face and neck lift with natural results.

You can look more youthful without pain, downtime, bruising or anyone thinking you had a facelift!  Yep, you heard that correctly. . . you don’t have to bruise and have pain with injections.  I take my time, hold pressure and use ice and numbing techniques when appropriate, and even use a cool state-of-the-art device called the Accuvein to minimize any bruising.  If you have had an unpleasant experience before with some of these procedures, you would be surprised to see that injections don’t have to hurt and bruise and leave you questioning results and your decision to receive them.  In the right hands, the procedures I have discussed can be very beneficial, safe, and painless.  Trust that you can see a more youthful you when you look in the mirror!

This is not a sponsored post and no goods or services were received.




    This is an excellent and informative post!The part about the neck is really interesting. It caused me to reevaluate my approach to injectables, which unfortunately has been where can I get the best deal, to who can really do the best job. I hope to make an appointment with Dr. Seiler in the near future.

    You will not be disappointed. I encourage you to reach out to them 205.870.0204,
    Thanks for reading,

    Interested in more information on Dr. Seiler.

    His website is and the number to book a consult is 205.870.0204. Give them a call they are great!

    I told the hubby just tonight that I was going to call to make my first consult about Botox and then I read this. It makes me want to drive all the way from Greenville to pay him a visit.

    I have used Dr Seiler for a couple years and love him! His staff is great!

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