An Interview with our top London practitioner and company founderBotox® is not only one of the most popular treatments available at Courthouse Clinics – it is one of the most popular cosmetic treatments worldwide. As a multi-billion dollar industry it attracts vast numbers of people each year looking to smooth fine lines and even out wrinkles. Botox® is clinically proven to safely achieve a youthful, rejuvenated appearance. It can ease insecurities and significantly boost confidence and self esteem. However, the treatment has received its fair share of negative press over the years. Magazines and newspapers are awash with horror stories of celebrities looking incredibly unnatural after Botox®, so if even those with access to the highest-paid doctors can get it wrong what hope is there for everyone else? I spoke with Dr Patrick Bowler, Medical Director and founder of Courthouse Clinics and an expert in the cosmetic industry, to find out his definition of the ‘best Botox® doctor’. Dr Bowler has over twenty years experience, is the co-founder and Fellow of the British College of Aesthetic Medicine and is a member of the American Society for Laser Medicine and Surgery. He has treated thousands of patients with Botox® and has seen how the industry has transformed over his extensive career. Hi Dr Bowler, thanks for taking the time to speak with me. First of all I’d just like to talk about Botox® itself – could you tell me what it is exactly? Botox® is a fully licensed and approved drug produced by Allergan, an international pharmaceutical company. A huge amount of clinical data has been accumulated over the past 25 years proving its safety and effectiveness. This is the only product we use in Courthouse Clinics except for the very rare instances where a patient has developed a resistance. Botox® is usually diluted with 2ml of saline solution, which gives it the optimum concentration so it does not spread outside the intended area of treatment. How do you know who is best suited to Botox®? I think it would actually be easier to tell you who isn’t suitable. For instance, I wouldn’t treat young patients under the age of 25, those showing signs of body dysmorphic disorder, sufferers of rare conditions involving muscle weakness, patients taking particular prescription medicines or anyone with heavy brows and top eyelids. I also wouldn’t treat older women with deep horizontal forehead lines. These horizontal lines develop because of a natural reflex keeping the eyes wide open and attractive. Treating these could produce a heavy brow and very unhappy patients. So I take it you’ve refused treatment in the past then? For what reasons? I have refused those with BDD [body dysmorphic disorder] because they hold a false image of themselves. It’s the cosmetic version of anorexia nervosa as anyone suffering from it is convinced they’re ugly and unattractive, often focusing on a single wrinkle or blemish that they need to perfect. These types of patients require expert psychological assessment and care. Treating their perceived cosmetic problems will never satisfy their needs and they will come back again wanting more, claiming the treatment has failed to make a difference. Occasionally patients return too early for follow up sessions. They tend to forget how they looked before! So I would refuse treatment at that point and review at a later date. I have also turned patients away because they are too young or too old for treatment. This not being ageist, but administering Botox® in unsuitable cases can produce undesirable effects. Do you think any of the patients refused treatment at Courthouse Clinics have been accepted elsewhere? Definitely, yes. Those with BDD, despite our best efforts to persuade them of their psychological issues, will go elsewhere and receive treatment. The consequence is that they will strive for a physical solution to their psychological problem, which of course always fails. They can never be satisfied and will eventually be on a downward spiral as their fears and concerns of their appearance are enhanced. Once you have decided a patient is suitable for Botox®, how do you know how much product to use and where? This is purely a matter of training and experience. Patients have a wide variety of needs and requirements and although there is a basic dosage regimen, it is common to vary the dosage and sites of injections to obtain the very best results. These tailor-made treatments can only ever be achieved by experts. Can anyone other than doctors administer Botox®? Botox® is a prescription medication that legally can only be prescribed by a doctor, dentist or nurse (with special training in prescribing). What happens next is open to abuse. The General Medical Council demands that the prescribing doctor examine the patient and agree to a treatment plan beforehand, and from there they can direct a deputy to administer the injections. Courthouse Clinics follow the legal procedure and medical ethics very closely by having experienced doctors involved in the entire process from consultation and assessment to the administration of the Botox®. Patients can feel secure in the knowledge that their treatment is in expert medical hands following the rule of law. So what sort of places should you avoid when looking to have treatment? Always avoid Botox® parties: pressure from friends, low prices and some alcohol thrown in can prove irresistible, but this is a really bad mix. A patient of mine in retrospect felt cajoled into having treatment and was not asked if she was pregnant or on any medication. She had two contraindications to treatment but fortunately had a normal, healthy baby 7 months later. A hard lesson learnt. Generally, beware of any company offering cheap prices that are too good to be true. They are at that price because, in order to make things profitable for the practitioner, there is insufficient or over-diluted Botox® injected – so the effects won’t last long. The product injected may not even be Botox® at all but an inferior and potentially dangerous product When having Botox®, is the perfect treatment a matter of volume or frequency of application? Too much volume means the Botox® has been over-diluted with saline, so will not be so effective – and worse still spread to unwanted areas. The most important factor is the concentration and number of units of Botox® used. Provided the optimum dosage is used, the treatment should last 4-6 months. Finally, what general advice would you give to someone looking to get Botox®? I would primarily say to find an experienced doctor working in an approved and regulated clinic. Courthouse Clinics, for instance, has a highly qualified team of doctors dedicated to the health and wellbeing of our patients. Every one of our doctors is assessed clinically and is subject to continual appraisal as part of our professional development programme. I would also say that taking a recommendation from a friend should be an important factor when choosing a cosmetic clinic. Always go for somewhere safe, dependable and highly regarded over gimmicks and low prices.
Allergan, the makers of Botox®, have supplied guidance on finding a suitable clinic that resonates greatly with the advice given by Dr Bowler. They have provided five questions that you should always try to ask when booking an appointment:
- Which brands and products do you use, and why?
- Has the product been extensively tested and researched?
- Is the manufacturer one you trust, and why?
- How widely is the product used around the world?
- How satisfied are your patients with the results?